演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

選択的腎血管遮断による,RAPN術後、早期腎障害の軽減の検討

演題番号 : P33-1

[筆頭演者]
演者)磯谷 周治:1 
[共同演者]
野間 康央:1、芦澤 健:1、家田 健史:1、知名 俊幸:1、北村 香介:1、河野 春奈:1、永田 政義:1、和久本 芳彰:1、武藤 智:1、堀江 重郎:1

1:順天堂大学・泌尿器科

 

INTRODUCTION AND OBJECTIVES: At the partial nephrectomy, renal ischemia is performed to prevent the renal bleeding. These ischemia may produce endothelial injury, inflammation, and reperfusion injury to following the Acute Kidney Injury (AKI). The aim of this study is to examine the protective effect by reducing the ischemic renal volume (IRV) on the post-PN AKI within the acceptable warm ischemia time (WIT).
METHODS: We retrospectively reviewed the patients in our single-institution RAPN database, and 35 subjects with WIT less than 25 minutes were included in this study. All patients were performed intrarenal blood flow distribution analysis and 14 patients were subjected for selective clamping.
The difference on the serum Cr value and the ratio of sCr between pre-operation and maximum value within 48 hours after RAPN was calculated as ΔsCr andΔsCr ratio, and the postoperative AKI was identified by the KDIGO Guideline. Statistical analyses were performed to examine the interaction effect of ischemic volume, comorbidities and clinical characteristics on renal function change after RAPN. The ischemic renal volume (IRV) for indicated renal arterial branch was calculated by using the computational imaging software.
RESULTS: With the univariate analysis,the development of AKI was significantly correlated with warm ischemic time, estimate blood loss, BSA, BMI, and partial ischemia with an ischemic region of 40%.
CONCLUSIONS: AKI after RAPN are highly associated with the dynamic compounding influence of WIT and IRV. To achieve the ideal postoperative renal function, limiting WIT and minimizing IRV may offer mitigate the rates of postoperative AKI.

キーワード

臓器別:腎・尿路・膀胱

手法別:内視鏡手術

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