Shekarriz Bijan, Shah Gaurang, Upadhyay Jyoti
Department of Urology, State University of New York, Upstate Medical University, Syracuse, New York, USA.
J Urol. 2004 Jul;172(1):54-7. doi: 10.1097/01.ju.0000132125.78189.93.
Laparoscopic partial nephrectomy for small renal tumors has been increasingly performed in the last few years. We prospectively evaluated preoperative and postoperative differential renal function by renal scan in patients with contralaterally functioning kidneys who underwent laparoscopic partial nephrectomy with hilar clamping.
From July 2002 to June 2003, 17 consecutive patients were included in this prospective protocol and underwent laparoscopic partial nephrectomy for exophytic tumors using en bloc hilar clamping. Preoperative renal scan with differential function was performed 1 month before and 3 months after surgery in all patients. technetium labeled diethylenetetraminepentaacetic acid scan was performed in all patients.
Mean warm ischemia time was 22.50 +/- 9.78 minutes (range 10 to 44). Preoperative differential renal function and glomerular filtration rate (GFR) in the affected kidneys were 50.20% +/- 4.90% (range 43 to 58) and 75.56 +/- 16.45 ml per minutes (range 39.4 to 105). At postoperative month 3 differential renal function and GFR in the affected kidney were 48.07% +/- 7.16% (range 39% to 63%) and 72.03 +/- 18.17 ml per minutes (range 31 to 101). There was a nonsignificant negative association between hilar clamp time and change in renal function (postoperative - preoperative) of the affected kidney (r = -0.26, p = 0.31), and a positive correlation between clamp time and change in GFR (r = 0.39, p = 0.12) that did not reach statistical significance.
In patients with contralaterally functioning kidney, temporary hilar clamping with a mean warm ischemia time of 22.5 minutes results in preservation of renal function in the affected kidney. Larger studies with longer followup are necessary to study the impact of warm ischemia further.
在过去几年中，腹腔镜下肾部分切除术治疗小肾肿瘤的应用越来越多。我们对接受腹腔镜下肾部分切除术并进行肾门阻断的对侧肾功能正常患者，通过肾扫描对术前和术后的肾分肾功能进行了前瞻性评估。
2002年7月至2003年6月，17例连续患者纳入本前瞻性研究方案，采用整块肾门阻断法对肾外生性肿瘤行腹腔镜下肾部分切除术。所有患者在术前1个月和术后3个月进行了分肾功能的肾扫描。所有患者均行锝标记二乙三胺五乙酸扫描。
平均热缺血时间为22.50±9.78分钟（范围10至44分钟）。患侧肾脏术前的分肾功能和肾小球滤过率（GFR）分别为50.20%±4.90%（范围43%至58%）和75.56±16.45毫升/分钟（范围39.4至105）。术后3个月时，患侧肾脏的分肾功能和GFR分别为48.07%±7.16%（范围39%至63%）和72.03±18.17毫升/分钟（范围31至101）。肾门阻断时间与患侧肾脏肾功能变化（术后-术前）之间存在无统计学意义的负相关（r = -0.26，p = 0.31），与GFR变化之间存在正相关（r = 0.39，p = 0.12），但未达到统计学意义。
对于对侧肾功能正常的患者，平均热缺血时间为22.5分钟的临时肾门阻断可使患侧肾脏的肾功能得以保留。需要进行更大规模、随访时间更长的研究以进一步探讨热缺血的影响。
