Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
Eur Urol. 2012 Jul;62(1):130-5. doi: 10.1016/j.eururo.2012.02.001. Epub 2012 Feb 14.
Renal scintigraphy may allow long-term monitoring of ischemic damage after partial nephrectomy (PN).
Evaluate use of renal scintigraphy for evaluating long-term effects of warm ischemia on renal function in patients with a normal contralateral kidney.
DESIGN, SETTING, AND PARTICIPANTS: We prospectively examined kidney function of 54 patients who underwent laparoscopic PN (LPN). Minimum follow-up time was 4 yr.
LPN was performed with warm ischemia by transperitoneal or retroperitoneal approach.
Demographic, perioperative, and pathologic data and postoperative complications were registered. Split renal function (SRF) and effective renal plasma flow (ERPF) were evaluated by renal scintigraphy preoperatively, at 3 and 12 mo postoperatively, then yearly. Baseline weighted differentials (b-WDs) of both SRF and ERPF in the affected kidney were calculated between baseline condition and every time point. Multivariate linear regression was used to find independent variables for increased b-WDs at 3 and 48 mo. P values<0.05 were considered significant.
The SRF and ERPF of kidneys treated by LPN decreased significantly at month 3 and subsequently remained stable through the duration of follow-up. Conversely, neither serum creatinine nor estimated glomerular filtration rate changed significantly during follow-up. The regression model showed statistical significance at month 3 for warm ischemia time (WIT) and age, whereas at 48 mo, statistical significance was reached by WIT alone. No new onset of cardiovascular disease was registered. No evidence of local recurrence was recorded with computed tomography scan. Our study may be underpowered due to small sample size; however, this is one of the largest long-term prospective series using renal scintigraphy to evaluate the renal function after LPN.
WIT contributes to irreversible kidney damage observed at month 3 that does not appear to worsen.
肾闪烁显像术可用于长期监测部分肾切除（PN）后的缺血性损伤。
评估肾闪烁显像术用于评估对侧肾脏正常的患者中热缺血对肾功能的长期影响。
设计、地点和参与者：我们前瞻性地检查了 54 例行腹腔镜 PN（LPN）的患者的肾功能。最小随访时间为 4 年。
通过经腹腔或腹膜后途径进行 LPN 并伴有热缺血。
登记了人口统计学、围手术期和病理数据以及术后并发症。术前、术后 3 个月和 12 个月以及每年通过肾闪烁显像术评估分肾功能（SRF）和有效肾血浆流量（ERPF）。受影响肾脏的 SRF 和 ERPF 的基线加权差异（b-WD）在基线条件和每个时间点之间进行计算。多元线性回归用于寻找 3 个月和 48 个月时 b-WD 增加的独立变量。P 值<0.05 被认为具有统计学意义。
LPN 治疗的肾脏的 SRF 和 ERPF 在术后 3 个月显著下降，随后在随访期间保持稳定。相反，在随访期间，血清肌酐或估计肾小球滤过率均无明显变化。回归模型显示，3 个月时，热缺血时间（WIT）和年龄具有统计学意义，而 48 个月时，仅 WIT 具有统计学意义。没有新的心血管疾病发生。通过计算机断层扫描未发现局部复发的证据。由于样本量小，我们的研究可能没有足够的效力；然而，这是使用肾闪烁显像术评估 LPN 后肾功能的最大的长期前瞻性系列研究之一。
WIT 导致 3 个月时观察到的不可逆肾损伤，且似乎不会恶化。
