Abstract
Objective:To discuss the clinical effect and safety evaluation of laparoscopic nephron sparing surgery (LNSS) under selective segmental renal artery clamping (SSRAC) and main renal artery clamping (MRAC).Methods:Eighty-four patients with T1 localized renal tumors who were admitted and treated from October 2017 to October 2018 were retrospectively analyzed, and they were classified into the S group (42 patients) and M group (42 patients). The patients in the S group received LNSS under SSRAC, while the patients in the M group received LNSS under MRAC. The duration of the operation, amount of intraoperative blood loss, intraoperative warm ischemia time, duration of postoperative hospital stay and positive rate of incisal edge; the serum creatinine and blood urea nitrogen values before and after the operation; and the occurrence rates of intraoperative and postoperative complications were compared.Results:All operations were completed smoothly. No patients had a positive incisal edge, and no patients were converted to MRAC during the operation. The duration of the operation and the amount of intraoperative blood loss increased in the S group compared with the M group. The differences were statistically significant (P <0.05). The differences in the intraoperative warm ischemia time, postoperative drainage and duration of postoperative hospital stay in both groups had no statistical significance (P >0.05). The differences in serum creatinine (SCr) and blood urea nitrogen (BUN) in both groups before the operation had no statistical significance (P >0.05). The SCr and BUN levels significantly increased 1 d and 1 m after the operation. The SCr and BUN levels 1 d and 1 m after the operation were significantly lower in the S group than in the M group, and the differences were statistically significant (P <0.05). The differences in the occurrence rates of intraoperative and postoperative complications in both groups had no statistical significance (P >0.05).Conclusion:SSRAC is a new renal artery clamping technology, and its curative effect on LNSS patients is significant. In addition, SSRAC has high safety and little influence on renal functions.
Highlights
With the progression of laparoscopy technology, laparoscopic nephron sparing surgery (LNSS) has been increasingly applied clinically
Yuan-hua Liu et al LNSS, renal functions are influenced by basic renal function, the number of nephrons retained and the warm ischemia time (WIT), and the WIT plays a key role.[4]
The duration of the operation and the amount of intraoperative blood loss increased in the S group compared with the M group
Summary
With the progression of laparoscopy technology, LNSS has been increasingly applied clinically. LNSS, renal functions are influenced by basic renal function, the number of nephrons retained and the warm ischemia time (WIT), and the WIT plays a key role.[4] Renal artery clamping methods mainly include MRAC, segmental renal artery clamping, “zero” vessel clamping and selective renal artery clamping.[5,6] Traditional nephron-sparing surgery mostly adopts MRAC for reducing the amount of intraoperative blood loss and improving the surgical field, which is beneficial for tumor excision and kidney recovery This technology leads to warm ischemia of the kidney and adverse impacts on renal functions.[7] In recent years, SSRAC has been increasingly applied in LNSS. SSRAC can achieve a tumor supply vessel clamping effect[8] and can effectively reduce patients’ renal WIT and reduce renal injury risk.[9,10] In this study, LNSS under SSRAC was adopted to treat patients with T1 localized renal tumors and to evaluate its curative effect as well as renal function changes in the perioperative period
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