选择性肾段动脉钳夹阻断对孤立肾猪肾部分切除术后残肾的保护作用
선택성신단동맥겸협조단대고립신저신부분절제술후잔신적보호작용
Protective effect of selective segmental renal artery clamping on the remnant solitary-kidney underwent partial nephrectomy
  • 万方数据
    中华泌尿外科杂志 중화비뇨외과잡지
    Chinese Journal of Urology
    2015年 11期 854-859 ,共6页

    徐述雄%王元林%储铸钢%徐元高%石华%李凯%冯梅%孙兆林%夏术阶

    서술웅%왕원림%저주강%서원고%석화%리개%풍매%손조림%하술계

    肾癌%肾部分切除术%选择性肾段动脉钳夹阻断%缺血再灌注损伤%肾功能 腎癌%腎部分切除術%選擇性腎段動脈鉗夾阻斷%缺血再灌註損傷%腎功能
    신암%신부분절제술%선택성신단동맥겸협조단%결혈재관주손상%신공능
    Renal cell carcinoma%Partial nephrectomy%Selective segmental renal artery clamping%Ischemia-reperfusion injury%Renal function
    目的 探讨在肾部分切除术(partial nephrectomy,PN)中选择性肾段动脉钳夹阻断(selective segmental renal artery clamping,SSRAC)对肾脏的保护作用.方法 2012年5月至2014年12月选取12头成年雄性贵州小型猪,以随机数字表法按肾动脉阻断方式分成2组:肾动脉主干钳夹阻断(main renal artery clamping,MRAC)组和SSRAC组,每组各6头.MRAC组和SSRAC组术前血肌酐(SCr)分别为(91.88 ±9.34) μmol/L和(92.92±10.52) μmol/L,尿素氮(BUN)分别为(5.49±0.74) mmol/L和(4.89±0.70) mmol/L,左肾T2弛豫时间分别为(34.08 ±2.43) ms和(34.60±2.15) ms,左肾表观弥散系数(apparent diffusion coefficient,ADC)值分别为(2.70 ±0.06)×10-3 mm2/s和(2.65 ±0.08)×10-3 mm2/s,两组间差异均无统计学意义(P＞0.05).麻醉后切除右肾,建立孤立肾动物模型.再取左侧与腰骶肌平行切口,SSRAC组和MRAC组分别夹闭左肾动脉下极支和左部肾动脉主干,两组均钳夹60 min,同时于左肾下极行PN.术后第1、7、14、21、28、90天复查两组的SCr和BUN.术后第1、7、28、90天行MRI扫描,复查左肾上极和中部的T2弛豫时间和ADC值.术后第1天和第90天每组分别处死3头,取左肾行病理检查,观察左肾上极和中极肾间质的炎症和纤维化情况.结果 MRAC组术后第1、7、14、21、28、90天的SCr分别为(342.47±30.50)、(242.23±25.74)、(154.43 ±15.65)、(146.60±11.79)、(149.00±13.07)、(132.17±10.94) μmol/L,SSRAC组分别为(258.30±28.50)、(133.37 ±13.54)、(119.40±10.28)、(122.27 ±9.16)、(123.10 ±9.10)、(93.20±9.90) μmol/L,两组比较差异均有统计学意义(P＜0.05).MRAC组术后第1天和第7天的BUN分别为(26.94 ±2.63)和(10.30±1.45) mmol/L,SSRAC组分别为(17.49 ±1.90)和(6.15±1.17)mmol/L,差异均有统计学意义(P＜0.05),术后第14、21、28、90天两组BUN比较差异均无统计学意义(P＞0.05).术后第1、7、28天,MRAC组左肾上极和中部T2弛豫时间分别为(46.90±2.13)、(55.20 ±2.38)、(39.70±2.43) ms,SSRAC组分别为(35.63±1.36)、(34.07 ±2.78)、(34.10 ±2.48) ms;MRAC组左肾上极和中部ADC值分别为(1.95 ±0.09)×10-3、(2.19 ±0.08)×10-3、(2.49±0.01)×10-3 mm2/s,SSRAC组分别为(2.60±0.09)×10-3、(2.64±0.06)×10-3、(2.70±0.09)×10-3 mm2/s,两组比较差异均有统计学意义(P＜0.05).术后第90天,两组的T2弛豫时间和ADC值比较差异均无统计学意义(P＞0.05).镜下观察,MRAC组左肾上极和中部术后第1天肾小管广泛性水样变性,第90天仅极少数肾小管轻度水样变性,肾间质在两个时间点均未见纤维组织增生及炎症细胞浸润;SSRAC组术后在两个时间点均未见异常改变.结论 在PN中采取SSRAC对残肾肾功能损伤轻微,残肾非缺血组织不经历水肿、炎症细胞浸润等病理损伤过程,说明该操作对残肾具有保护作用.
