OBJECTIVE:To investigate renal preservation by a novel method of perfusion using an oxygenated perfluorocarbon (PFC) emulsion via retrograde access to the kidney, as preserving renal function during urological surgery has been elusive, and the recognized technique of nephron-sparing surgery has increased its application and practice in modern urology. MATERIALS AND METHODS:After institutional review and approval, 30 New Zealand White rabbits were studied. In a solitary kidney model, each rabbit had the ureter catheterized before 40 min of renal artery occlusion. Each rabbit was randomized to one retrograde perfusion group, i.e. sham, normothermic PFC, chilled PFC, normothermic saline, and chilled saline. The rabbits were maintained for 2 weeks, during which renal function, urine output, systemic blood gases, weight and serum creatinine level were measured. After death, the kidneys were individually examined and graded by one renal pathologist unaware of the treatment. RESULTS:The rabbits treated with retrograde PFC perfusion (normothermic and chilled) had less change in their creatinine clearance, at 3.6 and 4.0 mL/min per kg, than the sham group, at 7.8 mL/min per kg, while also having significantly higher systemic venous oxygenation, at 26.3 and 10.0 mmHg, than the sham group, at 0.2 mmHg. Normothermic and chilled perfusion with PFC was also associated with less histological evidence of ischaemic damage, with mean (sd) scores of 13.0 (13.5) and 8.7 (4.5), respectively, than in the sham group, at 33.3 (16.8), while favourably matching the contralateral control kidney group, at 5.5 (2.3). The rabbits treated with saline retrograde perfusion also had better outcomes than the sham cohort. There were no adverse effects in any of the study arms or with the use of PFC. CONCLUSION:Retrograde oxygen delivery to the kidney through the urinary collecting system was successful in this pilot study. Renal function, laboratory and histological data indicate a trend towards renal preservation and even systemic oxygenation in the experimental groups compared with the sham rabbits, with no adverse effects attributed to this technique.

译文

目的:研究通过使用含氧的全氟化碳(PFC)乳剂通过逆行进入肾脏的一种新的灌注方法来保护肾脏,因为在泌尿外科手术中保留肾脏功能一直是遥不可及的,而保留肾单位的手术技术已经得到了广泛应用在现代泌尿外科中的应用和实践。
材料与方法:经过机构审查和批准,对30只新西兰白兔进行了研究。在孤立的肾脏模型中,每只兔子在肾动脉闭塞40分钟之前就已经插入了输尿管。每只兔子被随机分为一个逆行灌注组,即假手术,常温PFC,冷冻PFC,常温盐水和冷冻盐水。维持兔子2周,在此期间测量肾功能,尿量,全身血气,体重和血清肌酐水平。死亡后,由一名不了解治疗方法的肾脏病理学家对肾脏进行单独检查和分级。
结果:逆行PFC灌注(常温和冷藏)处理的兔子的肌酐清除率变化较小,分别为3.6和4.0 mL / min / kg,而假手术组则为7.8 mL / min / kg,但也显着高于假手术组。全身静脉氧合分别为26.3和10.0 mmHg,而假手术组为0.2 mmHg。 PFC的常温灌注和冷灌注也与缺血性损伤的组织学证据较少相关,与假手术组相比,平均(sd)评分分别为13.0(13.5)和8.7(4.5),而有利的是匹配对侧对照肾脏组,为5.5(2.3)。盐水逆行灌注治疗的兔子也比假手术组有更好的预后。在任何研究组中或使用PFC均无不良影响。
结论:在这项初步研究中,通过尿液收集系统向肾脏逆行输氧是成功的。肾脏功能,实验室和组织学数据表明,与假兔子相比,实验组的肾脏保存趋势甚至全身性充氧都有趋势,而该技术没有任何不良反应。

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