Precise Segmental Renal Artery Clamping Under the Guidance of Dual-source Computed Tomography Angiography During Laparoscopic Partial Nephrectomy
Precise Segmental Renal Artery Clamping Under the Guidance of Dual-source Computed Tomography Angiography During Laparoscopic Partial Nephrectomy
复制标题
腹腔镜肾部分切除术双源CT血管造影引导下精准节段性肾动脉钳夹
DOI：
10.1016/j.eururo.2012.05.056
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发表时间：
2012-12-01
期刊：
影响因子：
23.4
通讯作者：
Yin, Changjun
中科院分区：
文献类型：
--
作者：
Shao, Pengfei;Tang, Lijun;Yin, Changjun
背景：尽量减少热缺血损伤是肾部分切除术的技术重点之一。目的：探讨双源CT（DSCT）血管造影引导下腹腔镜肾部分切除术（laparoscopic partial renomatectomy，LPN）中精确夹闭肾段动脉的可行性，并分析影响手术效果的因素。设计、设置和参与者：回顾性分析了2009年12月至2011年11月期间接受治疗的125例单侧肾脏肿瘤患者，平均随访时间为18个月。干预：所有患者均接受腹膜后LPN，并精确夹闭供血段动脉。大多数靶支在靠近肺门实质处被切开。结果测量和统计学分析：对分类变量进行单变量和多变量logistic回归分析，对连续变量进行线性回归分析。结果和局限性：所有患者均成功分离并夹闭靶支，未夹闭肾动脉主干。中位估计失血量（EBL）为200 ml，9例患者接受输血。双源CT血管造影对供血动脉定位的准确率达93.6%。肿瘤的大小，位置和生长模式独立地影响了夹持分支的数量。夹闭的分支数量与术后肾功能和EBL显著相关。本研究的局限性，包括其回顾性的性质，数据是从一个单一的外科医生series.Conclusions：精确的节段动脉夹闭技术的指导下DSCT血管造影是可行的，有效的切除肿瘤和保护正常的实质。夹闭分支的数量与肿瘤特征相关，可以预测EBL和肾功能丧失。(C)2012年欧洲泌尿外科协会。由Elsevier B出版。V.保留所有权利。
Background: Minimizing warm ischemic (WI) injury is one technical focus of partial nephrectomy (PN). Inducing regional ischemia in the tumor area by clamping segmental renal arteries has become an alternative method to decrease WI injury.Objective: To study the technical feasibility of precise segmental artery clamping under the guidance of dual-source computed tomography (DSCT) angiography during laparoscopic partial nephrectomy (LPN) and to analyze the factors affecting surgical outcomes.Design, setting, and participants: Retrospective analysis of 125 patients with unilateral kidney tumor treated from December 2009 to November 2011 with a mean follow-up of 18 mo.Intervention: All patients received retroperitoneal LPN with the feeding segmental arteries precisely clamped. Most of the target branches were dissected close to the hilar parenchyma. The tumor was excised after precise clamping and renorrhaphy was performed.Outcome measurements and statistical analysis: Univariable and multivariable logistic regression analyses were performed for categorical variables, and continuous variables were analyzed by linear regression.Results and limitations: The target branches were isolated and clamped successfully in all patients without clamping the main renal artery. Median estimated blood loss (EBL) was 200 ml, and nine patients received blood transfusion. The accuracy of feeding artery orientation by DSCT angiography reached 93.6%. Tumor size, location, and growth pattern independently influenced the number of clamped branches. The number of clamped branches was significantly associated with postoperative renal function and EBL. Limitations of this study include its retrospective nature and that data are from a single-surgeon series.Conclusions: The precise segmental artery clamping technique under the guidance of DSCT angiography is feasible and efficient to excise the tumor and to protect the normal parenchyma. The number of clamped branches is associated with tumor characteristics and can predict EBL and loss of renal function. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.