腹腔镜肾部分切除术后影响早期肾功能变化因素分析
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摘要
目的分析肾肿瘤患者行后腹腔镜下肾部分切除术(LRN)后影响早期肾功能变化的相关因素。方法回顾性分析2016年6月至2018年6月行后腹腔镜下肾部分切除术的63例患者的临床资料,采用99mTc-DTPA肾核素扫描评估术前及术后3个月双侧肾脏的肾小球滤过率(GFR),收集患者年龄、性别、BMI、热缺血时间(WIT)、手术时间、R.E.N.A.L评分、病理类型、伴随疾病(高血压、糖尿病)、术中出血量、肿瘤部位、血肌酐,分析差异,并进行多因素回归分析。结果单因素分析结果显示,术后患肾GFR变化与年龄、高血压、BMI、R.E.N.A.L评分、WIT、术前患肾GFR水平等因素有相关性(P <0.05),多元线性回归结果显示,术后患肾GFR变化与年龄、R.E.N.A.L评分、WIT、术前患肾GFR水平等因素有相关性(P <0.05)。结论年龄、WIT、R.E.N.A.L评分、术前患肾GFR水平是影响患者后腹腔镜下肾部分切除术后肾功能恢复的危险因子。
Objective Analysis of related factors that affect early renal function after retroperitoneal laparoscopic partial nephrectomy in patients with renal tumor. Methods The clinical data of 63 patients who underwent retroperitoneal laparoscopic partial nephrectomy from June 2016 to June 2018 were retrospectively analyzed. Glomerular filtration rate(GFR)of the renal units with tumor was measured by from99 mTc-Diethylenetetramine pentaacetic acid(99 mTc-DTPA)renal scan preoperatively and 3 months postoperatively. Age,sex,body mass index(BMI),warm ischemia time(WIT),operation time,R.E.N.A.L score,pathological type,accompanying diseases(hypertension,diabetes),intraoperative blood loss,tumor location and serum creatinine were collected.The single factor analysis used t test,Multivariate linear regression analysis was used for multivariate analysis.Results The results of univariate analysis showed that Changes of Postoperative GFR in diseased kidneys were correlated with age,hypertension,BMI,R.E.N.A.L score,WIT and preoperative GFR level,and the difference was statistically significant(P < 0.05). The results of multiple linear regression showed that the changes of Postoperative GFR were correlated with age,R.E.N.A.L score,WIT and preoperative GFR level,and the correlation was statistically significant(P < 0.05). Conclusions Age,WIT,R.E.N.A.L score and preoperative GFR in diseased kidneys were risk factors for renal function recovery after retroperitoneal laparoscopic partial nephrectomy.
Objective Analysis of related factors that affect early renal function after retroperitoneal laparoscopic partial nephrectomy in patients with renal tumor. Methods The clinical data of 63 patients who underwent retroperitoneal laparoscopic partial nephrectomy from June 2016 to June 2018 were retrospectively analyzed. Glomerular filtration rate(GFR)of the renal units with tumor was measured by from99 mTc-Diethylenetetramine pentaacetic acid(99 mTc-DTPA)renal scan preoperatively and 3 months postoperatively. Age,sex,body mass index(BMI),warm ischemia time(WIT),operation time,R.E.N.A.L score,pathological type,accompanying diseases(hypertension,diabetes),intraoperative blood loss,tumor location and serum creatinine were collected.The single factor analysis used t test,Multivariate linear regression analysis was used for multivariate analysis.Results The results of univariate analysis showed that Changes of Postoperative GFR in diseased kidneys were correlated with age,hypertension,BMI,R.E.N.A.L score,WIT and preoperative GFR level,and the difference was statistically significant(P < 0.05). The results of multiple linear regression showed that the changes of Postoperative GFR were correlated with age,R.E.N.A.L score,WIT and preoperative GFR level,and the correlation was statistically significant(P < 0.05). Conclusions Age,WIT,R.E.N.A.L score and preoperative GFR in diseased kidneys were risk factors for renal function recovery after retroperitoneal laparoscopic partial nephrectomy.
引文
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[13]董洪超,王勤章,丁国富,等. T1b期肾癌患者经后腹腔镜肾部分切除术后的分肾功能分析[J].现代泌尿外科杂志,2017,22(3):181-184.
[14] DAWIDEK M T,CHAN E,BOYLE S L,et al. Assessing time of full renal recovery following minimally invasive partial nephrectomy[J]. Urology,2018,112:98-102.
[15]李晶,程文俊,郝永哲,等.(99m)Tc-DTPA肾动态显像在老年高血压早期肾损害中的诊断价值[J].实用医学杂志,2018,34(8):158-161.
[16] MASHNI J W,ASSEL M,MASCHINO A,et al. New chronic kidney disease and overall survival after nephrectomy for small renal cortical tumors[J]. Urology,2015,86(6):1137-1143.
