Temporary targeted renal blood flow interruption using a reverse thermosensitive polymer to facilitate bloodless partial nephrectomy: a swine survival study.
Temporary targeted renal blood flow interruption using a reverse thermosensitive polymer to facilitate bloodless partial nephrectomy: a swine survival study.
复制标题
使用反向热敏聚合物临时靶向肾血流中断以促进无血部分肾切除术：一项猪生存研究。
DOI：
10.1111/j.1464-410x.2012.10967.x
复制
发表时间：
2012
影响因子：
4.5
通讯作者：
Madras,PeterN
中科院分区：
文献类型：
--
作者：
Harty,NiallJ;Laskey,DanielH;Moinzadeh,Alireza;Flacke,Sebastian;Benn,JamesA;Villani,Rosanna;Kalra,Aarti;Libertino,JohnA;Madras,PeterN
关于这个主题有什么已知的？这项研究增加了什么？ LumagelTM 是一种反向热敏聚合物 (RTP)，之前在文献中曾被描述为提供临时血管闭塞，以允许进行无血肾部分切除术 (PN)，同时保持血液流向肾脏非目标部分。在体温下，LumagelTM 具有粘稠凝胶的稠度，但冷却后迅速转化为液态，并且此后不会重构。这一特性使其可用于需要暂时血管闭塞的情况。先前在冠状动脉中进行类似 RTP 的经验被证明是成功的，没有可检测到的不良事件。我们之前描述了我们的主要肾动脉以及节段和亚节段肾分支的暂时血管闭塞技术，以允许通过开放或微创方法进行无血 PN。这些实验是在急性环境下进行的。本研究是一项双臂生存试验，旨在评估这种 RTP 是否与用于无血 PN 的肺门钳夹一样安全。使用RTP后，存活的动物表现出正常生长，没有毒性，没有器官功能障碍，也没有RTP引起的病理变化。我们得出的结论是，LumagelTM 与采用肺门钳夹的传统 PN 一样安全，同时增加了肾切除期间不间断灌注的优势。 目的•检查随机选择的肾脏区域是否可以使用反向热敏聚合物 (RTP)、LumagelTM（Pluromed, Inc., Woburn, MA, USA）进行暂时性血流中断，然后进行部分肾切除术 (PN)，而不增加使用肺门的同一手术中遇到的风险。材料和方法•进行了双臂（RTP 与肺门夹）、6 周的猪生存研究。•四头猪使用肺门夹接受了 PN，而六头使用 RTP 接受了血流中断的 PN。•通过血管造影进行的 RTP 用于节段或亚段动脉的管腔内闭塞，并与使用肺门夹钳夹住肾主动脉进行了比较。每头猪的切除部位是随机的。•术前、第1、3和6周进行实验室研究。•宰杀猪前，重复进行血管造影，重点关注先前血流中断的部位。•随后对肾、肝、肺、心脏、骨骼肌进行肉眼和显微镜检查，并对支撑先前栓塞的血管进行检查。结果•所有动物均存活。 6 周内未出现异常化学或血液学结果。两组均未出现手术并发症。•通过血管造影，我们发现6周前因PN而用聚合物封堵的血管100%通畅。唯一的肉眼或微观异常与肾切除和疤痕形成有关，并且在两组中相似。结论•RTP 的有针对性的血流中断不会增加 PN 的额外风险，同时允许无血切除和不间断地血流至非目标肾组织。
What's known on the subject? and What does the study add?LumagelTMis a reverse thermosensitive polymer (RTP) that has previously been described in the literature as providing temporary vascular occlusion to allow for bloodless partial nephrectomy (PN) while maintaining blood flow to the untargeted portion of the kidney. At body temperature, LumagelTMhas the consistency of a viscous gel but upon cooling rapidly converts to a liquid state and does not reconstitute thereafter. This property has allowed for it to be used in situations requiring temporary vascular occlusion. Previous experience with similar RTPs in coronary arteries proved successful, with no detectable adverse events.We have previously described our technique for temporary vascular occlusion of the main renal artery, as well as segmental and sub‐segmental renal branches, to allow for bloodless PN in either an open or minimally invasive approach. These experiments were performed in the acute setting. This study is a two‐armed survival trial to assess whether this RTP is as safe as hilar clamping for bloodless PN. Surviving animals showed normal growth after using the RTP, absence of toxicity, no organ dysfunction, and no pathological changes attributable to the RTP. We conclude that LumagelTMis as safe as conventional PN with hilar clamping, while adding the advantage of uninterrupted perfusion during renal resection.OBJECTIVE•To examine whether randomly selected regions of the kidney could undergo temporary flow interruption with a reverse thermosensitive polymer (RTP), LumagelTM(Pluromed, Inc., Woburn, MA, USA), followed by partial nephrectomy (PN), without adding risks beyond those encountered in the same procedure with the use of hilar clamping.MATERIALS AND METHODS•A two‐armed (RTP vs hilar clamp), 6‐week swine survival study was performed.•Four swine underwent PN using hilar clamps, while six underwent PN with flow interruption using the RTP.•The RTP, administered angiographically, was used for intraluminal occlusion of segmental or subsegmental arteries and was compared with main renal artery clamping with hilar clamps. The resection site was randomized for each swine.•Laboratory studies were performed preoperatively, and at weeks 1, 3 and 6.•Before killing the swine, repeat angiography was performed with emphasis on the site of previous flow interruption.•Gross and microscopic examination of kidney, liver, lung, heart, skeletal muscle was later performed, and the vessel that had supported the previous plug was examined.RESULTS•All animals survived. No abnormal chemistry or haematology results were encountered over the 6 weeks. There were no surgical complications in either group.•Using angiography we found 100% patency of vessels that had been occluded with the polymer 6 weeks previously for PN. The only gross or microscopic abnormalities were related to the renal resection and scar formation, and were similar in the two groups.CONCLUSION•Targeted flow interruption with the RTP added no additional risk to PN while allowing bloodless resection and uninterrupted flow to untargeted renal tissue.
DOI：
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发表时间：
1982
期刊：
影响因子：
--
作者：
H. J. Gamble
通讯作者：
H. J. Gamble