Renal Damage Caused by Warm Ischaemia During Laparoscopic and Robot-Assisted Partial Nephrectomy: An Assessment Using Tc 99m-DTPA Glomerular Filtration Rate

摘要

Background: Few studies assessing the functional change of each kidney following warm ischaemia after partial nephrectomy are available.Objectives: Our aim was to identify the effects of the warm ischaemic time (WIT) on renal function after partial nephrectomy under the pneumoperitoneum. Design, setting, and participants: Forty-four consecutive patients who underwent laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RAPN) from June 2008 to May 2009 for a single cT1 renal tumour were included in this prospective protocol.Measurements: Technetium Tc 99m-diethylenetriaminepentaacetic acid (Tc 99m-DTPA) renal scintigraphy was used to determine the glomerular filtration rate (GFR) of both kidneys and each kidney individually. Tc 99m-DTPA GFR was performed preoperatively and 3 mo postoperatively. In addition, we analysed Tc 99m-DTPA scintigraphy GFR regionally in the healthy areas of the affected kidney.Results and limitations: Patients with WIT >28 min had a significantly greater decrease in the GFR of the affected kidney (p = 0.031). The GFR of the affected kidney showed a significant decrease perioperatively (46.4 +-14.3 to 37.9 +- 11.9 ml/min per 1.73 m2; p = 0.003). The functional change of the nonaffected kidney showed an increasing trend (47.5 +- 13.8 to 51.4 +- 14.3 ml/min per 1.73 m2), although it was not statistically significant (p = 0.103). Regional Tc 99m-DTPA GFR of both affected kidney and nonaffected kidney showed no significant differences perioperatively (6.3 +- 1.8 to 6.1 +- 1.9 ml/min per 1.73 m2; p = 0.641; 6.6 +- 1.9 to 7.1 +-2.0 ml/min per 1.73 m2; p = 0.200). On multivariate analysis, preoperative GFR, resected volume of marginal healthy tissue, and WIT were independent predictors for functional reduction of the affected kidney (p < 0.05). The study was limited by small numbers and short follow-up periods.Conclusions: Stationary overall renal function after LPN or.RAPN is masked possibly by functional compensation of ...