Kamiyama Yoshihiro, Yamashita Shinichi, Nakagawa Atsuhiro, Fujii Shinji, Goto Takuro, Mitsuzuka Koji, Ito Akihiro, Abe Takaaki, Tominaga Teiji, Arai Yoichi
Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Urology. 2019 Jan;123:265-272. doi: 10.1016/j.urology.2018.10.014. Epub 2018 Oct 22.
To evaluate renal damage after off-clamp partial nephrectomy (PN) using a novel surgical device, piezo actuator-driven pulsed water jet (ADPJ) system.
Sprague-Dawley rats were divided into 4 groups and subjected to sham operation, off-clamp PN by the piezo ADPJ system, radio knife, and soft coagulation, which have been used as thermal coagulation devices. Urine and blood samples were collected, and residual kidneys were harvested at 1, 7, 14, 30, and 90 days after PN. Serum blood urea nitrogen, creatinine, and urinary and serum kidney injury molecule-1 KIM-1 levels were measured. Morphological features and the extent of renal ischemia of resection surfaces were evaluated by hematoxylin-eosin staining and immunostaining using antibodies to 1-methyladenosine, respectively. In addition, the expression levels of KIM-1 mRNA extracted from each resection surface were analyzed by quantitative real-time reverse transcription polymerase chain reaction.
Serum blood urea nitrogen and creatinine were significantly lower with the piezo ADPJ system than with soft coagulation. Urinary and serum KIM-1 levels were also significantly decreased with the ADPJ. The extent of 1-methyladenosine immunostaining was significantly less with the ADPJ than with thermal coagulation devices. The expression levels of KIM-1 mRNA were also lower in the ADPJ system group.
The piezo ADPJ system might attenuate renal damage after off-clamp PN.
使用一种新型手术设备——压电致动器驱动脉冲水射流（ADPJ）系统，评估非阻断性部分肾切除术（PN）后的肾损伤情况。
将Sprague-Dawley大鼠分为4组，分别进行假手术、采用压电ADPJ系统进行非阻断性PN、使用已作为热凝设备的射频刀以及软凝固术。收集尿液和血液样本，并在PN术后1天、7天、14天、30天和90天采集残余肾脏。检测血清血尿素氮、肌酐以及尿液和血清肾损伤分子-1（KIM-1）水平。分别通过苏木精-伊红染色和使用针对1-甲基腺苷的抗体进行免疫染色，评估切除表面的形态学特征和肾缺血程度。此外，通过定量实时逆转录聚合酶链反应分析从每个切除表面提取的KIM-1 mRNA的表达水平。
与软凝固术相比，使用压电ADPJ系统时血清血尿素氮和肌酐水平显著降低。ADPJ组的尿液和血清KIM-1水平也显著降低。与热凝设备相比，ADPJ组的1-甲基腺苷免疫染色程度显著减轻。ADPJ系统组的KIM-1 mRNA表达水平也较低。
压电ADPJ系统可能减轻非阻断性PN后的肾损伤。
