Chen Fang-Min, Hu Rui-Jie, Jiang Xi-Nan, Zhong Si-Wen, Tang Shuai
Department of Urology, The Third Central Hospital of Tianjin, Tianjin Key Laboratory of Artificial Cell; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin.
The First People's Hospital of Jiujiang City, Jiujiang, Jiangxi.
Medicine (Baltimore). 2019 Jan;98(2):e13927. doi: 10.1097/MD.0000000000013927.
Laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking (SRPN) has been widely used in the treatment of localized renal tumors. However, the impact of ischemia-reperfusion injury (IRI) during SRPN remains controversial. This study aims to evaluate the correlation between affected renal function and affected renal volume after SRPN for localized renal tumor treatment, explore the effect of IRI on renal function after SRPN.A total of 39 patients who underwent SRPN for localized renal tumor from June 2009 to April 2012 were reviewed. These patients were followed-up for 5 years. The preoperative affected renal glomerular filtration rate (aGFRpre), postoperative affected renal glomerular filtration rate (aGFRpost), preoperative affected renal volume (aVolpre), and postoperative affected renal volume (aVolpost) were collected during the follow-up period. The correlation between aGFRpost/aGFRpre and aVolpost/aVolpre was compared.A total of 33 patients were successfully followed up. After 3, 6, 12, 24, and 60 months, aGFRpost was 34.6 ± 4.6, 34.7 ± 4.8, 34.9 ± 4.4, 35.1 ± 4.4, and 35.2 ± 4.2 mL/min. The correlation coefficients between aGFRpost/aGFRpre and aVolpost/aVolpre were 0.659 (P = .000), 0.667 (P = .000), 0.663 (P = .000), 0.629 (P = .000), and 0.604 (P = .000), respectively. The limitation of this study was the small cohort size.For the localized renal tumor, aGFRpost was associated with aVolpost, but was not associated with intraoperative factors, such as the time of clamping of the affected segmental renal artery. As a part of nephrons, the resected tumor tissue caused the lack of inherent nephrons, resulting in the loss of renal function. More nephrons should be maintained before resecting the tumor completely during SRPN.Trial registration: ChiCTR-RRC-17011418.
腹腔镜下保留肾单位的部分肾切除术联合节段性肾动脉阻断术（SRPN）已广泛应用于局限性肾肿瘤的治疗。然而，SRPN期间缺血再灌注损伤（IRI）的影响仍存在争议。本研究旨在评估SRPN治疗局限性肾肿瘤后患肾功能与患肾体积之间的相关性，探讨IRI对SRPN后肾功能的影响。
回顾性分析了2009年6月至2012年4月期间接受SRPN治疗局限性肾肿瘤的39例患者。对这些患者进行了5年的随访。随访期间收集术前患肾肾小球滤过率（aGFRpre）、术后患肾肾小球滤过率（aGFRpost）、术前患肾体积（aVolpre）和术后患肾体积（aVolpost）。比较aGFRpost/aGFRpre与aVolpost/aVolpre之间的相关性。
共33例患者成功随访。在3、6、12、24和60个月时，aGFRpost分别为34.6±4.6、34.7±4.8、34.9±4.4、35.1±4.4和35.2±4.2 mL/min。aGFRpost/aGFRpre与aVolpost/aVolpre之间的相关系数分别为0.659（P = 0.000）、0.667（P = 0.000）、0.663（P = 0.000）、0.629（P = 0.000）和0.604（P = 0.000）。本研究的局限性在于样本量较小。
对于局限性肾肿瘤，aGFRpost与aVolpost相关，但与术中因素无关，如患侧节段性肾动脉阻断时间。作为肾单位的一部分，切除的肿瘤组织导致固有肾单位缺失，从而导致肾功能丧失。在SRPN期间完全切除肿瘤之前，应保留更多的肾单位。
ChiCTR-RRC-17011418。
