目的：探讨逆行输尿管导管冷缺血的肾功能保护技术用于机器人辅助复杂性肾部分切除术的有效性 和安全性。方法：对 17 例 RENAL 评分≥ 7 分的复杂性肾肿瘤，予以超滑导丝引导下患侧输尿管导管逆行插管，行 常规机器人辅助腹腔镜下肾部分切除术。至阻断肾动脉同期，予以 4℃生理盐水逆行低温灌注。记录冷缺血时间、 手术时间、出血量、并发症及肾功能恢复情况等临床指标。结果：所有手术均在机器人辅助腹腔镜下完成，无中转 开腹、无中转肾癌根治术，无严重并发症。手术时长 156（122，204）min，其中冷缺血时间 22（15，36）min、出 血量 77（30，210）mL。术后 3 个月患肾的分肾功能与术前相比差异无统计学意义（P=0.35）。结论：逆行输尿管 导管冷缺血技术可用于高 RENAL 评分的复杂性机器人辅助肾部分切除术中保护肾功能。

Objective: To investigate the efficacy and safety of renal function preservation with retrograde ureteral cold ischemia technique in complex robot-assisted partial nephrectomy. Methods: 17 cases of complex renal tumors with RENAL score ≥7 were retrogradely intubated with a ureteral catheter on the affected side, and robot-assisted laparoscopic partial nephrectomy was performed. At the same time as clamping the renal artery, 4℃ normal saline was used for retrograde hypothermic perfusion. Clinical parameters such as cold ischemia time, operative time, bleeding volume, complications, pre- and postoperative renal function were recorded. Results: All surgeries were completed with no conversion to open surgery or radical nephrectomy, and no major complications occurred. The operative time was 156(122, 204)min, including 22(15, 36)min of cold ischemia time and 77(30, 210)mL of blood loss. There was no significant difference in the split renal function of the affected kidneys at 3 months postoperatively compared with that before surgery (P=0.35). Conclusion: Retrograde ureteral catheter cold ischemia technique can be used to protect renal function in high RENAL score and complex robot-assisted partial nephrectomy.

收稿日期：2023-12-05  录用日期：2024-09-09 

Received Date: 2023-12-05  Accepted Date: 2024-09-09 

基金项目：军队计生专项课题（17JS009）；解放军总医院第七医学中心创新培育基金（QZX-2023-17） 

Foundation Item: Special Project for Military Family Planning (17JS009); Innovation Cultivation Fund of the Seventh Medical Center of Chinese PLA General Hospital (QZX-2023-17) 

通讯作者：艾星，Email：aixing0007@163.com 

Corresponding Author: AI Xing, Email: aixing0007@163.com 

引用格式：马重，姚丽，赵福广，等 . 输尿管逆行冷缺血技术在机器人辅助复杂性肾部分切除术中的应用研究 [J]. 机器人外科学杂 志（中英文），2024，5（5）：922-925. 

Citation: MA C, YAO L, ZHAO F G, et al. Retrograde ureteral cold ischemia technique in complex robot-assisted partial nephrectomy[J]. Chinese Journal of Robotic Surgery, 2024, 5(5): 922-925. 注：马重，姚丽为共同第一作者 Co-first Author: MA Chong, YAO Li

[1] Ljungberg B, Bex A, Albiges L, et al. 2023 EAU guidelines on renal cell carcinoma presented at the eau annual congress milan 2023[M]. EAU Guidelines Office, 2023: 29-43. 

[2] Alessio P, Riccardo C, Riccardo B, et al. Estimating postoperative renal function after surgery for nonmetastatic renal masses: a systematic review of available prediction models[J]. Eur Urol Oncol, 2023, 6(2): 137-147. 

[3] Ward J. Determination of the optimum temperature for regional renal hypothermia during temporary renal ischaemia[J]. Br J Urol, 1975, 47(1): 17-24. 

[4] Lorenzo M, Mihir D, Vincenzo F. Renal preservation and partial nephrectomy: patient and surgical factors[J]. Eur Urol Focus, 2016, 2(6): 589-600. 

[5] BAI Y C, YANG Y K, WEI H B, et al. Clinical outcomes of roboticassisted laparoscopic partial nephrectomy with renal hypothermia perfusion by renal artery balloon catheter in treating patients with complex renal tumors[J]. Front Oncol, 2022, 26(12): 918143. 

[6] Lee J, Hwang Y C, Yoo S, et al. Changes in kidney function according to ischemia type during partial nephrectomy for T1a kidney cancer[J]. Sci Rep, 2022, 12(1): 4223-4229. 

[7] Jaime L, Ramakrishna V, David L, et al. Renal hypothermia achieved by retrograde endoscopic cold saline perfusion: technique and initial clinical application[J]. Urology, 2003, 61(5): 1023-1025. 

[8] Levey A S, Coresh J, Greene T, et al. Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values[J]. Clin Chem, 2007, 53(4): 766-772. 

[9] Mir C, Campbell A, Sharma N, et al. Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis[J]. Urology, 2013, 82(2): 263-268. 

[10] ZHOU Z H, LI Z Y, NING K, et al. Long-term effect of acute ischemic injury on the kidney underwent clamped partial nephrectomy[J]. iScience, 2023, 26(9): 107610-107619. 

[11] Dindo D, Demartines N, Clavien P A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Annals of Surgery, 2004, 240(2): 205-213. 

[12] Alexander K, Robert U. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth[J]. J Urol, 2009, 182(3): 844-853. 

[13] LIU F Y, YUAN H J, LI X, et al. Application of hypothermic perfusion via a renal artery balloon catheter during robot-assisted partial nephrectomy and effect on renal function[J]. Acad Radiol, 2019, 26(8): e196-e201. 

[14] XIONG L B, Nguyen J K, PENG Y L, et al. What happens to the preserved renal parenchyma after clamped partial nephrectomy?[J] Eur Urol, 2022, 81(5): 492-500. 

[15] Alessan A, Luca C, Marco S, et al. The role of warm ischemia time on functional outcomes after robotic partial nephrectomy: a radionuclide renal scan study from the clock randomized trial[J]. World J Urol, 2023, 41(5): 1337-1344. 

[16] Liu J, Kumar S, Dolzhenko E, et al. Molecular characterization of the transition from acute to chronic kidney injury following ischemia/ reperfusion[J]. JCI Insight, 2017, 2(18): e94716. 

[17] Becker F, Poppel V, Hakenberg W, et al. Assessing the impact of ischaemia time during partial nephrectomy[J]. Eur Urol, 2009, 56(4): 625-634. 

[18] Theodore S, Philip D, Jan C, et al. Induction of cold ischemia in patients with solitary kidney using retrograde intrarenal cooling: 2-year functional outcomes[J]. Int Urol Nephrol, 2013, 45(2): 313-320. 

[19] DONG K, SHEN M J, JU G Q, et al. Off-clamp retroperitoneoscopic tumour evacuation for sporadic renal angiomyolipomas with high renal nephrometry scores: a novel surgical technique and its outcomes[J]. Eur Urol, 2021, 79(2): 283-289. 

[20] 彭程 , 黄庆波 , 朱捷 , 等 . 基于三维影像重建的肾窦内肿瘤手术 难度评分系统 [J]. 机器人外科学杂志 , 2020, 1(5): 345-354.