Impact of different renal artery clamping strategies on postoperative renal function in patients with pre-existing renal insufficiency in robotic partial nephrectomy

LI Linfei; WANG Cong; WEI Ling; ZHENG Jun; SHEN Juan; LI Xuemei; FENG Jianli; SUN Daodong; WANG Yongquan

doi:10.16016/j.2097-0927.202504116

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Impact of different renal artery clamping strategies on postoperative renal function in patients with pre-existing renal insufficiency in robotic partial nephrectomy

Clinical Medicine | 更新时间：2025-07-27

- Impact of different renal artery clamping strategies on postoperative renal function in patients with pre-existing renal insufficiency in robotic partial nephrectomy
- Journal of Army Medical University Vol. 47, Issue 15, Pages: 1800-1805(2025)
- 作者机构：
  
  1.陆军军医大学（第三军医大学）第一附属医院泌尿外科，重庆
  2.陆军军医大学（第三军医大学）第一附属医院江北院区（陆军第九五八医院）泌尿外科，重庆
- 作者简介：
  
  WANG Yongquan， E-mail： wyq@tmmu.edu.cn
- 基金信息：
  
  the General Project of Natural Science Foundation of Chongqing(2024NSCQ-KJFZMSX0048)
- DOI：10.16016/j.2097-0927.202504116
  CLC： R334.1;R692.9;R699.2
- Received：29 April 2025，
  
  Revised：25 June 2025，
  
  Accepted：01 July 2025，
  
  Published：15 August 2025
- 稿件说明：
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李林飞，王聪，魏灵，等.不同肾动脉阻断策略对合并慢性肾功能不全患者机器人辅助肾部分切除术后肾功能的影响［J］.陆军军医大学学报，2025，47（15）：1800-1805.DOI：10.16016/j.2097-0927.202504116.

‍LI L F，WANG C，WEI L，et al.Impact of different renal artery clamping strategies on postoperative renal function in patients with pre-existing renal insufficiency in robotic partial nephrectomy［J］.J Army Med Univ，2025，47（15）：1800-1805.DOI：10.16016/j.2097-0927.202504116.
李林飞，王聪，魏灵，等.不同肾动脉阻断策略对合并慢性肾功能不全患者机器人辅助肾部分切除术后肾功能的影响［J］.陆军军医大学学报，2025，47（15）：1800-1805.DOI：10.16016/j.2097-0927.202504116. DOI：

‍LI L F，WANG C，WEI L，et al.Impact of different renal artery clamping strategies on postoperative renal function in patients with pre-existing renal insufficiency in robotic partial nephrectomy［J］.J Army Med Univ，2025，47（15）：1800-1805.DOI：10.16016/j.2097-0927.202504116. DOI：

摘要

目的

比较主干阻断（main artery clamping，MAC）与选择性分支阻断（selective artery clamping，SAC）两种肾动脉阻断策略对合并慢性肾功能不全患者机器人辅助肾部分切除术后肾功能的影响。

方法

采用回顾性队列研究设计，纳入2018年2月至2024年2月陆军军医大学第一附属医院泌尿外科住院收治的231例合并慢性肾功能不全［eGFR

90 mL/（min·1.73 m²）伴肾脏损伤标志，或eGFR

60 mL/（min·1.73 m²）］的肾肿瘤患者。根据术中肾动脉阻断策略，将患者分为MAC组（

=129）和SAC组（

=102）。术前采用基于机器学习的多模态全息三维重建技术制定个体化肾动脉阻断策略。采用酶法检测术前3 d、术后3 d及术后3个月的血清肌酐（serum creatinine，Scr）水平，并基于慢性肾脏病流行病学合作研究公式（chronic kidney disease epidemiology collaboration equation，CKD-EPI）公式计算估算肾小球滤过率（estimated glomerular filtration rate，eGFR）。采用核素肾动态显像（99mTc-DTPA或99mTc-MAG3）评估分肾肾小球滤过率（glomerular filtration rate，GFR）。

结果

术后3 d，SAC组患肾GFR下降幅度显著低于MAC组［（8.3±7.7）

（16.0±10.2） mL/（min·1.73 m²）， 95%

：-10.2~-5.2，

0.001］。Scr增量分析显示，SAC组升高幅度更低［8.2（2.5，18.7）

15.5（5.8，28.3） μmol/L，95%

：-12.3~-1.8，

=0.027］，eGFR下降更轻微［3.0（0.5，7.8）

7.5（2.0，14.3） mL/（min·1.73 m²），95%

：-6.2~-0.8，

=0.015］。术后3个月，SAC组Scr水平更低［（89.2±23.1）

（95.3±22.1） μmol/L，95%

：-11.9~-0.3，

=0.042］，患肾GFR更高［（33.5±10.5）

（26.1±10.9） mL/（min·1.73 m²），95%

：4.6~10.2，

0.001］。

结论

对于合并慢性肾功能不全的肾肿瘤患者，机器人辅助肾部分切除术中采用SAC策略较MAC能更好地保护术后肾功能，且不增加手术风险。

Abstract

Objective‍　‍To compare the effects of main artery clamping (MAC) and selective artery clamping (SAC) strategies on po

stoperative renal function in patients with chronic renal insufficiency undergoing robot-assisted partial nephrectomy. Methods‍　‍A retrospective cohort study was conducted on 231 patients with preoperative chronic renal insufficiency [eGFR

90 mL/(min·1.73 m²) with renal injury markers or eGFR

60 mL/(min·1.73 m²)

]

who underwent robot-assisted partial nephrectomy in the Department of Urology of the First Affiliated Hospital of Army Medical University from February 2018 to February 2024. According to intraoperative renal artery clamping strategy

they were divided into a MAC group (

=129) and a SAC group (

=102). Preoperatively

individualized renal artery clamping strategies were developed using a machine learning-based multimodal holographic 3-D reconstruction technique. Serum creatinine (Scr) level was measured at 3 d and 3 months after surgery

and estimated glomerular filtration rate (eGFR) was calculated using the chronic kidney disease epidemiology collaboration equation (CKD-EPI) formula. Renal dynamic imaging with 99mTc-DTPA or 99mTc-MAG3 was used to assess the GFR of the affected kidney. Results‍　‍At 3 d after surgery

the decrease in GFR of the affected kidney was significantly lower [(8.3±7.7)

(16.0±10.2) mL/(min·1.73 m²)

95%

: -10.2~-5.2

0.001

]

in the SAC group than the MAC group. Scr increment analysis showed that the SAC group exhibited notably lower Scr increase [8.2 (2.5

18.7)

15.5 (5.8

28.3) μmol/L

95%

: -12.3~-1.8

P=0.027

]

and milder eGFR decline [3.0 (0.5

7.8)

7.5 (2.0

14.3) mL/(min·1.73 m²)

95%

: -6.2~-0.8

=0.015

]

. And

in 3 months after surgery

the SAC group had lower Scr level [(89.2±23.1)

(95.3±22.1) μmol/L

95%

: -11.9~-0.3

=0.042

]

and higher GFR of the affected kidney [(33.5±10.5)

(26.1±10.9) mL/(min·1.73 m²)

95%

: 4.6~10.2

0.001

]

. Conclusion‍　‍For patients with chronic renal insufficiency undergoing robot-assisted partial nephrectomy

SAC strategy is superior to MAC strategy in protecting postoperative renal function without increasing surgical risk.

关键词

Keywords

references

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