Factors Influencing the Feasibility of Segmental Artery Clamping During Retroperitoneal Laparoscopic Partial Nephrectomy
Factors Influencing the Feasibility of Segmental Artery Clamping During Retroperitoneal Laparoscopic Partial Nephrectomy
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DOI：
10.1016/j.urology.2019.03.024
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发表时间：
2019-07-01
期刊：
影响因子：
2.1
通讯作者：
Wang, Zengjun
中科院分区：
文献类型：
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作者：
Qian, Jian;Jiang, Jie;Wang, Zengjun
目的探讨后腹腔镜肾部分切除术（LPN）治疗T1型肾肿瘤时能否成功准确夹闭节段动脉的影响因素。患者和方法回顾了2012年6月至2018年2月期间接受腹膜后LPN治疗的临床T1肿瘤患者（n = 248），包括人口统计学和临床特征。然而，仅有225例（90.7%）可用于分析。精确节段动脉夹持是LPN中首选的夹持方法。如不成功，转至肾主动脉夹持。比较两种夹持方式的围手术期特点及功能结局。结果225例患者中，190例采用节段动脉夹持术，35例（15.6%）转为肾主动脉夹持术。没有一例转为开腹手术。与成功的节段动脉夹持术相比，夹持肾主动脉的手术时间更长，估计失血量更少，肾小球滤过率降低更高。单变量分析确定了以下特征影响节段性动脉夹持的可行性：性别；高血压;肿瘤位置、生长方式、靶动脉数；R.E.N.A.L.肾测量评分；梅奥粘附概率（MAP）评分。多变量分析表明，男性、高RNS和高MAP评分是降低节段性动脉夹持能力的独立因素。结论LPN联合节段动脉夹持术在T1肾肿瘤切除中是安全的。男性和RNS或MAP评分较高的病例可能需要额外的认知。(C) 2019 Elsevier Inc.
OBJECTIVE To investigate factors that may predict successful precise segmental artery clamping during retroperitoneal laparoscopic partial nephrectomy (LPN) for treatment of T1 kidney tumor.PATIENTS AND METHODS Patients with clinical T1 tumors (n = 248) who received retroperitoneal LPN from June 2012 through February 2018 were reviewed, including demographics and clinical features. However, only 225 cases (90.7%) were available to analyze. Precise segmental artery clamping was the first clamping method selected during the LPN. If unsuccessful, conversion to main renal artery clamping was conducted. The perioperative features and functional outcomes of the 2 clamping types were compared.RESULTS Of the 225 patients, 190 procedures were effectively performed using segmental artery clamping, while 35 (15.6%) were converted to main renal artery clamping. None were converted to open surgery. Clamping the main renal artery was associated with longer operative time, less estimated blood loss, and higher glomerular filtration rate reduction, compared with successful segmental artery clamping. Univariable analyses determined that the following features affected the feasibility of segmental artery clamping: gender; hypertension; tumor location, growth pattern, and targeted artery number; R.E.N.A.L. nephrometry score (RNS); and Mayo adhesive probability (MAP) score. The multivariable analyses indicated that male gender, high RNS, and elevated MAP score were independent factors lowering the viability of segmental artery clamping.CONCLUSION LPN with segmental artery clamping is generally safe for removing T1 kidney tumors. Extra cognizance may be required in men and cases with high RNS or MAP score. (C) 2019 Elsevier Inc.