Comparison the efficacy and safyty of renal artery selective blocking and full occlusion in retroperitoneal laparoscopic partial nephrectomy

Objective To compare the efficacy and safety on renal carcinoma with Segmental Artery Clamping and main renal artery clamping retroperitoneal laparoscopic partial nephrectomy( RLPN). Methods A retrospective analysis of a consecutive series of 56 patients who underwent RLPN( Including Segmental Artery Clamping and main renal artery clamping) from June 2010 to May 2013. According to the renal artery occlusion methods,56 patients divided into 38 patients underwent surgeries with main renal artery clamping,and 18 underwent surgeries with segmental artery clamping.Chief complaint Blood loss,warm ischemia( WI) time,the creatinine after operation,Length of stay,and short term complications after operation. Result All the patients' surgical were successful and the margins were negative the selective blockade group,WI( 33. 94 ± 9. 40) min,blood loss was( 155. 56 ± 70. 50) mL,the Creatinine before and afer surgery were( 68.39 ±15.70) μmol/L and( 96.39 ±26.40) μmol/L respectively. Postoperative creatinine percentage was41% ±24%,Length of stay was( 9. 17 ± 2. 70) d,1 case intraoperative blood transfusion( 5. 6%),1 cases of postoperative complications( fistula). full occlusion group were( 23. 13 ± 10. 80) min、( 143. 68 ± 104. 40) mL、( 70. 02 ± 20. 00) μmol /L、( 105.70 ±38.30) μmol/L、58% ±34%、( 11.37 ±3.20) d respectively. 2 case intraoperative blood transfusion( 5.3%),2 cases of postoperative complications( 1 cases of Multiple organ dysfunction and 1 case of hydronephrosis). Patients in the two group of renal artery occlusion time,amount of bleeding,hospitalization time,preoperative creatinine,intraoperative blood transfusion rate,complication rate compared to P 0. 05,postoperative creatinine and postoperative creatinine decreased percentage of P 0. 05. Conclusion For small renal cell carcinoma,selective renal artery occlusion operation time is prolonged,but kidney warm ischemia area is small,no hemorrhage increased significantly,to protect the normal regional renal units,better recovery of renal function after operation. Conclusions: LPN with segmental artery clamping is safe and feasible in clinical practice. It minimizes the intraoperative WI injury and improves early postoperative affected renal function compared with main renal artery clamping.