后腹腔镜下肾部分切除术中热缺血时间的再探讨

背景与目的：腹腔镜下开展的肾部分切除术已经逐渐成为治疗单发T1期肾癌的可选术式。但是受诸多因素的影响，肾蒂阻断时间时常超过肾脏耐受的热缺血时间30 min的上限，可能对患者肾功能造成严重损害，而损害程度目前尚无定论。本研究旨在比较后腹腔镜下肾部分切除术中热缺血时间对术侧残余肾功能的影响。方法：将2012年1月—2014年1月开展的后腹腔镜下肾部分切除术44例患者分为2组：观察组(热缺血时间>30 min)21例，对照组(热缺血时间≤30 min)23例。重点对比2组患肾手术前后肾小球滤过率的差异。结果：观察组术前术后肾小球滤过率分别为29.3～53.0 mL/min(33.1±5.2)mL/min]和23.1～4 0.5 mL/min(27.3±5.9)mL/min](P=0.054)，对照组术前术后肾小球滤过率分别为27.4～49.6 mL/min(32.3±4.1)mL/min]和23.8～44.4 mL/min(29.1±5.0)mL/min](P=0.07)，2组之间肾小球滤过率减少幅度分别为5.2～12.9 mL/min(5.1±0.3) mL/min]和3.6～5.2 mL/min(4.0±0.7)mL/min](P=0.051)，差异均无统计学意义。结论：热缺血时间30～60 min并未对术侧残余肾功能产生具有统计学意义的严重损害，但在保证手术安全性的同时应尽力缩短患肾的热缺血时间以尽可能多地保留术侧残余肾功能。

Re-discussion of warm ischemia time during retroperitoneal laparoscopic partial nephrectomy for renal carcinoma

Background and purpose: Laparoscopic partial nephrectomy has been one of the surgery options for patients with single renal carcinoma of T1 stage. Under the effect of some factors, intraoperative renal blood flow clamping somtimes exceeds the safe limit of 30 minutes of warm ischemia time (WIT) for renal tissues, that might results in warm ischemia-reperfusion injury to severe extent. However, there still remains controversy about the depth of this warm ischemia-reperfusion injury. So this study aimed to evaluate the effects of longer WIT on ipsilateral residual renal tissues. Methods: Forty-four patients underwent retroperitoneal laparoscopic partial nephrectomy from Jan. 2012 to Jan. 2014. All of them were divided into observe group (WIT>30 min) and control group (WIT≤30 min). The differences of glomerular filtration rate (GFR) of operative kidney Pre- and post-operatively between two groups were analyzed. Results: The pre- and post-operative GFRs of operative kidney in observe group were 29.3-53.0 mL/min(33.1±5.2) mL/min], 23.1-40.5 mL/min(27.3±5.9) mL/min] respectively (P=0.054). The preand post-operative GFRs of operative kidney in control group were 27.4-49.6 mL/min(32.3±4.1) mL/min], 23.8-44.4 mL/min(29.1±5.0) mL/min], respectively (P=0.07). There was no statistically differences of the depth of the decrease of GFRs after surgery between the two groups (P=0.051). Conclusion: WIT of 30-60 min does not result in statistically significant injury for ipsilateral residual renal function. However, it is still necessary to reserve more ipsilateral residual renal function through minimizing WIT under the premise of ensuring the safety of surgery.