Satinsky 겸자를 이용한 신동정맥 동시 결찰을 통한 복강경 부분 신적출술의 초기 경험
The Effectiveness of Simultaneous Renal Artery-vein Clamping during Laparoscopic Partial Nephrectomy on the Surgical Outcome
방정균, 송채린, 김청수, 안한종, 홍범식, 박형근,
소속 상세정보
방정균 ( Bang Jeong-Kyoon )
서울아산병원 비뇨기과
송채린 ( Song Cheryn )
울산대학교 의과대학 비뇨기과학교실
김청수 ( Kim Choung-Soo )
울산대학교 의과대학 비뇨기과학교실
안한종 ( Ahn Han-Jong )
울산대학교 의과대학 비뇨기과학교실
홍범식 ( Hong Bum-Sik )
울산대학교 의과대학 비뇨기과학교실
박형근 ( Park Hyung-Keun )
울산대학교 의과대학 비뇨기과학교실
KMID : 0358320070480090897
Abstract
Purpose:We wanted to compare the surgical outcomes of laparoscopic partial nephrectomy(LPN) performed with and without simultaneous artery-vein clamping.
Materials and Methods:Between April 2005 and December 2006, elective LPN was performed for 56 patients with renal tumors with using hilar clamping by a Satinsky clamp in 42(75%) patients, and with using artery-only or no clamping in the rest of the patients. The Satinsky and non-Satinsky groups were compared for their perioperative characteristics, the pathologic findings and the complication rate. The postoperative renal function was evaluated with measuring the serum creatinine and also by 99technetium labeled diethylenetetraminepentaacetic acid(DTPA) renal scanning.
Results:Renal cell carcinoma was diagnosed in 43(76.8%) patients and all had negative margins. There were no significant differences between the two groups for tumor size(2.1 vs. 2.0cm, respectively), the operative time(210.9 vs. 199.3 min, respectively) and the hospital stay(5.9 vs. 5.6 days, respectively). The mean warm ischemia time was longer when the Satinsky clamp was applied(38.5 vs. 21.9 min, respectively, p=0.03). The postoperative serum creatinine level and glomerular filtration rate(GFR) were 1.13mg/dl and 41.4ml/min/m2, respectively, in the Satinsky group and 1.17mg/dl and 33.5ml/min/m2, respectively, in the non-Satinsky group, without significant differences. The postoperative transfusion rate was lower in the Satinsky group(9.5 vs. 28.5%, respectively, p=0.28), although more pelvocalyceal system repair was done in the Satinsky group (47.6 vs. 7.7%, respectively, p=0.006).
Conclusions:Simultaneous clamping of the renal artery and vein during LPN enables efficient removal of tumors that are deep in the renal sinus with a safe margin, it facilitates closure of the pelvocalyceal system and it reduces the need for transfusion without impairing renal function. (Korean J Urol 2007;48:897-902)
키워드
Laparoscopy;Nephrectomy;Kidney neoplasms
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