肾动脉球囊导管低温灌注在腹腔镜肾部分切除术中的应用

目的 评价腹腔镜肾部分切除术前行肾动脉球囊导管置入术进行低温灌注的可行性和安全性.方法 选取解放军总医院2013年3月至2016年12月35例拟行腹腔镜肾脏肿瘤部分切除术患者,肿瘤位于左肾22例,右肾13例,肿瘤长径2.3～7.0 cm,平均(4.1±1.2) cm.切除术前行肾动脉球囊导管置入术,术中经球囊导管灌注4℃低温液体,记录切除术中肾脏冷缺血时间,手术时间,术中出血量,比较术前,术后第1、3、7天肌酐清除率(Ccr)和肾小球滤过率估值(eGFR),统计术中及术后并发症.结果 35例患者肾动脉球囊导管均置入成功,技术成功率100％.1例患者行切除术前球囊导管滑脱,2例术中发现阻断不全另使用动脉钳阻断,另32例成功行单纯肾动脉球囊导管低温灌注下腹腔镜肾部分切除术,术中及术后均未出现严重并发症.患肾冷缺血时间平均45(20～125) min;介入手术时间平均28(20～40) min;外科手术时间平均147(95～235) min;术中出血量平均180(50～1 000) ml;术前,术后第1、3、7天Ccr分别为(96.5±15.1)、(75.2±10.5)、(54.3±13.8)、(91.8±14.1) ml/min,eGFR分别为(99.5±15.3)、(70.3±12.5)、(65.5±11.7)、(96.8±12.3) ml·min-1·1.73 m-2.经统计分析,术前、术后第7天Ccr和eGFR值分另别同术后第1、3天值相比较,两组均存在统计学差异(P＜0.01),术前同术后第7天比较,两组均无明显统计学差异(P＞0.05).结论 腹腔镜肾部分切除术前行肾动脉球囊导管低温灌注安全、可行,有利于延长肾缺血时间、保护肾功能.

The application of hypothermic perfusion via renal artery balloon catheter in laparoscopic partial nephrectomy

Objective To evaluate the feasibility and safety of hypothermic perfusion via renal artery balloon catheter before laparoscopic partial nephrectomy.Methods A total of 35 patients,who were arranged to receive laparoscopic partial nephrectomy during the period from March 2013 to December 2016 at the General Hospital of PLA,China,were enrolled in this study.The tumor was located in the left kidney in 22 patients and in the right kidney in 13 patients.The long diameter of the tumors was 2.3-7.0 cm,with a mean of (4.1±1.2) cm.Before laparoscopic partial nephrectomy,the implantation of renal artery balloon catheter was performed in all patients.The intraoperative renal cold-ischemia time,the time spent for operation and the amount of intraoperative blood loss were recorded.The creatinine clearance rate (Ccr) and estimated glomerular filtration rate (eGFR) were determined before operation as well as at one,3 and 7 days after operation.The intraoperative and postoperative complications were analyzed.Results Successful implantation of renal artery balloon catheter was accomplished in all 35 patients,with the technical success rate being 100％.Slipping of balloon catheter before laparoscopic partial nephrectomy occurred in one patient;in 2 patients incomplete occlusion of renal artery was found during operation and artery forceps had to be used to occlude the renal artery.In the other 32 patients,laparoscopic partial nephrectomy under the condition of hypothermic perfusion via renal artery balloon catheter was successfully carried out.No severe complications occurred during and after the operation.The average cold-ischemia time of the diseased kidney was 45 (20-125) min,the mean time for interventional procedure was 28 (20-40) min,the average surgery time was 147(95-235) min,the average amount of intraoperative blood loss was 180(50-1000) ml.The Ccr values determined before and at one,3,7 days after nephrectomy were (96.5±15.1),(75.2±10.5),(54.3±13.8) and (91.8±14.1) ml/min respectively.The eGFR values determined before and at one,3,7 days after nephrectomy were (99.5±15.3),(70.3±12.5),(65.5±11.7) and (96.8±12.3) ml·min-1·m-2 respectively.Statistical analysis indicated that in both groups the preoperative and 7-day postoperative Ccr values and eGFR values were significantly different from their one-day and 3-day postoperative values (P＜0.01),but no statistically significant differences existed between preoperative values and 7-day postoperative ones (P＞0.05).Conclusion Hypothermic perfusion via renal artery balloon catheter before laparoscopic partial nephrectomy is clinically safe and feasible,it can prolong the safe time of renal ischemia and protect renal function.