摘要
目的 探讨在肾部分切除术(partial nephrectomy,PN)中选择性肾段动脉钳夹阻断(selective segmental renal artery clamping,SSRAC)对肾脏的保护作用.方法 2012年5月至2014年12月选取12头成年雄性贵州小型猪,以随机数字表法按肾动脉阻断方式分成2组:肾动脉主干钳夹阻断(main renal artery clamping,MRAC)组和SSRAC组,每组各6头.MRAC组和SSRAC组术前血肌酐(SCr)分别为(91.88 ±9.34) μmol/L和(92.92±10.52) μmol/L,尿素氮(BUN)分别为(5.49±0.74) mmol/L和(4.89±0.70) mmol/L,左肾T2弛豫时间分别为(34.08 ±2.43) ms和(34.60±2.15) ms,左肾表观弥散系数(apparent diffusion coefficient,ADC)值分别为(2.70 ±0.06)×10^-3 mm2/s和(2.65 ±0.08)×10^-3 mm2/s,两组间差异均无统计学意义(P>0.05).麻醉后切除右肾,建立孤立肾动物模型.再取左侧与腰骶肌平行切口,SSRAC组和MRAC组分别夹闭左肾动脉下极支和左部肾动脉主干,两组均钳夹60 min,同时于左肾下极行PN.术后第1、7、14、21、28、90天复查两组的SCr和BUN.术后第1、7、28、90天行MRI扫描,复查左肾上极和中部的T2弛豫时间和ADC值.术后第1天和第90天每组分别处死3头,取左肾行病理检查,观察左肾上极和中极肾间质的炎症和纤维化情况.结果 MRAC组术后第1、7、14、21、28、90天的SCr分别为(342.47±30.50)、(242.23±25.74)、(154.43 ±15.65)、(146.60±11.79)、(149.00±13.07)、(132.17±10.94) μmol/L,SSRAC组分别为(258.30±28.50)、(133.37 ±13.54)、(119.40±10.28)、(122.27 ±9.16)、(123.10 ±9.10)、(93.20±9.90) μmol/L,两组比较差异均有统计学意义(P<0.05).MRAC组术后第1天和第7天的BUN分别为(26.94 ±2.63)和(10.30±1.45) mmol/L,SSRAC组分别为(17.49 ±1.90)和(6.15±1.17)mmol/L,差异均有统计学意义(P<0.05),术后第14、21、28、90天两组BUN比较差异均无统计学意义(P>0.05).术后第1、7、28天,MRAC组左肾上极和中部T2弛豫时间分别为(46.90±2.13)、(55.20 ±2.38)、(39.70±2.43) ms,SSRAC组分别为(35.63±1.36)、(34.07 ±2.78)、(34.10 ±2.48) ms;MRAC组左肾上极和中部ADC值分别为(1.95 ±0.09)×10^-3、(2.19 ±0.08)×10^-3、(2.49±0.01)×10^-3 mm2/s,SSRAC组分别为(2.60±0.09)×10^-3、(2.64±0.06)×10^-3、(2.70±0.09)×10^-3 mm2/s,两组比较差异均有统计学意义(P<0.05).术后第90天,两组的T2弛豫时间和ADC值比较差异均无统计学意义(P>0.05).镜下观察,MRAC组左肾上极和中部术后第1天肾小管广泛性水样变性,第90天仅极少数肾小管轻度水样变性,肾间质在两个时间点均未见纤维组织增生及炎症细胞浸润;SSRAC组术后在两个时间点均未见异常改变.结论 在PN中采取SSRAC对残肾肾功能损伤轻微,残肾非缺血组织不经历水肿、炎症细胞浸润等病理损伤过程,说明该操作对残肾具有保护作用.
