Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Endourol. 2012 Nov;26(11):1483-8. doi: 10.1089/end.2012.0122. Epub 2012 Sep 17.
To investigate changes in renal function after retroperitoneal laparoscopic partial nephrectomy (LPN) with renal hypothermia induced by ice-slush cooling.
Seventy-one patients undergoing retroperitoneal LPN with renal hypothermia were included. Perioperative outcomes were reviewed retrospectively. The total renal function was evaluated by an estimated glomerular filtration rate (eGFR) preoperatively and 6 months postoperatively in 69 patients. Split renal function (SRF) was also evaluated by 99mTc-mercaptoacetyltriglycine scintigraphy preoperatively and 6 months postoperatively in 61 patients.
The median operative time was 246 minutes (range, 155-424). The median cold ischemic time, including the initial 15 minutes of hypothermia, was 57 minutes (range, 34-112). In the 21 patients whose renal temperature was monitored, median lowest renal temperature was 20.7°C (range, 12.1-27.6). The median baseline eGFR and 6-month postoperative eGFR were 77.2 mL/min/1.73 m(2) (range, 36.1-121.3) and 68.3 mL/min/1.73 m(2) (range, 33.2-103.4), and the median baseline SRF and 6-month postoperative SRF of the affected kidney were 49.3% (range, 40.3-57.6) and 40.7% (range, 13.8-54.5). Using multivariate analysis, the baseline eGFR (p<0.0001) and the ischemic time (p=0.0073) were associated with the 6-month postoperative eGFR, and the 6-month postoperative SRF was only associated with a baseline SRF (p=0.0185).
Ice-slush cooling could provide renal hypothermia also under LPN. The decrease in renal function was small, whereas our ischemic time was longer than experts' warm ischemic series. These observations suggested the protective effect of our cooling methods against ischemic injury.
探讨应用冰泥冷却行后腹腔镜肾部分切除术（LPN）时低温肾保护对肾功能的影响。
回顾性分析 71 例行后腹腔镜肾部分切除术患者的临床资料。69 例行 LPN 术的患者在术前和术后 6 个月时用估算肾小球滤过率（eGFR）评估总的肾功能，61 例行 LPN 术并进行 99mTc-巯基乙酰三甘氨酸闪烁扫描的患者评估分肾功能（SRF）。
中位手术时间为 246 分钟（范围 155-424 分钟），中位冷缺血时间（包括最初 15 分钟低温时间）为 57 分钟（范围 34-112 分钟）。在 21 例术中监测肾脏温度的患者中，中位最低肾脏温度为 20.7°C（范围 12.1-27.6°C）。中位基线 eGFR 和术后 6 个月 eGFR 分别为 77.2 mL/min/1.73 m2（范围 36.1-121.3）和 68.3 mL/min/1.73 m2（范围 33.2-103.4），中位基线和术后 6 个月患侧 SRF 分别为 49.3%（范围 40.3-57.6%）和 40.7%（范围 13.8-54.5%）。多因素分析显示，基线 eGFR（p<0.0001）和缺血时间（p=0.0073）与术后 6 个月 eGFR 相关，而术后 6 个月 SRF 仅与基线 SRF 相关（p=0.0185）。
冰泥冷却法可用于 LPN 术，且能提供低温肾保护。术后肾功能下降较小，而我们的缺血时间比专家的温热缺血系列更长。这些观察结果表明，我们的冷却方法对缺血性损伤具有保护作用。
