Department of Urology, Tohoku University, Graduate School of Medicine, Sendai, Japan.
Urology. 2011 Apr;77(4):814-8. doi: 10.1016/j.urology.2010.12.007. Epub 2011 Feb 18.
To evaluate the changes in split renal function after retroperitoneal laparoscopic partial nephrectomy with renal hypothermia using ice-cold saline.
From June 2002 to October 2009, 32 patients (median age 56 years) underwent retroperitoneal laparoscopic partial nephrectomy with hypothermia using ice-cold saline for the treatment of small renal tumors. The total renal function was monitored using the estimated glomerular filtration rate. Split renal function was evaluated using technetium-99m dimercaptosuccinic acid renal scintigraphy preoperatively and 3 months postoperatively.
The median renal ischemic time, including the initial 10 minutes for cooling, was 52 minutes (range 28-101). Of the patients whose renal temperature was monitored, the lowest renal temperature during cooling was 15-25°C. The median decrease in the estimated glomerular filtration rate was 7.2 mL/min/1.73 m(2) (range -16.3 to 33.7). The median decrease in the contribution of the affected kidney to global renal function was 5.3% (range 0.4%-21.1%). On multivariate analysis, a shorter ischemia duration was an independent predictor of a lesser decrease in the contribution of the affected kidney (P = .0032).
The methods we have described are simple and effective to facilitate suboptimal hypothermia. The decrease in the renal contribution of the affected kidney appeared to be minimal, although the ischemic time was relatively longer in our series.
评估使用冰盐水肾低温进行后腹腔镜肾部分切除术对分肾功能的影响。
2002 年 6 月至 2009 年 10 月，32 例（中位年龄 56 岁）患者因小肾肿瘤接受使用冰盐水进行的后腹腔镜肾部分切除术合并肾低温治疗。总肾功能通过估算肾小球滤过率进行监测。术前和术后 3 个月采用 99mTc-二巯丁二酸肾闪烁扫描术评估分肾功能。
中位肾脏缺血时间（包括初始冷却的 10 分钟）为 52 分钟（范围 28-101）。在监测肾脏温度的患者中，冷却过程中最低肾脏温度为 15-25°C。估算肾小球滤过率中位数下降 7.2mL/min/1.73m2（范围-16.3 至 33.7）。受影响肾脏对整体肾功能的贡献中位数下降 5.3%（范围 0.4%-21.1%）。多因素分析显示，较短的缺血时间是受影响肾脏贡献下降较小的独立预测因素（P=0.0032）。
我们描述的方法简单有效，有助于实现次优低温。尽管我们的研究中缺血时间相对较长，但受影响肾脏的肾功能下降似乎很小。