    목적 탐토재신부분절제술(partial nephrectomy,PN)중선택성신단동맥겸협조단(selective segmental renal artery clamping,SSRAC)대신장적보호작용.방법 2012년5월지2014년12월선취12두성년웅성귀주소형저,이수궤수자표법안신동맥조단방식분성2조:신동맥주간겸협조단(main renal artery clamping,MRAC)조화SSRAC조,매조각6두.MRAC조화SSRAC조술전혈기항(SCr)분별위(91.88 ±9.34) μmol/L화(92.92±10.52) μmol/L,뇨소담(BUN)분별위(5.49±0.74) mmol/L화(4.89±0.70) mmol/L,좌신T2이예시간분별위(34.08 ±2.43) ms화(34.60±2.15) ms,좌신표관미산계수(apparent diffusion coefficient,ADC)치분별위(2.70 ±0.06)×10-3 mm2/s화(2.65 ±0.08)×10-3 mm2/s,량조간차이균무통계학의의(P＞0.05).마취후절제우신,건립고립신동물모형.재취좌측여요저기평행절구,SSRAC조화MRAC조분별협폐좌신동맥하겁지화좌부신동맥주간,량조균겸협60 min,동시우좌신하겁행PN.술후제1、7、14、21、28、90천복사량조적SCr화BUN.술후제1、7、28、90천행MRI소묘,복사좌신상겁화중부적T2이예시간화ADC치.술후제1천화제90천매조분별처사3두,취좌신행병리검사,관찰좌신상겁화중겁신간질적염증화섬유화정황.결과 MRAC조술후제1、7、14、21、28、90천적SCr분별위(342.47±30.50)、(242.23±25.74)、(154.43 ±15.65)、(146.60±11.79)、(149.00±13.07)、(132.17±10.94) μmol/L,SSRAC조분별위(258.30±28.50)、(133.37 ±13.54)、(119.40±10.28)、(122.27 ±9.16)、(123.10 ±9.10)、(93.20±9.90) μmol/L,량조비교차이균유통계학의의(P＜0.05).MRAC조술후제1천화제7천적BUN분별위(26.94 ±2.63)화(10.30±1.45) mmol/L,SSRAC조분별위(17.49 ±1.90)화(6.15±1.17)mmol/L,차이균유통계학의의(P＜0.05),술후제14、21、28、90천량조BUN비교차이균무통계학의의(P＞0.05).술후제1、7、28천,MRAC조좌신상겁화중부T2이예시간분별위(46.90±2.13)、(55.20 ±2.38)、(39.70±2.43) ms,SSRAC조분별위(35.63±1.36)、(34.07 ±2.78)、(34.10 ±2.48) ms;MRAC조좌신상겁화중부ADC치분별위(1.95 ±0.09)×10-3、(2.19 ±0.08)×10-3、(2.49±0.01)×10-3 mm2/s,SSRAC조분별위(2.60±0.09)×10-3、(2.64±0.06)×10-3、(2.70±0.09)×10-3 mm2/s,량조비교차이균유통계학의의(P＜0.05).술후제90천,량조적T2이예시간화ADC치비교차이균무통계학의의(P＞0.05).경하관찰,MRAC조좌신상겁화중부술후제1천신소관엄범성수양변성,제90천부겁소수신소관경도수양변성,신간질재량개시간점균미견섬유조직증생급염증세포침윤;SSRAC조술후재량개시간점균미견이상개변.결론 재PN중채취SSRAC대잔신신공능손상경미,잔신비결혈조직불경력수종、염증세포침윤등병리손상과정,설명해조작대잔신구유보호작용.
