Department of Urology, PeKing Union Medical College Hospital, Chinese Academy of Medical Sciences and PeKing Union, Medical College, Beijing 100730, China.
Clin Transl Oncol. 2012 May;14(5):382-5. doi: 10.1007/s12094-012-0812-4.
The objective of this study was to evaluate the clinical application value of in situ hypothermic perfusion of kidneys during retroperitoneal laparoscopic partial nephrectomy (RLPN).
We used in situ hypothermic perfusion of kidneys during RLPN in 12 patients with renal tumour. Renal arterial-catheterisation for temporary balloon occlusion of renal artery was used Hypothermic ischaemia was achieved by continuous perfusion of Ringer's solution at 4°C through the renal artery.The collecting system was repaired by 4/0 Dixon and renal reconstruction was performed by 1/0 Dixon.We compared data between the RLPN group and open partial nephrectomy (OPN) group.
All RLPN operations were successfully completed. Ten of their pathological results were renal cell carcinoma, while two were reninoma and harmatoma respectively. Entry to the collecting system in two patients was repaired intraoperatively. No additional vascular repair was done. There were no significant postoperative complications. The renal function of the kidney was well preserved postoperatively. Neither local recurrence nor distant metastasis was found during the follow-up. There was a statistically significant difference in mean operative time and mean hypothermic ischaemia time between two groups. No difference was noted in mean tumour diameter, intraoperative blood loss, and preoperative and postoperative creatinine clearance rate.
The technique of incorporating hypothermic ischaemia via arterial perfusion into RLPN is feasible and safe, which expands the armamentarium of the urologist with the help of radiologists. It is of high clinical applied value, especially for the more complex nephron-sparing surgery.
本研究旨在评估腹膜后腹腔镜肾部分切除术（RLPN）中肾脏原位低温灌注的临床应用价值。
我们在 12 例肾肿瘤患者中使用 RLPN 时进行肾脏原位低温灌注。通过肾动脉临时球囊阻断，对患者的肾动脉进行动脉置管。通过肾动脉持续灌注 4°C 的林格氏液来实现低温缺血。使用 4/0 Dixon 修复集合系统，使用 1/0 Dixon 进行肾脏重建。我们比较了 RLPN 组和开放肾部分切除术（OPN）组的数据。
所有 RLPN 手术均成功完成。其中 10 例的病理结果为肾细胞癌，2 例分别为肾血管平滑肌脂肪瘤和血管肌纤维瘤。2 例患者术中进入集合系统进行修复。未进行额外的血管修复。术后无明显并发症。术后肾功能良好保存。随访期间未发现局部复发或远处转移。两组患者的平均手术时间和平均低温缺血时间有显著差异。两组的平均肿瘤直径、术中出血量、术前和术后肌酐清除率无差异。
将动脉灌注低温缺血技术纳入 RLPN 是可行且安全的，这为泌尿科医生提供了更多的治疗手段，有助于帮助放射科医生。该技术具有很高的临床应用价值，特别是在更复杂的保肾手术中。
