The Protective Effect Of Laparoscopic Zero Ischemic Partial Nephrectomy On Postoperative Renal Function

Objective:A clinical controlled trial was conducted using clinical scientific research methods.Patients with stage T1a renal tumor undergoing laparoscopic surgery were divided into two groups at random.Two groups were divided into two groups:laparoscopic partial nephrectomy with zero ischemia and partial nephrectomy with traditional occlusion of renal artery.The difference of preoperative renal function and postoperative renal function,postoperative complications and long-term survival rate were compared between the two groups.The purpose of this study is to explore whether laparoscopic partial nephrectomy,a new operative method,has a positive effect on patients after operation compared with traditional partial nephrectomy with renal artery occlusion.Methods:Patients with stage T1a renal neoplasms who meet the inclusion criteria and exclusion criteria are strictly randomized.The percentage of creatinine changes was calculated by recording the values of Serum creatinine(Scr)and urea nitrogen(BUN)at 3days,2 weeks and 1 months after surgery in both groups.A improved and abbreviated MDRD equation was used to estimate the glomerular filtration rate(GFR)by using serum creatinine level,observation of the difference of the three indexes of Scr,BUN,GFR between the two groups.1 year survival rate was obtained by observing postoperative complications and 1 year follow-up of patients in both groups.Use statistical methods to analyze date and come to a conclusion.Results:Two groups of patients underwent laparoscopic partial nephrectomy with different methods to block the renal artery and its branches.The traditional laparoscopic partial nephrectomy blocked the renal artery directly,while the zero ischemic partial nephrectomy blocked the branch artery of the renal artery.After partial nephrectomy with different methods,creatinine and urea nitrogen reached the highest value on the 3rd day after operation,then gradually decreased,and recovered gradually at 1 months,close to the normal level.On the 3rd day after operation,creatinine[229.92±13.96μmol/L],urea nitrogen[9.99±1.76 mmol/L]and glomerular filtration rate[22.81±3.40 ml/min/1.73m~2]in laparoscopic partial ischemic nephrectomy group were significantly lower than those in normal partial nephrectomy group[creatinine 349.40±22.73μmol/L,urea nitrogen12.96±1.93 mmol/L,glomerular filtration rate 13.51±1.83 ml/min/1.73m~2](P<0.05).However,there was no significant difference in creatinine,urea nitrogen and glomerular filtration rate between the two groups at 2 weeks,1 month after operation(P>0.05).The 1-year survival rate of the two groups was 100 percent and there was no significant difference between the two groups.Conclusion:Laparoscopic partial nephrectomy with zero ischemia has a significant protective effect on renal function in the near future.But the effect on long-term renal function is not significant.After one year’s follow-up,none of the patients in the zero-ischemic partial nephrectomy group had relapsed renal tumor or died,which proved the safety and efficacy of this procedure in the treatment of localized renal cell carcinoma.