Cheema Zubair, Alsinnawi Mazen, Casey Rowan G, Corr John
Colchester University NHS Foundation Trust, Colchester, Essex, United Kingdom.
Can J Urol. 2014 Jun;21(3):7277-82.
Different techniques are used in open partial nephrectomy (OPN) for localized renal cancer, with variable impact on renal function. Regional renal ischemia technique by using different clamps and without the need to occlude renal vessels is gaining popularity. In our study, we present the largest international series; and the first in the United Kingdom; describing OPN using soft bowel clamp. We study the impact of this regional ischemia innovative technique on renal function, postoperative complications and oncological outcomes.
We retrospectively analyzed the first 100 OPN cases done between 2001 and 2011. All available data on the hospital databases were analyzed; recording patient demographics, tumor characteristics, operative procedure details, histopathology results and long term follow up.
A direct comparison with other studies that have used different clamps to achieve regional ischemia was performed. Our technique has the advantage of being used for interpolar and hilar/central tumors. Our mean tumor size was higher at 4.1 cm. Our positive margin rate for malignant tumors was comparable with other studies, same for mean operative time and hospital stay. None had significant deterioration in renal function that required renal replacement therapy. Median blood loss was 400 mL. Our series has the advantage of showing the long term follow up data.
We believe the technique we have developed using soft bowel clamp to produce regional renal ischemia is practical and successful. It can be applied safely in all OPN cases, with excellent oncological outcome and clinically acceptable renal function preservation.
开放性部分肾切除术（OPN）治疗局限性肾癌采用了不同技术，对肾功能的影响各异。使用不同夹子且无需阻断肾血管的区域肾缺血技术正逐渐受到欢迎。在我们的研究中，我们呈现了最大的国际系列病例；也是英国首例；描述了使用软肠钳进行的OPN。我们研究了这种区域缺血创新技术对肾功能、术后并发症和肿瘤学结果的影响。
我们回顾性分析了2001年至2011年间完成的前100例OPN病例。分析了医院数据库中所有可用数据；记录患者人口统计学信息、肿瘤特征、手术操作细节、组织病理学结果和长期随访情况。
与其他使用不同夹子实现区域缺血的研究进行了直接比较。我们的技术具有可用于肾极间和肾门/中央肿瘤的优势。我们的平均肿瘤大小更高，为4.1厘米。我们恶性肿瘤的切缘阳性率与其他研究相当，平均手术时间和住院时间也相同。没有患者出现需要肾脏替代治疗的肾功能显著恶化情况。中位失血量为400毫升。我们的系列病例具有展示长期随访数据的优势。
我们认为我们开发的使用软肠钳产生区域肾缺血的技术是实用且成功的。它可以安全地应用于所有OPN病例，具有出色的肿瘤学结果和临床上可接受的肾功能保留情况。
