Maruschke Matthias, Hagel Katja, Hakenberg Oliver, Scheeren Thomas
Department of Urology, Helios Hanseklinikum Stralsund, Große Parower Str. 47-53, 18435, Stralsund, Germany.
Department of Internal Medicine, Filder Klinik, Filderstadt, Germany.
Clin Exp Nephrol. 2018 Jun;22(3):735-742. doi: 10.1007/s10157-017-1506-6. Epub 2017 Dec 2.
Partial nephrectomy (PNx) can be associated with macrocirculatory and microcirculatory alterations, ultimately leading to acute kidney injury (AKI). Measuring kidney tissue oxygenation (μHbO2) and microcirculation during open PNx might be feasible to early detect these alterations and prevent postoperative AKI.
μHbO2 and microcirculation were measured in 45 patients undergoing PNx by reflectance spectrophotometry and laser Doppler flowmetry (O2C™, Lea, Germany), related to ischemia time and tumour size. Pre- and postoperative creatinine levels were determined.
μHbO2 was lower after reperfusion than before clamping (72 vs. 75%), while microcirculation and regional haemoglobin did not differ. Ischemia time was 15.7 min on average. μHbO2 was higher without ischemia (80 vs. 70%, p = 0.109) and in T1a- than T1b-tumours, independent of ischemia time and reperfusion. The renal collecting system (RCS) was opened in 19/45 patients with μHbO2 of 68% after reperfusion compared to 74% with intact RCS. Postoperative complications occurred in 6/45 patients (13%). μHbO2 was 68% before clamping vs. 75% without complications. Serum creatinine of patients with T1b was higher compared to T1a (103 vs. 87 µmol/L). Patients with larger tumours had higher postoperative creatinine levels (173 vs. 124 µmol/L; p = 0.052).
We showed for the first time that the method is feasible to monitor renal tissue oxygenation at the level of microcirculation non-invasively and reproducibly during PNx. Tumour size seems to have a decisive influence on oxygenation and postoperative renal function. Our results imply that postoperative complications may be predicted by low intraoperative renal oxygenation and microcirculatory flow measurements.
部分肾切除术（PNx）可能与大循环和微循环改变相关，最终导致急性肾损伤（AKI）。在开放性PNx期间测量肾组织氧合（μHbO2）和微循环可能有助于早期发现这些改变并预防术后AKI。
通过反射分光光度法和激光多普勒血流仪（O2C™，德国Lea公司）对45例行PNx的患者测量μHbO2和微循环，并与缺血时间和肿瘤大小相关联。测定术前和术后肌酐水平。
再灌注后μHbO2低于夹闭前（72%对75%），而微循环和局部血红蛋白无差异。平均缺血时间为15.7分钟。无缺血时μHbO2较高（80%对70%，p = 0.109），T1a期肿瘤高于T1b期肿瘤，与缺血时间和再灌注无关。45例患者中有19例打开了肾集合系统（RCS），再灌注后μHbO2为68%，而RCS完整的患者为74%。45例患者中有6例（13%）发生术后并发症。夹闭前μHbO2为68%，无并发症患者为75%。T1b期患者的血清肌酐高于T1a期（103对87 μmol/L）。肿瘤较大的患者术后肌酐水平较高（173对124 μmol/L；p = 0.052）。
我们首次表明该方法在PNx期间以无创且可重复的方式在微循环水平监测肾组织氧合是可行的。肿瘤大小似乎对氧合和术后肾功能有决定性影响。我们的结果表明，术中肾氧合和微循环血流测量值低可能预示术后并发症。
