Department of Urology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
J Endourol. 2020 Apr;34(4):523-530. doi: 10.1089/end.2019.0580. Epub 2020 Apr 2.
Although artery-only (AO) clamping has been proposed to minimize ischemic renal damage compared with artery-vein (AV) clamping, the benefit of AO clamping during laparoscopic partial nephrectomy (LPN) is still controversial. We performed a systematic review and meta-analysis to test the difference between AO clamping and AV clamping in partial nephrectomy (PN). A systematic review of the literature on PubMed, Web of Science, the Cochrane Library, and Embase was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement to search-related studies. Data were extracted using a reporting checklist proposed by the Meta-analysis of Observational Studies in Epidemiology Group. RevMan 5.3 software and Stata 12.0 were used to do meta-analysis. The present meta-analysis included 2 retrospective and 3 prospective studies, including 242 patients who underwent AO clamping and 369 patients who underwent AV clamping, which compared AO and AV clamping in LPN for renal cell carcinoma. At baseline, no statistically significant differences were detected between AO and AV clamping groups in terms of body mass index ( = 0.23), tumor size ( = 0.95), but AO clamping group had significantly lower RENAL Score (fixed effects [FE]: weighted mean difference [WMD]: 0.36, = 0.007). For surgical outcomes analysis, no significant difference was detected regarding to warm ischemia ( = 0.58), operating time ( = 0.40), transfusion rate ( = 0.58), and estimated blood loss ( = 0.35) between two groups. The assessment of renal function by creatinine value both at the early postoperative ( = 0.36) and at last follow-up ( = 0.38) revealed no difference. There was no significant difference in estimated glomerular filtration rate (eGFR) ( = 0.62), and at the early postoperative percentage decrease of eGFR ( = 0.79). However, a higher percentage decrease of eGFR decrease at last follow-up was demonstrated for the AV clamping group (FE: WMD: 2.42, < 0.00001). These results suggest that AO clamping might be a better choice for PN in long term. Randomized controlled trial studies with larger sample numbers and long-term follow-up and split renal function assessment should be conducted in the future to confirm our conclusion.
尽管与动脉-静脉（AV）夹闭相比，仅夹闭动脉（AO）可最大程度地减少缺血性肾损伤，但在腹腔镜部分肾切除术（LPN）中使用 AO 夹闭的益处仍存在争议。我们进行了一项系统评价和荟萃分析，以检验在部分肾切除术（PN）中 AO 夹闭与 AV 夹闭之间的差异。根据系统评价和荟萃分析报告的首选报告项目声明，对 PubMed、Web of Science、Cochrane 图书馆和 Embase 中的文献进行了系统评价搜索相关研究。使用由观察性研究荟萃分析流行病学组提出的报告清单提取数据。RevMan 5.3 软件和 Stata 12.0 用于进行荟萃分析。
本荟萃分析包括 2 项回顾性研究和 3 项前瞻性研究，共纳入 242 例接受 AO 夹闭和 369 例接受 AV 夹闭的患者，比较了 LPN 治疗肾细胞癌时的 AO 和 AV 夹闭。在基线时，AO 夹闭组和 AV 夹闭组在体重指数（ = 0.23）和肿瘤大小（ = 0.95）方面无统计学差异，但 AO 夹闭组的 RENAL 评分明显较低（固定效应 [FE]：加权均数差 [WMD]：0.36， = 0.007）。
对于手术结果分析，两组之间的热缺血时间（ = 0.58）、手术时间（ = 0.40）、输血率（ = 0.58）和估计失血量（ = 0.35）无显著差异。两组术后早期（ = 0.36）和末次随访时（ = 0.38）的肌酐值评估肾功能无差异。肾小球滤过率估计值（eGFR）（ = 0.62）和术后早期 eGFR 百分比下降（ = 0.79）无显著差异。然而，AV 夹闭组在末次随访时的 eGFR 下降百分比更高（FE：WMD：2.42， < 0.00001）。
这些结果表明，AO 夹闭可能是长期 PN 的更好选择。未来应进行具有更大样本量和长期随访以及分肾功能评估的随机对照试验研究，以证实我们的结论。
