Segmental Renal Artery Clamping Versus Main Renal Artery Clamping In Laparoscopic Partial Nephrectomy:A Systematic Review And Meta-analysis

Objetive:To compare the advantages and disadvantages between srac and mrac in laparoscopic partial nephrectomy from the feasibility ? safety and their effects on postoperative renal function.Methods:A systematic search of the electronic databases,including PubMed,Web of Science,Cochrane library,CNKI,Medline,CNKI,Wanfang database(from the date of their establishments to March 2018),the reviewer retrieved literature about comparison between SRAC and MRAC in laparoscopic partial nephrectomy.According to exclude and include standards,the reviewer extracted all relevant data from the screened documents and then analyzed the extracted date by using RevMan5.3 software.Statistical data including operation time,intraoperative blood loss,warm ischemia time?postoperative hospital stay and postoperative complications and postoperative renal function were observed.Results:The Meta-analysis shows significantly increased operation time(WMD=24.94,95%CI:13.27-36.61,P<0.0001)and intraoperative blood loss(WMD=69.43,95%CI:23.94-114.93,P=0.003)in SRAC group.It does less harm to 3-day postoperative renal function than traditional main renal artery clamping in laparoscopic partial nephrectomy and is still superior to mrac in the following 3 months(WMD=-9.1,95%CI:-10.49--7.71,P<0.00001,though there is no significant differences in the total renal function because of the contralateral renal compensatory function(MD=-3.94,95%CI:(-9.10~1.22),P=0.13).The data in operation time,hospital stay and complication rates shows no significance.Conclusion:The meta-analysis shows that SRAC is superior to MRAC in renal function recovery(especially affected renal)in short term but no obviously significant differences in oerpration time and intraoperative blood loss,with equivalent complic-ation and average hospital stay.Selective renal artery clamping is safe and feasible based on preliminary study.Due to the inherent limitation of the studies included,further multicenter well-designed radomized controlled trials with more samples are needed to confirm our findings.