Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
J Urol. 2011 Aug;186(2):411-5. doi: 10.1016/j.juro.2011.03.151. Epub 2011 Jun 17.
To our knowledge the benefit of routine drainage after partial nephrectomy has never been investigated, although a drain after partial nephrectomy can be associated with morbidity. We report our initial experience with omitting the drain in select cases of superficial renal cortical tumors.
From a surgery database we identified 512 consecutive open partial nephrectomies performed by a single surgeon between January 2005 and May 2009 using standardized technique. The study group included 75 evaluable patients (14.6%) who did not have a drain placed. Clinical data, surgical information, histological type and postoperative complications within 90 days of the procedure using the modified Clavien system were included in analysis.
Median patient age was 64 years (IQR 49, 70) and 56.8% of the patients were male. Median tumor size was 2.0 cm (IQR 1.5, 3.0) and more than 70% were malignant. A total of 38 patients (50.7%) underwent renal artery clamping and cold ischemia with a median clamp time of 30 minutes. The overall complication rate was 13.3% (10 patients). In 4 patients (5.3%) complications were related to an absent drain, including grade I urinary leak, grade II perirenal collection, grade III urinoma requiring percutaneous drainage and grade III urinary leak with urosepsis, respectively. No deaths occurred in this cohort.
Omitting drainage after partial nephrectomy in a select group of patients without collecting system entry is feasible and safe. The decision to place a drain after partial nephrectomy for small renal cortical tumors must be made intraoperatively and should be tailored to each case.
据我们所知，尽管部分肾切除术后引流可能会带来并发症，但常规引流对部分肾切除术后的益处尚未得到研究。我们报告了在选择的浅层肾皮质肿瘤病例中，省略引流的初步经验。
我们从手术数据库中确定了 2005 年 1 月至 2009 年 5 月间由同一位外科医生进行的 512 例连续开放性部分肾切除术，采用标准化技术。研究组包括 75 例可评估患者（14.6%），未放置引流管。分析中包括临床数据、手术信息、组织学类型和术后 90 天内使用改良 Clavien 系统的并发症。
中位患者年龄为 64 岁（IQR 49, 70），56.8%为男性。肿瘤大小中位数为 2.0 厘米（IQR 1.5, 3.0），超过 70%为恶性。共有 38 例（50.7%）行肾动脉夹闭和冷缺血，中位夹闭时间为 30 分钟。总的并发症发生率为 13.3%（10 例）。在 4 例患者（5.3%）中，并发症与无引流管有关，分别为 I 级尿漏、II 级肾周积液、III 级尿囊肿需要经皮引流和 III 级尿漏伴尿脓毒症。该队列中无死亡病例。
在没有集合系统进入的情况下，选择合适的患者群体省略部分肾切除术后的引流是可行和安全的。对于小的肾皮质肿瘤，部分肾切除术后是否放置引流管必须在术中决定，并应根据每个病例进行个体化。
