术中肾门血管损伤的影响因素及防治策略研究进展

Research progress on the influencing factors and prevention strategies of intraoperative renal hilar vascular injury

摘要

术中肾门血管损伤是肾脏手术中少见但后果严重的并发症之一，在腹腔镜及机器人辅助手术广泛开展的背景下，其发生风险及影响因素受到临床关注。既往研究表明，该并发症的发生涉及手术操作、解剖特点及患者个体差异等多重因素，但相关认识尚缺乏系统归纳。本文围绕术中肾门血管损伤的危险因素及防治进展进行综述，从手术相关因素与患者相关因素两方面对其发生机制进行分析，并总结术前评估、术中预防及术后处理策略。现有证据显示，手术方式、肾门解剖处理、能量器械应用及手术复杂性是重要的技术相关因素，而肾门解剖变异、肾周黏性脂肪、慢性炎症及合并基础疾病等患者因素可显著增加损伤风险。加强术前影像学评估、优化手术策略及规范操作流程，有助于降低并发症发生率。随着智能影像与精准导航技术的发展，肾脏手术的安全性有望进一步提高。

Abstract

Intraoperative renal hilar vascular injury is an uncommon but potentially life-threatening complication in renal surgery. With the widespread adoption of laparoscopic and robot-assisted techniques, increasing attention has been directed toward its risk profile and influencing factors. Previous studies suggest that the occurrence of this complication is influenced by multiple determinants, including surgical techniques, anatomical characteristics, and patient-specific factors; however, a comprehensive synthesis of current evidence remains limited. This review summarizes the major risk factors and advances in prevention and management strategies for intraoperative renal hilar vascular injury. The underlying mechanisms are discussed from both surgical and patient-related perspectives, and key measures involving preoperative assessment, intraoperative prevention, and postoperative management are outlined. Available evidence indicates that surgical approach, renal hilar dissection strategies, use of energy devices, and procedural complexity represent important technical determinants, whereas anatomical variations, adherent perinephric fat, chronic inflammation, and comorbidities are significant patient-related risk factors. Enhanced preoperative imaging evaluation, optimization of surgical planning, and standardized operative techniques may contribute to risk reduction. Emerging technologies, particularly intelligent imaging and precision navigation systems, hold promise for further improving the safety of renal surgery.

关键词

肾门血管损伤 / 机器人手术 / 手术风险因素 / 肾周脂肪 / 解剖变异 / 能量器械 / 防治策略

Key words

renal hilar vascular injury / robot-assisted surgery / surgical risk factors / perirenal fat / anatomical variations / energy-based devices / prevention and management strategies

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