Effect Of Time Of Renal Artery Stem Blockade On Early Renal Function After Laparoscopic Preservation Of Nephron

Objective: Analysis of possible risk factors affecting early renal function changes after laparoscopic preservation of nephron units,and to determine whether the time of warm ischemia is the main risk factor.To explore the effect of different time of renal ischemia blocking warm ischemia on early renal function after laparoscopic preservation of nephron,and to determine the safety time of renal ischemia.Improve awareness of early postoperative renal function changes.Methods: A retrospective study of 48 patients who had undergone peritoneoscope-reserved nephrectomy since March 2016 at Jilin University Bethune Third Clinical Hospital was performed.According to the different time of renal arterial blockade during operation,they were divided into three groups.Group A(blocking time <25 min),Group B(25 min ≤ blocking time <30 min),and Group C(30 min ≤ blocking time).By analysis of preoperative 24 h,postoperative 1 week,and postoperative 3 months,99Tcm-DTPA was injected intravenously into the “projectile pill”.The renal dynamic imaging revealed changes in the total renal and subrenal glomerular filtration rate(GFR)values.Theserum creatinine value(SCR)was changed 24 h before and after surgery(24 hours,1 week,and 3 months).Application of analysis of variance and multiple linear regression analysis of the possible factors affecting the recovery of renal function and the effect of different renal arterial block time on early renal function after surgery,and thus to identify the safety of blocking time.Result: 1)The GFR of ipsilateral in all three groups decreased to some extent compared with the preoperative values at different time points.However,in group C,the ipsilateral kidney GFR decreased by 19.27 ± 3.09 and 14.51 ± 2.39 respectively at 1 week and 3 months after operation.While A New decreased 10.97 ± 2.73 and 7.54 ± 0.89,respectively.B group decreased by 12.53±2.78,9.11±1.70 respectively.The degree of decrease in group C was significantly higher than that in group A and B,with significant difference(P <0.05).It is considered that hot ischaemia≥30 minutes has a greater impact on the early renal dysfunction of the affected ipsilateral kidney.2)Multiple regression analysis showed that the renal artery blocked the warm ischemic time,and preoperative ipsilateral GFR was the main factor of early postoperative renal dysfunction.The effect of operation time on early postoperative renal impairment was insignificant.Conclusion:1.Renal artery occlusion,warm ischemia time,and preoperative renal GFR are two independent risk factors for early renal dysfunction in patients undergoing laparoscopic nephrectomy.2.Nephron surgery will retain the retention of ipsilateral renal function decline,but blocking the main artery of the warm ischemia in the control of renal function within 30 min relatively small...