    Objective To evaluate the protective effect of selective segmental renal artery clamping (SSRAC) on the remnant solitary-kidney underwent partial nephrectomy so as to provide a foundation for the using of SSRAC in clinical practices.Methods A total of 12 male pigs were randomized equally into 2 groups according to the method of renal artery clamping such as main renal artery clamping (MRAC) and SSRAC.The preoperative serum creatinine (SCr) of the MRAC group and the SSRAC group were (91.88 ± 9.34) mol/L and (92.92 ± 10.52) mol/L, blood urea nitrogen (BUN) were (5.49 ± 0.74) mmol/L and (4.89 ± 0.70) mmol/L, T2 relaxation time of the left kidney were (34.08 ± 2.43) ms and (34.60 ± 2.15) ms, and the apparent diffusion coefficient (ADC) of the left kidney were (2.70 ± 0.06) × 10 3 mm2/s and (2.65 ±0.08) × 10-3 mm2/s, all without significant differences (P ＞0.05).Each subject underwent right radical nephrectomy to c reate the condition of a solitary kidney.On the left kidney,a lower pole partial nephrectomy was performed, employing either SSRAC or MRAC for 60 minutes.SCr and BUN were measured at 6 time points thereafter (day 1,7, 14,21,28,90).Magnetic resonance imaging was performed at 4 time points thereafter (day 1,7,28,90) using a 3.0T magnet, and T2 relaxation time and apparent diffusion coefficient (ADC) of the upper and middle pole of left kidney were detected.Inflammatory cell infiltration as well as interstitial fibrosis of the upper and middle pole of left kidney were determined using renal histology on the 1 st and 90th day after operation.Results The values of SCr in the MRAC group ((342.47 ± 30.50) μmol/L, (242.23 ± 25.74) μmol/L, (154.43 ± 15.65) μmol/L, (146.60 ± 11.79) μmol/L, (149.00 ± 13.07) μmol/L, (132.17 ± 10.94) μmol/L) were significantly higher than those in the SSRAC group ((258.30 ± 28.50) μmol/L, (133.37 ± 13.54) μmol/L, (119.40 ± 10.28) μmol/L,(122.27 ±9.16) μmol/L, (123.10 ±9.10) μmol/L, (93.20 ±9.90) μmol/L) on day 1,7, 14, 21,28,90 after PN (P ＜ 0.05).The values of BUN in the MRAC group ((26.94 ± 2.63) mmol/L, (10.30 ± 1.45) mmol/L)were significantly higher than those in the SSRAC group ((17.49 ± 1.90) mmol/L, (6.15 ± 1.17) mmol/L) on day 1, 7 after PN (P ＜ 0.05), but there were no significant differences between the two groups on day 14, 21,28,90 after PN(P ＞0.05).On day 1,7,28 after PN, T2 relaxation time of the upper and middle pole of left kidney in the MRAC group ((46.90 ± 2.13) ms, (55.20 ± 2.38) ms, (39.70 ± 2.43) ms)were significantly higher than those in the SSRAC group((35.63 ± 1.36) ms, (34.07 ±2.78) ms, (34.10 ± 2.48) ms) (P ＜ 0.05);ADC of the upper and middle pole of left kidney in the MRAC group ((1.95±0.09) × 10-3 mm2/s, (2.19 ±0.08) × 10-3 mm2/s, (2.49 ±0.01) × 10-3 mm2/s) were significantly lower than those in the SSRAC group ((2.60 ± 0.09) × 10-3 mm2/s, (2.64 ± 0.06) × 10-3 mm2/s, (2.70 ± 0.09) × 10-3 mm2/s)(P ＜ 0.05).On day 90 after PN, there were no significant differences on the T2 relaxation time and ADC between the two groups (P ＞ 0.05).The upper and middle pole of left kidney in the MRAC group experienced extensive tubular hydropic degeneration on day 1 , and on day 90 tubular hydropic degeneration alleviated;while no change was found in SSRAC group at the two time points.Conclusion Using SSRAC in PN, the damage of renal function is mild, and the remnant non-ischemic tissues don't experience edema and inflammatory cell infiltration, which shows that SSRAC has a protective effect on the remnant kidney in early and late stage after PN.
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