Department of Urology Regina Elena, National Cancer Institute, Rome, Italy.
J Urol. 2012 Apr;187(4):1190-4. doi: 10.1016/j.juro.2011.11.100. Epub 2012 Feb 14.
We evaluated the feasibility and safety of laparoscopic and robotic assisted partial nephrectomy with controlled hypotensive anesthesia to avoid hilar clamping and eliminate renal ischemia.
A total of 60 patients with renal tumors who were candidates for nephron sparing surgery and had no contraindication to hypotensive anesthesia underwent partial nephrectomy without hilar clamping and with controlled hypotension during tumor excision. A total of 40 laparoscopic partial nephrectomies and 20 robotic assisted partial nephrectomies were done. All patients who were candidates for laparoscopic or robotic assisted partial nephrectomy regardless of tumor site, size or growth pattern were included in study. The surgical field was assessed for bleeding and visibility using a numerical rating scale.
Median tumor size was 3.6 cm (range 1.8 to 10), median operative time was 2 hours (range 1 to 3.5), median blood loss was 200 ml (range 30 to 700 ml) and median hospital stay was 3 days (range 3 to 8). All margins were negative. The median duration of controlled hypotension with a median mean arterial pressure of 65 mm Hg (range 55 to 70) was 14 minutes (range 7 to 16). No patient required intraoperative transfusion but 4 (6.6%) required transfusion postoperatively. Complications developed postoperatively in 3 patients, ie port site bleeding, hemorrhage and hematoma, respectively. Median preoperative and postoperative serum creatinine was 0.9 and 1.10 mg/dl, respectively. The median preoperative and postoperative estimated glomerular filtration rate was 87.20 and 75.60 ml/minute/1.73 m2, respectively.
Controlled hypotension allowed laparoscopic and robotic assisted partial nephrectomy to be done without renal hilar clamping. All procedures were completed safely and perioperative outcomes are encouraging.
我们评估了在控制性降压麻醉下进行腹腔镜和机器人辅助部分肾切除术的可行性和安全性，以避免肾门阻断并消除肾缺血。
共有 60 名符合保肾手术适应证且无降压麻醉禁忌证的肾肿瘤患者，在肿瘤切除过程中不进行肾门阻断，并采用控制性降压进行部分肾切除术。共进行了 40 例腹腔镜部分肾切除术和 20 例机器人辅助部分肾切除术。所有符合腹腔镜或机器人辅助部分肾切除术适应证的患者，无论肿瘤部位、大小或生长模式如何，均纳入本研究。使用数字评分量表评估手术野的出血和可见度。
中位肿瘤大小为 3.6cm（范围 1.8 至 10），中位手术时间为 2 小时（范围 1 至 3.5），中位出血量为 200ml（范围 30 至 700ml），中位住院时间为 3 天（范围 3 至 8）。所有切缘均为阴性。中位控制性降压时间为 14 分钟（范围 7 至 16 分钟），平均动脉压中位数为 65mmHg（范围 55 至 70mmHg）。无患者术中需要输血，但有 4 例（6.6%）术后需要输血。术后 3 例患者出现并发症，分别为切口部位出血、出血和血肿。中位术前和术后血清肌酐分别为 0.9 和 1.10mg/dl。中位术前和术后估算肾小球滤过率分别为 87.20 和 75.60ml/min/1.73m2。
控制性降压允许在不阻断肾门的情况下进行腹腔镜和机器人辅助部分肾切除术。所有手术均安全完成，围手术期结果令人鼓舞。
