Comparison Of The Effect On Postoperative Side Kidney Function Between Retroperitoneal Laparoscopic Partial Nephrectomy With Renal Hypothermia And Non Hypothermia

Objectives:Comparison of the effect on postoperative side kidney function between retroperitoneal laparoscopic partial nephrectomy with renal hypothermia and non hypothermia Methods:58 cases of renal tumor underwent retroperitoneal laparoscopic partial nephrectomy in Fujian Provincial Hospital from Dec. 2012 to Mar. 2015 were retrospectively collected. All cases were performed by the same surgeon. They were divided into hypothermia group(30 cases) and normothermia group(28 cases) according to whether the kidney was cooled by dropping frozen physical saline around the kidney through trocar. Both the hypothermia group and normothermia group were divided into low ischemia group(22 cases of low warm ischemia group:WI?30min;13cases of low ice ischemia group:CI?30min)and long ischemia group(6cases of long warm group:WI>30min;17cases of long ice group:CI>30min).Preoperative GFR of the side kidney with renal tumour was measured by renal isotope ECT. Review of the renal isotope ECT at the 3th,6 th,12 th month time points after surgery, the decreased GFR of the side kidney with renal tumour and at each time points after surgery were compared between groups. Results:1 All the operations were completed successfully in both groups, no serious bleeding, urine leakage, postoperative death occurred.The average operating time of hypothermia group and normothermia group was 191.57±53.32 min and 191.86±36.64 min, and the average loss of blood of them was 87.00±67.6ml and 81.43±63.40 ml, respectively, the difference was not significant between the two groups(P > 0.05). The average renal artery occlusion time of hypothermia group and normothermia group was 32.53±7.31 min and 28.75±5.76 min, respectively. The renal ischemia time of hypothermia group was longer than normothermia group's,The difference was statistically significant(P < 0.05).2.In hypothermia group and normothermia group:after operative 3 months,the affected side postoperative GFR were average dropped 9.68±4.98ml/min ?14.26±4.40ml/min compared with preoperative, respectively. The difference was statistically significant; After operative 6 months,the affected side postoperative GFR were average dropped 9.21±5.06ml/min ? 13.18±6.57ml/min compared with preoperative, respectively. The difference was statistically significant. After operative 12 months, the affected side postoperative GFR were average dropped 9.93±6.04ml/min?12.17±6.82ml/min compared with preoperative,respectively. the difference was not significant between the two groups.3.In low warm ischemia group and long warm group, After operative 3 months the affected side postoperative GFR were average dropped 13.22±3.82ml/min?18.08±4.59ml/min compared with preoperative, respectively( P < 0.05).After operative 6 months the affected side postoperative GFR were average dropped 11.90±6.26ml/min?17.87±5.91ml/min compared with preoperative, respectively(P<0.05).After operative 12 months the affected side postoperative GFR were average dropped 10.50±5.96ml/min ? 18.32±6.68ml/min compared with preoperative, respectively.(P<0.05).4.In low ice ischemia group and long ice groups,After operative 3 months the affected side postoperative GFR were average dropped 9.45±4.83ml/min ?9.86±5.22ml/min compared with preoperative, respectively( P > 0.05).After operative 6 months the affected side postoperative GFR were average dropped 8.33±4.76ml/min?9.88±5.32ml/min compared with preoperative, respectively(P>0.05).After operative 12 months the affected side postoperative GFR were average dropped 9.82±6.47ml/min ? 10.02±5.89ml/min compared with preoperative, respectively(P>0.05).5.In low ice ischemia group and low warm ischemia group:After operative 3 months the affected side postoperative GFR were average dropped 9.45±4.83ml/min?13.22±3.82ml/min compared with preoperative, respectively( P < 0.05).After operative 6 months the affected side postoperative GFR were average dropped 8.33±4.76ml/min?11.90±6.26ml/min compared with preoperative,respectively(P>0.05).After operative 12 months the affected side postoperative GFR were average dropped 9.82±6.47ml/min ? 10.50±5.96ml/min compared with preoperative, respectively(P>0.05).6. In long ice ischemia group and long warm group:After operative 3 months the affected side postoperative GFR were average dropped 9.86±5.22ml/min?18.08±4.59ml/min compared with preoperative,respectively(P<0.05).After operative 6 months the affected side postoperative GFR were average dropped 9.88 ±5.32ml/min?18.08±4.59ml/min compared with preoperative,respectively(P<0.05).After operative 12 months the affected side postoperative GFR were average dropped 10.02 ± 5.89ml/min ? 18.32 ± 6.68 ml/min compared with preoperative, respectively(P<0.05). Conclusions:In early postoperative(3-6months) retroperitoneal laparoscopic partial nephrectomy with renal hypothermia can protect the affected side renal function, made renal tolerate longer ischemia time, is better suited for patients with more complex tumor anatomy or the renal artery occlusion forecast time will longer, and is worthy of clinical popularization and preferential.