Chae Min Suk, Shim Jung-Woo, Choi Hoon, Hong Sung Hoo, Lee Ji Youl, Jeong Woohyung, Lee Bongsung, Kim Eunji, Hong Sang Hyun
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
Cancers (Basel). 2022 Apr 14;14(8):1985. doi: 10.3390/cancers14081985.
We investigated the effects of multimodal combined bundle therapy, consisting of remote ischemic preconditioning (RIPC) and intrathecal morphine block (ITMB), on the early recovery of kidney function after robot-assisted laparoscopic partial nephrectomy (RALPN) in patients with renal cell carcinoma (RCC). In addition, we compared the surgical and analgesic outcomes between patients with and without bundle treatment. This prospective randomized double-blind controlled trial was performed in a cohort of 80 patients with RCC, who were divided into two groups: a bundle group ( = 40) and non-bundle group ( = 40). The primary outcome was postoperative kidney function, defined as the lowest estimated glomerular filtration rate (eGFR) on postoperative day (POD) 2. Surgical complications, pain, and length of hospital stay were assessed as secondary outcomes. The eGFR immediately after surgery was significantly lower in the bundle group compared to the preoperative baseline, but serial levels on PODs 1 and 2 and at three and six months after surgery were comparable to the preoperative baseline. The eGFR level immediately after surgery was lower in the non-bundle than bundle group, and serial levels on PODs 1 and 2 and at three months after surgery remained below the baseline. The eGFR level immediately after surgery was higher in the bundle group than in the non-bundle group. The eGFR changes immediately after surgery, and on POD 1, were smaller in the bundle than in the non-bundle group. The non-bundle group had longer hospital stays and more severe pain than the bundle group, but there were no severe surgical complications in either group. The combined RIPC and ITMB bundle may relieve ischemia-reperfusion- and pain-induced stress, as a safe and efficient means of improving renal outcomes following RALPN in patients with RCC.
我们研究了由远程缺血预处理（RIPC）和鞘内吗啡阻滞（ITMB）组成的多模式联合束治疗对肾细胞癌（RCC）患者机器人辅助腹腔镜肾部分切除术（RALPN）后肾功能早期恢复的影响。此外，我们比较了接受和未接受束治疗患者的手术和镇痛效果。这项前瞻性随机双盲对照试验在80例RCC患者中进行，这些患者被分为两组：束治疗组（n = 40）和非束治疗组（n = 40）。主要结局是术后肾功能，定义为术后第2天的最低估计肾小球滤过率（eGFR）。手术并发症、疼痛和住院时间作为次要结局进行评估。与术前基线相比，束治疗组术后立即的eGFR显著降低，但术后第1天和第2天以及术后3个月和6个月的连续水平与术前基线相当。非束治疗组术后立即的eGFR水平低于束治疗组，术后第1天和第2天以及术后3个月的连续水平仍低于基线。束治疗组术后立即的eGFR水平高于非束治疗组。束治疗组术后立即和术后第1天的eGFR变化小于非束治疗组。非束治疗组的住院时间比束治疗组长，疼痛比束治疗组更严重，但两组均无严重手术并发症。联合RIPC和ITMB束治疗可能减轻缺血再灌注和疼痛引起的应激，是改善RCC患者RALPN术后肾脏结局的一种安全有效的方法。
