The clinical value of the backward ureteral perfusing ice water combined with perirenal ice water cooling in the protection of renal function during RLNSS in 16 cases

Objective: To investigate the clinical value of the backward ureteral perfusing ice water combined with perirenal ice water cooling in the protection of renal function during the retroperitoneal laparoscopic nephron sparing surgery(RLNSS).Methods: Sixteen patients were treated with the RLNSS under the protection of the backward ureteral perfusing ice water combined with perirenal ice water cooling.Eleven cases with kidney cancer were treated with partial nephrectomy,and 5 cases with renal angiomyolipoma were treated with tumor enucleation.The F6 ureteral catheter was inserted into the ipsilateral ureter of patient with lithotomy position before operation.The retroperitoneal cavity of patient with lateral position was established using 4-hole method.The aspirator was placed into the fourth hole,which was used to perirenal ice water cooling through sucking out ice saline water during operation.The RLNSS was implemented under the condition of the backward ureteral perfusing ice water combined with perirenal ice water cooling,and the renal artery was blocked during the operation.Results: The RLNSS in 16 patients were successfully completed under the protection of low temperature.The average operation time,renal artery blocking time and blood loss were 95(85 to 160)min,42(29 to 55) min and 80(60 to 150) mL,respectively.The average decreasing temperature degree in skin,kidney surface and tumor surface were 0.8℃,11.5℃ and 10.2℃,respectively.Compared before operation,the proportion of the glomerular filtration rate(GFR) in total GFR decreased significantly after 2 weeks and 3 months of operation(P<0.01),but the difference of the proportion of GFR in total GFR between between 2 weeks and 3 months after operation was not statistical significance(P>0.05),and the further renal function damage was not found.Conclusions: The clinical effect of the backward ureteral perfusing ice water combined with perirenal ice water cooling during RLNSS is good,which can effectively prolong the renal ischemia time and protect the renal function,especially for patients with solitary kidney or long renal artery blocking time.