S.C.D.U. Urologia, Azienda Ospedaliera Universitaria "San Luigi Gonzaga", Orbassano, TO, Italy.
World J Urol. 2012 Apr;30(2):257-63. doi: 10.1007/s00345-011-0729-5. Epub 2011 Jul 19.
To assess the effects of warm ischaemia time (WIT) on renal function after laparoscopic partial nephrectomy (LPN) for renal masses in patients with a normal contralateral kidney.
From October 2006 to December 2008, 53 patients treated with LPN were enrolled in this prospective study. Effective renal plasma flow (ERPF) was estimated with 99mTc-mercaptoacetyltriglycine renal scintigraphy before the intervention and after 3 and 12 months. Multiple linear regression analysis was used to assess the effects of demographic and operative variables on postoperative renal function. Logistic regression analysis was used to evaluate the associations between the same variables and a ≥20% reduction in postoperative ERPF compared with baseline (defined as significant loss of renal function-LRF). ROC curve analysis was used to identify potential ischaemia time cut-off points.
Fifty-one patients were eligible. The mean lesion size was 30 mm, and the mean WIT was 21.9 min. Longer WIT was associated with lower postoperative ERPF values (P < 0.001). A logistic regression model confirmed that longer WITs were significantly associated with ERPF decreases ≥20% (OR 1.454 and 1.741, for each 1-min increase, respectively). ROC analysis identified 25 min as a 'safe' cut-off for WIT (AUC 0.874, P < 0.001). Postoperative ERPF differences between the two groups (WIT ≤25 and >25 min) were significant.
Longer WIT was associated with LRF, as estimated with renal scintigraphy. LRF occurred within 3 months and remains stable until the 12th month after LPN. Every effort should be made to minimise warm ischaemic intervals during LPN, and the limit of 25 min should be not exceeded.
评估正常对侧肾脏肾肿瘤患者腹腔镜部分肾切除术（LPN）后热缺血时间（WIT）对肾功能的影响。
2006 年 10 月至 2008 年 12 月，前瞻性研究纳入 53 例行 LPN 治疗的患者。在干预前和术后 3 个月及 12 个月，用 99mTc-巯基乙酰三甘氨酸肾闪烁显像术估计有效肾血浆流量（ERPF）。采用多元线性回归分析评估人口统计学和手术变量对术后肾功能的影响。采用逻辑回归分析评估相同变量与术后 ERPF 较基线下降≥20%（定义为肾功能显著丢失-LRF）之间的关系。ROC 曲线分析用于确定潜在的缺血时间截断点。
51 例患者符合条件。病变平均大小为 30mm，平均 WIT 为 21.9min。较长的 WIT 与术后 ERPF 值较低相关（P<0.001）。逻辑回归模型证实，较长的 WIT 与 ERPF 下降≥20%显著相关（分别为每增加 1min，OR 1.454 和 1.741）。ROC 分析确定 25min 为 WIT 的“安全”截断点（AUC 0.874，P<0.001）。两组间术后 ERPF 差异有统计学意义（WIT≤25 和>25min）。
用肾闪烁显像术估计，较长的 WIT 与 LRF 相关。LRF 发生在 LPN 后 3 个月内，并持续稳定至 12 个月。应尽量减少 LPN 期间的热缺血间隔，且不应超过 25min 限制。
