Initial Investigation Of Renal Hypothermia Achieved By Retrograde Cold Saline Perfusion Through Ureter

Objective:To evaluate the method of retrograde cold saline perfusion through ureter can be achieved renal cooling. To compared with the method used in traditional open operation of adding ice-slush cooling kidney,and how about the renal function after retrograde perfusion through ureter.Background:From1991,Clayman was successed using laparoscope for radical nephrectomy,the laparoscope was used more widely in urlogy than before.Many operations can be completed by laparoscope.There was many superiorities in using laoparoscope,such as patients was less wounded, recoved quickly,but the flaw was also easy to see,such as learning curve was longer,must be use instrument completely.Some simply technique in open operation was unconvenient to used in laoparoscope operation,such as renal partial nephrectomy.In partial nephrectomy operation renal pedicle vessel must be block to warrant the clear operation visual field.But block vessel will lead to renal ischemia damaged, and be low the renal temperture can be extented the tolerance of this ischemia .The most effective measure in opening operation was add ice-slush aroud renal.Although this measure was also used in laoparoscope operation,it was inconvenient.The major problem is adding ice repeatly,which will be prolong operating time,affect operation visual ,hinder manipulation.The foreign used new methods in laoparoscope was arterial cannula perfusion,retrograde perfusion, near-freezing saline irrigation. The risk was high when renal arterial cannula perfusion was used,the retrograde cold saline perfusion used renal intrinsical piper work,irrigate ice water,this operation was no affect operation vesion,using non-specially tools and simple.The correlative animal experiments has already be underway,and one patient who was under radical nephrectomy in this experiment used this method was confirm to be low the renal temperature,and pathology was confirmed that there was little damage to kidney after operation.But there is no reported in domestic,we hope through animal experiment to confirm if this method was feasibility or security.Methods:18 dogs was used in research expermient,divided into 3 group,6 was in each group.Block bilateral renal vessel, group A was give ice around renal (ice-slush block group),group B was give both retrograde cold salin perfusion(retrograde perfusion group),group C was only vessel block(ordinary temperature block group),to obtain nomal dog's blood and urine as group D(normal group).Use biopsy needle to take 6 stripe renal tissue as pathology constrast. Used DM6801A thermoelectricity to detected renal temperature of group A and group B.After renal vessel was blocked,moniter room temperature,surface of renal temperature,renal cortex temperature.After 60mins,recovered renal blood supply, then closed the dogs aboden layer,and give the bladder stoma.At 0h,4h,8h,to obtain vein blood,to detected the serum creatinine,serum cystatinC,to obtain urine to detect immunoglobulin,transferrin retinol binding protein,α1-microglobulin,β2-microglobulin.And after experiment, kidney was used for pathology.Then compare the marker of the normal dog's blood and urine followed the consequence of laboratory detection. Statistical method: Compare the result of different group at the same time used completely randomized design one-way ANOVA,and different group among them used LSD-t test.Results:1,The effect of retrograde perfusionThe renal cortex in retrograde perfusion group was stable after 15min retrograde perfusion,the extent of renal termperture was 9℃,the lowest of renal cortex was 23.8℃.But ice-slush group ,the renal temperature be lowed swiftly,the extent of renal temperature lowed was 20℃,the cortex was low to 7.4℃, the temperature reduced obversionly.2,The renal impaired marker:0 h, the markers of Cys C,IgG,TFN,RBP in group A and group B has obviously statics difference(P<0.05); the serum creatinine and Cys C in group A and group C has obviously statics difference(P<0.05);the serum creatinine and Cys C in group A and group D has obviously statics difference(P<0.05).4h, SCr,Cys C,IgG,TFN,RBP,α1-MG,β2-MG in group A and group B has obviously statistics difference(P<0.05). SCr,Cys C,RBP,β2-MG in group A and group C has obviously statistics difference(P<0.05). SCr,RBP,β2-MG among group A and group D has obviously statistics difference(P<0.05).8h , SCr,Cys C,IgG,TFN,RBP,α1-MG,β2-MG in groupA and group B has obviously statistics difference(P<0.05); SCr,Cys C,TFN,RBP,α1-MG,β2-MG in groupA and group C has obviously statistics difference(P<0.05); SCr,RBP,β2-MG anmong group A and group D has obviously statistic difference(P<0.05).3,The results of light microscope and electron microscopeElectron microscope:in group B,partly renal tubules was degenerationg,cellular swelling,renal capsule narrow,foot processes derangement and effacement,even disappear;in group A,renal glomerulus was normal,but foot processes derangerment derangement and effacement;in group C,renal glomerulus was normal,but foot processes derangerment,part renal tubules cellular was swelled.light microscope: in group B,renal glomerulus was hyperemia and swelling,proximal convoluted tubules was dropsy and degeneration;in group A,the construction of renal glomerulus was nomal,merely hyperaemia; in group C,renal glomerulus and tubuli renals was normal,renal glomerulus was merely moisture hyperaemia,medulla and mesenchymal was also hyperaemia。Conclusion:The renal temperature achieved by retrograde perfusion can reach the temperature in theory to protect renal function in animals experiments. But followed the markers of renal injuryed being detected,we found:①the renal glomeruls,tubulus,renal function in ice-slush group was normal.②the renal glomeruls ,tubulus ,renal function was injury obviously in retrograde perfusion group.③the renal glomeruls ,tubulus ,renal function was injury obviously in only vessel block group. In ice-slush group,the kidney hypothermia was achieved by ice-slush,and the kidney was also protected.In retrograde perfusion group,the kidney hypothermia was also achieved,and renal function should be protect in theory. In fact ,renal glomeruli and tubules was obviously damaged. The security of method retrograde perfusion must be further investigate.