Department of Urology, School of Medicine, Ibn-i Sina Hospital, Ankara University, Altındag, Ankara, Turkey.
Int Urol Nephrol. 2021 Jul;53(7):1317-1323. doi: 10.1007/s11255-021-02812-y. Epub 2021 Feb 25.
To evaluate the effect of artery-only (AO) and artery-vein (AV) clamping during partial nephrectomy (PN) on short- and long-term renal function outcome.
Medical records of 154 patients in the AO group and 192 patients in the AV group who underwent open and minimally invasive (laparoscopic/robotic) PN between January 2011 and January 2018 were retrospectively assessed. Preoperative patient and tumor-specific characteristics in addition to perioperative factors and renal function outcomes were compared. The change in the estimated glomerular filtration rate (eGFR) from postoperative 1-3 days, 12 and 24 months after surgery was calculated. Acute kidney injury (AKI) was defined a as a > 25% reduction in eGFR.
There were no statistically significant differences between the clamping techniques in terms of postoperative 1-3 days, 12 and 24 months eGFR change percentage and risk of progression to chronic kidney disease (CKD). No significant difference in short- and long-term renal functions was found between the minimally invasive or open AO and AV clamping subgroups at any time point. In multivariate analysis, the R.E.N.A.L score (AO group p = 0.026, AV group p < 0.001) and preoperative eGFR (AO group p < 0.001, AV group p = 0.010) were strong predictors of the acute kidney injury in both groups. Older age (AO group p = 0.045, AV group p = 0.010) and preoperative eGFR (AO group p = 0.008, AV group p = 0.002) were significantly associated with CKD progression at 2-year follow-up in both groups.
AV clamping does not adversely affect postoperative renal function compared to AO clamping. Preoperative patient- and tumor-related factors are more important for renal function regardless of the clamping technique.
评估在部分肾切除术（PN）中仅夹闭动脉（AO）和动静脉（AV）对短期和长期肾功能结果的影响。
回顾性分析 2011 年 1 月至 2018 年 1 月期间接受开放和微创（腹腔镜/机器人）PN 的 154 例 AO 组和 192 例 AV 组患者的病历。比较了术前患者和肿瘤特征以及围手术期因素和肾功能结果。计算了术后 1-3 天、12 个月和 24 个月时估算肾小球滤过率（eGFR）的变化。急性肾损伤（AKI）定义为 eGFR 下降> 25%。
在术后 1-3 天、12 个月和 24 个月时 eGFR 变化百分比和进展为慢性肾脏病（CKD）的风险方面，两种夹闭技术之间没有统计学上的显著差异。在任何时间点，微创或开放的 AO 和 AV 夹闭亚组之间的短期和长期肾功能均无显著差异。多变量分析显示，R.E.N.A.L 评分（AO 组 p=0.026，AV 组 p<0.001）和术前 eGFR（AO 组 p<0.001，AV 组 p=0.010）是两组发生 AKI 的强预测因素。年龄较大（AO 组 p=0.045，AV 组 p=0.010）和术前 eGFR（AO 组 p=0.008，AV 组 p=0.002）与两组 2 年随访时 CKD 进展显著相关。
与 AO 夹闭相比，AV 夹闭不会对术后肾功能产生不利影响。无论夹闭技术如何，术前患者和肿瘤相关因素对肾功能更为重要。
