Palacios Diego Aguilar, McDonald Michael, Miyake Makito, Rosser Charles J
Section of Urologic Oncology, MD Anderson Cancer Center Orlando, Orlando, FL 32806, USA.
BMC Res Notes. 2013 Oct 3;6:399. doi: 10.1186/1756-0500-6-399.
Recently studies have demonstrated improved outcomes in patients undergoing nephron-sparing surgery (NSS) for low stage renal tumors, thus NSS is widely accepted as the treatment option for these patients. With NSS, there is a risk of renal hemorrhage and thus haemostatic agents may be routinely applied to the cut surface of the kidney. Herein we compare two commercially available haemostatic agents applied intra-operatively to the cut surface of the kidney. Post-operative outcomes (oncologic and non-oncologic) are reported.
The medical records of 23 patients with suspicious renal mass documented on axial imaging and who underwent open NSS via a mini-subcostal incision were extensively reviewed. One of two haemostatic agents (Floseal®, n = 11; Arista®, n = 12) was intra-operatively applied to the cut surface of the kidney. Chi-square and T- student test was used to compare outcomes between the cohort of 11 patients who had Floseal® and the 12 patients who had Arista®.
Median pre-operative size of renal mass was 4.3 cm (range 1.5-7.0 cm). Final pathology revealed 3 oncocytomas and 20 renal cell carcinoma (17 clear cell, 1 chromophobe and 2 papillary), pT1a = 14 and pT1b = 6. Mean intra-operative blood loss and hospital stay between the Floseal®vs. Arista® cohorts did not significantly differ (227 mL vs. 250 mL, p = 0.68 and 4.4 days vs. 4.5 days, p = 0.76, respectively). Intra-operative and post-operative complications were not different between the two cohorts. No recurrences have been documented with a mean follow-up of 18 months.
Along with meticulous surgical technique, the use of either haemostatic agent (Floseal® or Arista®) was not associated with high rate of intra-operative or post-operative haemorrhage. Thus either haemostatic agent may be successfully used during NSS.
最近的研究表明，对于低分期肾肿瘤患者，保留肾单位手术（NSS）的治疗效果有所改善，因此NSS已被广泛接受为这些患者的治疗选择。进行NSS手术时，存在肾出血的风险，因此可能会常规在肾脏切面上应用止血剂。在此，我们比较了两种术中应用于肾脏切面的市售止血剂，并报告术后结果（肿瘤学和非肿瘤学方面）。
对23例经轴向成像记录有可疑肾肿块且通过肋下小切口接受开放性NSS手术的患者的病历进行了广泛回顾。两种止血剂之一（Floseal®，n = 11；Arista®，n = 12）术中应用于肾脏切面。采用卡方检验和t检验比较使用Floseal®的11例患者和使用Arista®的12例患者之间的结果。
肾肿块术前中位大小为4.3 cm（范围1.5 - 7.0 cm）。最终病理显示3例嗜酸细胞瘤和20例肾细胞癌（17例透明细胞癌、1例嫌色细胞癌和2例乳头状癌），pT1a = 14例，pT1b = 6例。Floseal®组与Arista®组之间的术中平均失血量和住院时间无显著差异（分别为227 mL对250 mL，p = 0.68；4.4天对4.5天，p = 0.76）。两组之间的术中及术后并发症无差异。平均随访18个月，未记录到复发情况。
除了精细的手术技术外，使用任何一种止血剂（Floseal®或Arista®）均与术中或术后高出血率无关。因此，在NSS手术中两种止血剂均可成功使用。
