Arnoux V, Descotes J L, Fiard G, Terrier N, Boillot B, Thuillier C, Rambeaud J J, Long J A
Service d'urologie et transplantation rénale, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
Prog Urol. 2013 Apr;23(5):317-22. doi: 10.1016/j.purol.2012.10.012. Epub 2012 Dec 7.
To evaluate impact of the use of haemostatic agent in partial nephrectomy on perioperative outcomes.
We reviewed the files of patients candidates for partial nephrectomy in our center between 2005 and 2010. The use of haemostatic agent and surgical procedure data were noted. Perioperative outcomes in haemostatic agent group were compared with perioperative outcomes in conventional surgical haemostasis group.
Among the 131 patients included, haemostatic agent was used in 91 cases (69.5%). There was no statistically difference between the two groups on age, sex, BMI, ASA score, tumor size and RENAL score. The use of haemostatic agent was more frequent for patients operated with laparoscopy (10.7%, P=0.04). Concerning perioperative outcomes, there was no difference between the two groups on surgical complications, transfusions, conversion to radical nephrectomy and hospital stay. Median warm ischaemia time was comparable into the two groups. In multivariate analysis, haemorrhage, complications and transfusions were not predicted by the use of haemostatic agent.
Use of haemostatic agent in partial nephrectomy had no benefice on perioperative outcomes in our series. Rapport between utility and cost for these agents must be discussed in partial nephrectomy.
评估在部分肾切除术中使用止血剂对围手术期结果的影响。
我们回顾了2005年至2010年间本中心部分肾切除术候选患者的病历。记录止血剂的使用情况和手术操作数据。将止血剂组的围手术期结果与传统手术止血组的围手术期结果进行比较。
在纳入的131例患者中，91例（69.5%）使用了止血剂。两组在年龄、性别、体重指数、美国麻醉医师协会（ASA）评分、肿瘤大小和RENAL评分方面无统计学差异。腹腔镜手术患者使用止血剂更为频繁（10.7%，P = 0.04）。关于围手术期结果，两组在手术并发症、输血、转为根治性肾切除术和住院时间方面无差异。两组的中位热缺血时间相当。在多变量分析中，使用止血剂并不能预测出血、并发症和输血情况。
在我们的系列研究中，部分肾切除术中使用止血剂对围手术期结果无益处。在部分肾切除术中必须讨论这些药物的效用与成本之间的关系。
