"Regina Elena" National Cancer Institute, Department of Urology, Via Elio Chianesi 53, 00144, Rome, Italy,
Curr Urol Rep. 2013 Oct;14(5):465-70. doi: 10.1007/s11934-013-0359-0.
In the last decade, many authors reported single center experiences of "off-clamp", "clamp-less", or "unclamped" minimally invasive partial nephrectomy (MIPN). These procedures, despite the potential risk of increased intraoperative blood loss, attempted to minimize the loss of renal function by eliminating ischemic renal injury. "Zero ischemia" MIPN has emerged as new treatment option in 2011, initially performed under controlled hypotension, and later mainly by performing a "superselective microdissection". The former technique minimizes the arterial bleeding from the renal stump, allowing surgeon to dissect the tumor in a bloodless field; the latter consists of identifying, antegradely from the renal hilum, the tertiary and quaternary arterial branches directly supplying the kidney neoplasm, and then selectively controlling them before dissecting the renal mass. This review critically analyzes these techniques, focusing on perioperative, oncologic and functional outcomes.
在过去的十年中，许多作者报告了“无阻断”、“无夹闭”或“不夹闭”微创部分肾切除术（MIPN）的单中心经验。这些手术尽管存在术中出血量增加的潜在风险，但试图通过消除缺血性肾损伤来最大程度地减少肾功能损失。“零缺血”MIPN 于 2011 年成为新的治疗选择，最初在控制性低血压下进行，后来主要通过进行“超选择性微解剖”来实现。前者技术最大限度地减少了来自肾残端的动脉出血，使外科医生能够在无血的情况下解剖肿瘤；后者包括从前肾门向前识别直接供应肾肿瘤的三级和四级动脉分支，然后在解剖肾肿块之前选择性地控制它们。这篇综述批判性地分析了这些技术，重点关注围手术期、肿瘤学和功能结果。
