Yu Junjie, Wen Rumin
Department of Urology, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China.
Department of Urology, Affiliated Hospital of Xuzhou Medical College, Xuzhou 221002, China. Email:
Zhonghua Wai Ke Za Zhi. 2014 Apr;52(4):267-70.
To assess the effects of warm ischaemia time (WIT) on renalfunction after laparoscopic partial nephrectomy (LPN) for renal masses in patients.
From January 2010 to December 2012, 39 patients treated with LPN for a single T1 renal tumor were enrolled in this prospective study. There were 24 male and 15 female patients. Their age was (58 ± 10) years old, and their body mass index was (27 ± 3) kg/m(2). The mean operation time was (132 ± 12) minutes, and the mean WIT was (29 ± 8) minutes. Clinical parameters, the single glomerular filtration rates (sGFR) were compared before the operation and after 3 and 12 months in order to observer the effects on renal function and find the factors predicting the renal function impairment.
There were significant differences between 3, 12 months after the operation ((26.8 ± 5.6) ml/min and (28.6 ± 5.6) ml/min, respectively) and preoperation ((31.9 ± 6.3) ml/min) in sGFR (F = 4.882 and 5.511, both P < 0.05). And there were significant negative correlations between the sGFR in 3 and 12 months after the operation and WIT (r = -0.569, P = 0.000 and r = -0.448, P = 0.004) . The preoperative sGFR (β = 0.260, 95%CI:0.089-0.431) and WIT (β = 0.369, 95%CI:0.189-0.555) were independent predictors for function decline of the operated kidney (both P < 0.05). The analysis showed that the effects of WIT within 30 minutes on renal function is relatively small. Longer WIT was associated with lower postoperative sGFR values (F = 22.128 and 20.552, both P = 0.000) .
For the LPN operation, the longer of the WIT, the more serious of renal function damage. sGFR is an accurate measurement to assess the renal damage. Every effort should be made to minimise WIT during LPN, and the limit of 30 minutes should be not exceeded.
评估热缺血时间（WIT）对患者肾肿瘤行腹腔镜肾部分切除术（LPN）后肾功能的影响。
2010年1月至2012年12月，39例因单一T1期肾肿瘤接受LPN治疗的患者纳入本前瞻性研究。其中男性24例，女性15例。年龄（58±10）岁，体重指数（27±3）kg/m²。平均手术时间（132±12）分钟，平均WIT（29±8）分钟。比较术前、术后3个月及12个月的临床参数及单个肾小球滤过率（sGFR），以观察对肾功能的影响并找出预测肾功能损害的因素。
术后3个月、12个月的sGFR（分别为（26.8±5.6）ml/min和（28.6±5.6）ml/min）与术前（（31.9±6.3）ml/min）相比差异有统计学意义（F = 4.882和5.511，P均<0.05）。术后3个月和12个月的sGFR与WIT呈显著负相关（r = -0.569，P = 0.000；r = -0.448，P = 0.004）。术前sGFR（β = 0.260，95%CI：0.089 - 0.431）和WIT（β = 0.369，95%CI：0.189 - 0.555）是患肾肾功能下降的独立预测因素（P均<0.05）。分析显示，30分钟内的WIT对肾功能的影响相对较小。WIT越长，术后sGFR值越低（F = 22.128和20.552，P均 = 0.000）。
对于LPN手术，WIT越长，肾功能损害越严重。sGFR是评估肾损伤的准确指标。LPN手术中应尽一切努力缩短WIT，且不应超过30分钟的时限。
