Clinical Original Article
The effect of warm ischemia duration on renal function early after laparoscopic partial nephrectomy
Jing Cao, Wenjun Chen, Jiaming Wen, Jingang Zhao, Chuanjun Du
Published 2015-06-15
Cite as Chin J Urol, 2015, 36(6): 414-418. DOI: 10.3760/cma.j.issn.1000-6702.2015.06.004
Abstract
ObjectiveTo assess the effect of variable durations of warm ischemia on renal function early after laparoscopic partial nephrectomy (LPN) and make the definite safety duration of renal warm ischemia.
MethodsThe clinical data of 76 patients treated with LPN from October 2012 to June 2014 were retrospectively analyzed. The patients were divided into 3 groups based on warm ischemic time, namely group A (28 cases) with warm ischemia time less than 20 min, group B (34 cases) with warm ischemia time more than 20 min and less than 30 min, group C (14 cases) with warm ischemia time more than 30 min.LPN was performed with renal artery clamping alone in all the patients.Preoperative and postoperative renal scintigraphic scan was performed to access glomerular filtration rate (GFR) in all patients.The GFR values were compared among before, 1 week, 1 month and 3 months after operation.The factors predicting the early renal injury were assessed by multivariate regression analysis.
ResultsThe renal GFR of the kidney underwent LPN decreased 19.43(17.70, 22.06) ml/min at 1 week, 17.04(13.94, 20.70) ml/min at 1 month, 13.82(10.72, 18.73) ml/min at 3 months after the surgery in group C, respectively.In group A, the renal GFR of the operated-side decreased 12.07(10.91, 13.42) ml/min, 10.04(9.16, 11.75) ml/min, 8.44(7.07, 9.72) ml/min, respectively.In group B, the renal GFR of the operated-side decreased 13.64(12.48, 16.72) ml/min, 10.29(9.17, 14.27)ml/min, 9.63(7.85, 12.59) ml/min, respectively.The GFR decreased greater in group C than that in group A and B(P<0.05). The total renal GFR decreased (10.70±4.93)ml/min at three months in group C, compared with (5.64±4.12)ml/min in group A and (6.37±4.32)ml/min in group B, respectively. The decreased value in group C was greater than that in group A and B(P<0.05). However, the differences of the total renal GFR among the 3 groups were not significant at 1 week and 1 month(P>0.05). The multivariate regression analysis revealed that warm ischemia duration was the independent risk factor of the early renal injury.
ConclusionsWarm ischemia duration is the major factor regarding the early renal recovery after LPN.Warm ischemia time more than 30 min may not only greatly affect the renal function but also the renal function recovery rate.
Key words:
Laparoscopes; Nephrectomy; Warm ischemia; Renal function
Contributor Information
Jing Cao
Department of Urology, Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou 310009, China
Wenjun Chen
Jiaming Wen
Jingang Zhao
Chuanjun Du