Objective To evaluate the protective effect of selective segmental renal artery clamping (SSRAC) on the remnant solitary-kidney underwent partial nephrectomy so as to provide a foundation for the using of SSRAC in clinical practices.Methods A total of 12 male pigs were randomized equally into 2 groups according to the method of renal artery clamping such as main renal artery clamping (MRAC) and SSRAC.The preoperative serum creatinine (SCr) of the MRAC group and the SSRAC group were (91.88 ± 9.34) mol/L and (92.92 ± 10.52) mol/L, blood urea nitrogen (BUN) were (5.49 ± 0.74) mmol/L and (4.89 ± 0.70) mmol/L, T2 relaxation time of the left kidney were (34.08 ± 2.43) ms and (34.60 ± 2.15) ms, and the apparent diffusion coefficient (ADC) of the left kidney were (2.70 ± 0.06) × 10 3 mm2/s and (2.65 ±0.08) × 10^-3 mm2/s, all without significant differences (P 〉0.05).Each subject underwent right radical nephrectomy to c reate the condition of a solitary kidney.On the left kidney,a lower pole partial nephrectomy was performed, employing either SSRAC or MRAC for 60 minutes.SCr and BUN were measured at 6 time points thereafter (day 1,7, 14,21,28,90).Magnetic resonance imaging was performed at 4 time points thereafter (day 1,7,28,90) using a 3.0T magnet, and T2 relaxation time and apparent diffusion coefficient (ADC) of the upper and middle pole of left kidney were detected.Inflammatory cell infiltration as well as interstitial fibrosis of the upper and middle pole of left kidney were determined using renal histology on the 1 st and 90th day after operation.Results The values of SCr in the MRAC group ((342.47 ± 30.50) μmol/L, (242.23 ± 25.74) μmol/L, (154.43 ± 15.65) μmol/L, (146.60 ± 11.79) μmol/L, (149.00 ± 13.07) μmol/L, (132.17 ± 10.94) μmol/L) were significantly higher than those in the SSRAC group ((258.30 ± 28.50) μmol/L, (133.37 ± 13.54) μmol/L, (119.40 ± 10.28) μmol/L,(122.27 ±9.16) μmol/L, (123.10 ±9.10) μmol/L, (93.20 ±9.90) μmol/L) on day 1,7, 14, 21,28,90 after PN (P 〈 0.05).The values of BUN in the MRAC group ((26.94 ± 2.63) mmol/L, (10.30 ± 1.45) mmol/L)were significantly higher than those in the SSRAC group ((17.49 ± 1.90) mmol/L, (6.15 ± 1.17) mmol/L) on day 1, 7 after PN (P 〈 0.05), but there were no significant differences between the two groups on day 14, 21,28,90 after PN(P 〉0.05).On day 1,7,28 after PN, T2 relaxation time of the upper and middle pole of left kidney in the MRAC group ((46.90 ± 2.13) ms, (55.20 ± 2.38) ms, (39.70 ± 2.43) ms)were significantly higher than those in the SSRAC group((35.63 ± 1.36) ms, (34.07 ±2.78) ms, (34.10 ± 2.48) ms) (P 〈 0.05);ADC of the upper and middle pole of left kidney in the MRAC group ((1.95±0.09) × 10^-3 mm2/s, (2.19 ±0.08) × 10^-3 mm2/s, (2.49 ±0.01) × 10^-3 mm2/s) were significantly lower than those in the SSRAC group ((2.60 ± 0.09) × 10^-3 mm2/s, (2.64 ± 0.06) × 10^-3 mm2/s, (2.70 ± 0.09) × 10^-3 mm2/s)(P 〈 0.05).On day 90 after PN, there were no significant differences on the T2 relaxation time and ADC between the two groups (P 〉 0.05).The upper and middle pole of left kidney in the MRAC group experienced extensive tubular hydropic degeneration on day 1 , and on day 90 tubular hydropic degeneration alleviated;while no change was found in SSRAC group at the two time points.Conclusion Using SSRAC in PN, the damage of renal function is mild, and the remnant non-ischemic tissues don't experience edema and inflammatory cell infiltration, which shows that SSRAC has a protective effect on the remnant kidney in early and late stage after PN.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2015年第11期854-859,共6页
Chinese Journal of Urology
基金
贵州省科技厅一贵州省人民医院联合基金[黔科合LS(2012)005]
贵阳市社会发展与民生科技计划基金[筑科合同(2012103]056号]
贵州省卫生厅基金(gzwkj2011-1-002)
关键词
肾癌
肾部分切除术
选择性肾段动脉钳夹阻断
缺血再灌注损伤
肾功能
Renal cell carcinoma
Partial nephrectomy
Selective segmental renal artery clamping
Ischemia-reperfusion injury
Renal function