Renal Functional and Perioperative Outcomes of Selective Versus Complete Renal Arterial Clamping During Robot-Assisted Partial Nephrectomy
Renal Functional and Perioperative Outcomes of Selective Versus Complete Renal Arterial Clamping During Robot-Assisted Partial Nephrectomy
复制标题
机器人辅助肾部分切除术期间选择性与完全肾动脉钳夹的肾功能和围手术期结果
作者：
J. Furukawa;H. Miyake;N. Hinata;M. Muramaki;Kazushi Tanaka;M. Fujisawa
目标。本研究的目的是比较机器人辅助肾部分切除术(RAPN)中选择性与常规完全肾动脉夹闭患者的临床结果。方法：研究方法。本研究包括19例肾肿瘤患者，他们接受了RAPN联合选择性动脉阻断(组1)。比较两组患者的肾功能及围手术期转归，并与同期行肾动脉完全阻断的20例肾肿瘤患者进行比较。结果。在第1组，所有患者均可在选择性动脉阻断下完成肿瘤切除，术中未转为传统的完全阻断RAPN。两组在肿瘤大小、肾功能评分、术前肾小球滤过率(EGFR)等方面差异无统计学意义，在术中出血量、手术时间、热缺血时间等方面也无明显差异。尽管两组间术后4周的EGFR下降率无显著差异，但1组术后1周的EGFR下降率明显低于2组。选择性阻断或完全阻断也是术后1周EGFR下降10%的独立预测因素，而不是4周。结论。精确的节段性夹闭技术用于RAPN是可行和安全的，可改善术后特别是术后早期的肾功能。
Objective. The objective of this study was to investigate clinical outcomes in patients undergoing selective versus conventional complete renal arterial clamping during robot-assisted partial nephrectomy (RAPN). Methods. This study included 19 patients with renal tumors who received RAPN incorporating selective arterial clamping (group 1). The renal functional as well as perioperative outcomes in group 1 were compared with those in 20 patients with renal tumors undergoing RAPN with total clamping of the renal artery (group 2) during the same period. Results. In group 1, tumor resection under selective arterial clamping could be completed in all patients without intraoperative conversion to conventional RAPN with total clamping. There were no significant differences in the tumor size, RENAL nephrometry score, or preoperative estimated glomerular filtration rate (eGFR) between groups 1 and 2. Furthermore, no significant differences were noted in the estimated blood loss, operative time, or warm ischemia time between the 2 groups. Although there was no significant difference in the rate of decrease in eGFR 4 weeks after RAPN between the 2 groups, the rate of decrease in eGFR 1 week after RAPN in group 1 was significantly lower than that in group 2. The choice of selective or total clamping was also identified as an independent predictor of a postoperative decrease in eGFR by > 10% at 1 week, but not 4 weeks, after RAPN. Conclusions. A precise segmental clamping technique is feasible and safe for performing RAPN, resulting in an improved postoperative renal function, particularly early after surgery.
影响因子：
51.1
作者：
Huang, William C.;Levey, Andrew S.;Rosso, Paul
通讯作者：
Rosso, Paul