[17] WINER A G,ZABOR E C,VACCHIO M J,et al. The effect of patient and surgical characteristics on renal function after partial nephrectomy[J]. Clin Genitourin Cancer,2018,16(3):191-196.
[18] SATASIVAM P,RAO K,GUGGENHEIMER K,et al. The effect of hypertension and diabetes on the degree of renal function deterioration after unilateral nephrectomy[J]. BJU Int,2011,108(9):1508-1512.
[19]唐刚,周志明,张镕,等.上海市松江区佘山镇常住人口肾功能损伤情况及其相关因素[J].上海预防医学,2018,30(5):358-362.
[20]瓦斯里江瓦哈甫,马鑫,张旭,等.腹腔镜肾部分切除术后体质指数变化对肾功能影响的分析[J].微创泌尿外科杂志,2015,4(4):200-207.
[21] REINSTATLER L,KLAASSEN Z,BARRETT B,et al. Body mass index and comorbidity are associated with postoperative renal function after nephrectomy[J]. Int Braz J Urol,2015,41(4):697-704.
[22]程庆砾.肥胖与肾脏:值得关注的临床问题[J].中华肾病研究电子杂志,2017,6(3):97.
[23]中华医学会内分泌学分会肥胖学组.中国成人肥胖症防治专家共识[J].中华内分泌代谢杂志,2011,27(9):711-717.
[24] MIYAKE H,FURUKAWA J,HINATA N,et al. Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy[J]. Int J Clin Oncol,2015,20(3):586-592.
[25] OKHUNOV Z,RAIS-BAHRAMI S,GEORGE A K,et al. The comparison of three renal tumor scoring systems:C-Index,P.A.D.U.A.,and R.E.N.A.L. nephrometry scores[J]. J Endourol,2011,25(12):1921-1924.
[26]方咏,王道虎,罗俊航,等. R.E.N.A.L.评分系统在后腹腔镜保留肾单位手术中的应用研究[J].微创泌尿外科杂志,2013,2(1):40-43.
[27] WANG Y,SHAO J,MA X,et al. Robotic and open partial nephrectomy for complex renal tumors:a matched-pair comparison with a long-term follow-up[J]. World J Urol,2017,35(1):73-80.
[28] MUFARRIJ P W,KRANE L S,RAJAMAHANTY S,et al.Does nephrometry scoring of renal tumors predict outcomes in patients selected for robot-assisted partial nephrectomy?[J]. J Endourol,2011,25(10):1649-1653.
[29] CAMPBELL J,CHAN G,LUKE P P. Early clamp release during laparoscopic partial nephrectomy:Implications for preservation of renal function[J]. Can Urol Assoc J,2017,11(7):E261-E265.
[30] DONG W,WU J,SUK-OUICHAI C,et al. Ischemia and functional recovery from partial nephrectomy:Refined perspectives[J]. Eur Urol Focus,2017,4(4):572-578.
[31] LEE H,SONG B D,BYUN S S,et al. Impact of warm ischaemia time on postoperative renal function after partial nephrectomy for clinical T1 renal cell carcinoma:A propensity scorematched study[J]. BJU Int,2018,121(1):46-52.
[32]曹靖,陈文军,甲明,等.热缺血时间对腹腔镜下肾部分切除术后早期肾功能的影响分析[J].中华泌尿外科杂志,2015,2015(6):414-418.
[2] WINER A G,ZABOR E C,VACCHIO M J,et al. The Effect of patient and surgical characteristics on renal function after partial nephrectomy[J]. Clin Genitourin Cancer,2018,16(3):191-196.
[3]叶永利,郑昱,闫飞,等.保留肾单位微创手术的治疗进展[J].现代泌尿生殖肿瘤杂志,2016(6):369-371.
[4] YANG C,WANG Z,HUANG S,et al. Retroperitoneal laparoscopic partial nephrectomy versus radical nephrectomy for clinical T1 renal hilar tumor:comparison of perioperative characteristics and short-term functional and oncologic outcomes[J]. J Laparoendosc Adv Surg Tech A,28(10):1183-1187.
[5]孙超,张斌.后腹腔镜根治性肾切除术与保留肾单位的肾部分切除术治疗肾癌的效果比较[J].中外医学研究,2016,14(6):52-53.
[6] TACHIBANA H,TAKAGI T,KONDO T,et al. Robot-assisted laparoscopic partial nephrectomy versus laparoscopic partial nephrectomy:A propensity score-matched comparative analysis of surgical outcomes and preserved renal parenchymal volume[J].Int J Urol,2018,25(4):359-364.
[7]王林辉,时佳子.肾癌肾部分切除术的指征应该怎么把握[J].中华泌尿外科杂志,2018,39(6):403-406.
[8]姜少军,王斌,谢克基,等.经腹腹腔镜下零缺血时间行肾部分切除术的初步经验[J].实用医学杂志,2017,33(12):87-89.
[9] STEVANOVIC A,SCHAEFER P,COBURN M,et al. Renal function following xenon anesthesia for partial nephrectomy-An explorative analysis of a randomized controlled study[J]. PLoS One,2017,12(7):e181022.
