输尿管逆行冷缺血技术在机器人辅助复杂性肾部分切除术中的应用研究

Retrograde ureteral cold ischemia technique in complex robotassisted partial nephrectomy

目的:探讨逆行输尿管导管冷缺血的肾功能保护技术用于机器人辅助复杂性肾部分切除术的有效性和安全性。方法:对17例RENAL评分≥7分的复杂性肾肿瘤,予以超滑导丝引导下患侧输尿管导管逆行插管,行常规机器人辅助腹腔镜下肾部分切除术。至阻断肾动脉同期,予以4℃生理盐水逆行低温灌注。记录冷缺血时间、手术时间、出血量、并发症及肾功能恢复情况等临床指标。结果:所有手术均在机器人辅助腹腔镜下完成,无中转开腹、无中转肾癌根治术,无严重并发症。手术时长156(122,204)min,其中冷缺血时间22(15,36)min、出血量77(30,210)mL。术后3个月患肾的分肾功能与术前相比差异无统计学意义(P=0.35)。结论:逆行输尿管导管冷缺血技术可用于高RENAL评分的复杂性机器人辅助肾部分切除术中保护肾功能。

Objective:To investigate the efficacy and safety of renal function preservation with retrograde ureteral cold ischemia technique in complex robot-assisted partial nephrectomy.Methods:17 cases of complex renal tumors with RENAL score≥7 were retrogradely intubated with a ureteral catheter on the affected side,and robot-assisted laparoscopic partial nephrectomy was performed.At the same time as clamping the renal artery,4℃normal saline was used for retrograde hypothermic perfusion.Clinical parameters such as cold ischemia time,operative time,bleeding volume,complications,pre-and postoperative renal function were recorded.Results:All surgeries were completed with no conversion to open surgery or radical nephrectomy,and no major complications occurred.The operative time was 156(122,204)min,including 22(15,36)min of cold ischemia time and 77(30,210)mL of blood loss.There was no significant difference in the split renal function of the affected kidneys at 3 months postoperatively compared with that before surgery(P=0.35).Conclusion:Retrograde ureteral catheter cold ischemia technique can be used to protect renal function in high RENAL score and complex robot-assisted partial nephrectomy.