| Objective By collecting clinical data and peritumoral tissue from patients undergoing partial nephrectomy,we aim to explore the factors affecting the kidney’s tolerance to warm ischemic injury and the pathological changes in renal tissue under different warm ischemic times.Provide theoretical support for donor kidney evaluation.Methods A prospective analysis was conducted on 30 patients who underwent partial nephrectomy in the Urology Department of XX Hospital from November 2021 to January 2023.Patients were grouped based on whether cooling measures were implemented during partial nephrectomy,the duration of renal artery occlusion during surgery,and the presence of underlying diseases.Preoperative and postoperative GFR values of the affected kidney and the difference in GFR before and after surgery were statistically analyzed.Peritumoral tissues from patients undergoing partial nephrectomy were collected and fixed at 20 min,30min,40 min,50min,and 60 min of renal tissue warm ischemia.Renal tissue damage was scored under a light microscope,followed by statistical analysis.Result Both groups successfully completed the surgery without any complications such as bleeding,urinary fistula,or acute renal failure postoperatively.The average surgery times for the normothermic group and the cooling group were 96.54±23.40 min and114±25.18 min,respectively.The average blood loss was 100.00(50.00)ml and 60(50.00)ml,respectively.The average renal artery occlusion times were 23.85±7.68 min and 25.36±8.42 min,respectively.The average size of the excised tissue was21.45±16.02cm3 and 32.49±26.82cm3,respectively.These differences were not statistically significant(P>0.05).The differences in GFR of the affected kidney before and after surgery in the normothermic group and the cooling group were 15.20(3.55)ml/min and 8.08(5.96)ml/min,respectively,and this difference was statistically significant(P < 0.05).When the renal artery occlusion time was ≤ 20 min,the differences in GFR of the affected kidney before and after surgery in the normothermic group and the cooling group were 12.58±5.65ml/min and 9.57±2.91 ml/min,respectively,and this difference was not statistically significant(P>0.05).When the renal artery occlusion time was >20min,the differences in GFR of the affected kidney before and after surgery in the normothermic group and the cooling group were 15.59(5.10)ml/min and 7.55(7.04)ml/min,respectively,and this difference was statistically significant(P<0.05).The differences in GFR before and after surgery in the group with underlying diseases and the group without underlying diseases were13.06±6.22ml/min and 13.68±6.99ml/min,respectively,and this difference was not statistically significant(P>0.05).The glomerular injury scores for the 20 min,30min,40 min,50min,and 60 min warm ischemia groups were 0.33±0.61,0.90±0.76,2.43±0.90,3.73±0.87,and 5.30±0.75,respectively.The differences in scores between adjacent time points were statistically significant(P<0.05).The scores for tubular injury in each group were 0.77±0.73,2.90±0.76,4.47±0.73,5.23±0.86,and 5.87±0.43,respectively.The differences in scores between adjacent time points were statistically significant(P<0.05).At the same time point,patients with two underlying diseases had more severe glomerular damage than patients without underlying diseases,and this difference was statistically significant(P<0.05).According to the Remuzzi score,in the 20 min group,a total of 18 renal tissues scored less than 7,accounting for 60%,with an average of 5.84+1.70.In the 30 min group,7 renal tissues scored less than 7,accounting for 23.33%,with an average of7.43+1.57.In the 40 min group,only 2 renal tissues scored less than 7,accounting for6.67%.Conclusion 1.In laparoscopic partial nephrectomy,the protective effect of cooling measures is not apparent when the ischemic time of the blocked renal artery is ≤20min.However,when the ischemic time is >20min,intraoperative cooling measures have a certain protective effect on the kidney.In this experiment,underlying diseases did not result in increased renal damage during partial nephrectomy;2.As the warm ischemic time extends,both glomerular and tubular damage gradually increase,with tubular damage always being more severe than glomerular damage.The renal tubules are more sensitive to warm ischemic injury than the glomeruli.In the same warm ischemic time,patients with two underlying diseases had more severe glomerular damage;3.Considering only warm ischemia and underlying diseases,60% of the donor kidneys can be used for kidney transplant when warm ischemic time is 20 min,23.33% of the donor kidneys can be used for kidney transplant when warm ischemic time is 30 min,and 93.33% of the donor kidneys are not suitable for kidney transplant when warm ischemic time is 40 min.In the application of marginal donor kidneys,those with underlying diseases should be carefully considered for use. |
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