[10] CAMPBELL S,UZZO R G,ALLAF M E,et al. Renal Mass and Localized Renal Cancer:AUA Guideline[J]. J Urol,2017,198(3):520-529.
[11]王云鹏,陈光富,张旭,等.影响腹腔镜保留肾单位手术术后肾功能恢复的因素分析[J].微创泌尿外科杂志,2015,4(6):380-384.
[12] PATEL H D,PIERORAZIO P M,JOHNSON M H,et al. Renal functional outcomes after surgery,ablation,and active surveillance of localized renal tumors:A systematic review and meta-analysis[J]. Clin J Am Soc Nephrol,2017,12(7):1057-1069.
[13]董洪超,王勤章,丁国富,等. T1b期肾癌患者经后腹腔镜肾部分切除术后的分肾功能分析[J].现代泌尿外科杂志,2017,22(3):181-184.
[14] DAWIDEK M T,CHAN E,BOYLE S L,et al. Assessing time of full renal recovery following minimally invasive partial nephrectomy[J]. Urology,2018,112:98-102.
[15]李晶,程文俊,郝永哲,等.(99m)Tc-DTPA肾动态显像在老年高血压早期肾损害中的诊断价值[J].实用医学杂志,2018,34(8):158-161.
[16] MASHNI J W,ASSEL M,MASCHINO A,et al. New chronic kidney disease and overall survival after nephrectomy for small renal cortical tumors[J]. Urology,2015,86(6):1137-1143.
[17] WINER A G,ZABOR E C,VACCHIO M J,et al. The effect of patient and surgical characteristics on renal function after partial nephrectomy[J]. Clin Genitourin Cancer,2018,16(3):191-196.
[18] SATASIVAM P,RAO K,GUGGENHEIMER K,et al. The effect of hypertension and diabetes on the degree of renal function deterioration after unilateral nephrectomy[J]. BJU Int,2011,108(9):1508-1512.
[19]唐刚,周志明,张镕,等.上海市松江区佘山镇常住人口肾功能损伤情况及其相关因素[J].上海预防医学,2018,30(5):358-362.
[20]瓦斯里江瓦哈甫,马鑫,张旭,等.腹腔镜肾部分切除术后体质指数变化对肾功能影响的分析[J].微创泌尿外科杂志,2015,4(4):200-207.
[21] REINSTATLER L,KLAASSEN Z,BARRETT B,et al. Body mass index and comorbidity are associated with postoperative renal function after nephrectomy[J]. Int Braz J Urol,2015,41(4):697-704.
[22]程庆砾.肥胖与肾脏:值得关注的临床问题[J].中华肾病研究电子杂志,2017,6(3):97.
[23]中华医学会内分泌学分会肥胖学组.中国成人肥胖症防治专家共识[J].中华内分泌代谢杂志,2011,27(9):711-717.
[24] MIYAKE H,FURUKAWA J,HINATA N,et al. Significant impact of R.E.N.A.L. nephrometry score on changes in postoperative renal function early after robot-assisted partial nephrectomy[J]. Int J Clin Oncol,2015,20(3):586-592.
[25] OKHUNOV Z,RAIS-BAHRAMI S,GEORGE A K,et al. The comparison of three renal tumor scoring systems:C-Index,P.A.D.U.A.,and R.E.N.A.L. nephrometry scores[J]. J Endourol,2011,25(12):1921-1924.
[26]方咏,王道虎,罗俊航,等. R.E.N.A.L.评分系统在后腹腔镜保留肾单位手术中的应用研究[J].微创泌尿外科杂志,2013,2(1):40-43.
[27] WANG Y,SHAO J,MA X,et al. Robotic and open partial nephrectomy for complex renal tumors:a matched-pair comparison with a long-term follow-up[J]. World J Urol,2017,35(1):73-80.
[28] MUFARRIJ P W,KRANE L S,RAJAMAHANTY S,et al.Does nephrometry scoring of renal tumors predict outcomes in patients selected for robot-assisted partial nephrectomy?[J]. J Endourol,2011,25(10):1649-1653.
[29] CAMPBELL J,CHAN G,LUKE P P. Early clamp release during laparoscopic partial nephrectomy:Implications for preservation of renal function[J]. Can Urol Assoc J,2017,11(7):E261-E265.
[30] DONG W,WU J,SUK-OUICHAI C,et al. Ischemia and functional recovery from partial nephrectomy:Refined perspectives[J]. Eur Urol Focus,2017,4(4):572-578.
[31] LEE H,SONG B D,BYUN S S,et al. Impact of warm ischaemia time on postoperative renal function after partial nephrectomy for clinical T1 renal cell carcinoma:A propensity scorematched study[J]. BJU Int,2018,121(1):46-52.
[32]曹靖,陈文军,甲明,等.热缺血时间对腹腔镜下肾部分切除术后早期肾功能的影响分析[J].中华泌尿外科杂志,2015,2015(6):414-418.