The Establishment And Apply Of Hypothermic Perfusion Platform Of Kidney In Laparoscopic

Objective: 1.To investigate theoretically the feasibility,safety,stability,repeatability and operability of a laparoscopic hypothermic perfusion platform in situ.2.To demonstrate that the hypothermic perfusion platform can be effectively applied,and achieve the goal of protecting renal function on a Laparoscopic partial nephrectomy model.3.To establish a standardized,modularized and programmed protocol of specific operational procedures,operational processes will be systematic,modular,programmed,making it easy to learn,so that it can be extended to other kidney surgery operations,and even to all surgical procedures requiring hypothermia protection of organs.Methods: 1.Search for literatures on line to determine the key techniques,core parameters of the operation platform.2.Twenty-six patients with renal tumor stage T1 were randomly divided into the experimental group and the control group.The laparoscopic partial nephrectomy was performed under hypothermic perfusion platform in situ.The average operation time,bleeding volume,perfusion time,creatinine changes in 1 weeks,1 month and 3 months post-operation in two groups were compared,then statistical analysis was performed.Results: The perfusion platform can be constructed by the conventional instruments and can be successfully completed under laparoscope.The steps are as follows: 1,to determine the appropriate filling height of 1.6m(the lowest height of surgical bed is 90cm);intra-renal artery perfusion pressure was maintained at 60 mmHg,simulating physiological conditions of renal artery pressure.2.To shape the child scalp needle to an angle of about 15 degrees so that it can be inserted into the artery and vein of the kidney very well,ensuring the stability of the perfusion velocity.3,To Secure the two scalp needle on the psoas fascia,reducing the activity,guaranteeing the stability of the scalp needle during perfusion.4,To block the renal vein firstly,then the artery after the renal vein get filled.Perfusate were extracted from the renal vein until the surface o f kidney turned pale.Perfusion velocity of 40ml/min can ensure the maximum perfusion effect.5,Twenty-six cases were successfully operated;Thirteen cases in the experimental group: BMI24.5±3.1kg/m2,RENAL score 3.1 ± 1.1,Bleeding volume 53 ± 5ml,operation time 15.8 ± 4.1min,perfusion time 5.4± 0s,average age 63 ± 10 years,tumor diameter 3.1 + 1.1cm,preoperative baseline creatinine 56±11mmol /L,creatinine 1 week after operation 67±12mmol/L,creatinine 1 month after operation 61±9mmol/L,creatinine 3 months after operation 59 ± 10mmol/L.Thirteen cases in the control group: BMI26±2.4kg/m2,RENAL score 3.3±0.7,Bleeding volume49±7ml,operation time 16.5±7.5min,perfusion time 0s,average age 58±14 岁 years,tumor diameter 3.2±0.9cm,preoperative baseline creatinine 64±9mmol /L,creatinine 1 week after operation 80±8mmol/L,creatinine 1 month after operation 77±11mmol/L,creatinine 3 months after operation 70±9mmol/L.SPSS17.0 was used for analysis,By means of mean ± standard deviation,t test.Preoperat ive and postoperative paired t test,independent sample t test.P<0.05 indicated statistical significance.BMI t=1.891,RNEAL t=0.854 score,bleeding volume t=2.015,operation time t=1.247,preoperative creatinine t=1.732,1 week postoperative creatinine t =4.349、1 month postoperative creatinine t=5.112、3 months postoperative creatinine t=4.821,There was significant difference in creatinine between 1 weeks,1 month and 3 months after operation.Conclusion: The hypothermic perfusion platform is simple,requiring no special equipment.Operation of laparoscopic partial nephrectomy proves that the perfusion platform is safe,reliable and stable,no operation difficulty,time or cost increase.The laparoscopic hypothermic perfusion platform in situ at is repeatable and operative,,the surgical procedure is easy to learn,the protection of renal function is obviously effective,it is worthy of a promotion to other surgical operation field.