腹腔镜保留肾单位肾部分切除术后肾功能分析  

Analysis of renal function after laparoscopic nephron sparing surgery

作　　者：于得水[1] 丛军[1] 徐卓群[1] 董坚[1] 程晓东[1] 施卫国[1] 顾震华[1] 徐新宇[1] 吴岩[1] 

机构地区：[1]无锡市第二人民医院泌尿外科,江苏214002

出　　处：《国际泌尿系统杂志》2011年第3期307-312,共6页International Journal of Urology and Nephrology

摘　　要：目的寻求影响腹腔镜下保留肾单位肾部分切除术（LNSS）后肾功能恢复的主要因素，检测LNSS的安全性，明确肾脏热缺血安全时间：方法回顺性分析本院30例次LNSS患者的临床资料，术前及术后3个月采用99Tcm-二乙三胺五乙酸肾动态显象检测肾小球滤过率（GFR），术前、术后24h及术后一脚检测血肌酐水平，统计分析影响术后24h、1周及3个月。埒功能的有关因素，包括患者年龄、性别、病灶大小、部位、术前血叭酐、GFR及分肾功能、手术时间、气压、气流量、肾动脉阻断时间、术中失血量等。结果30例次患者术前、术后24h及术后1周血肌酐均值分别为（80．76±17．5）、（91．79±20．3）、（86．67±11．5）umol／L，术后24h较术前上升1366％（P〈0．01），手术时间是其主要影响因素，手术时间在180min内患者，术后24hml肌酐水平优于〉180影响LNSS术后24h血肌酐水平主要因素为手术时间，但一周后均可恢复，影响术后3个月GFR主要因素为术中肾动脉5H断时间，术中应注意将其控制在30min内。210min者；术后1周较术前上升7．31％（P〉0．05），表明1周后患者血叽酐均能恢复；术前、术后3个月GFR均值分别为（74．83±22．39）ml／min（其中非术倾4（3512±1199）ml／min、术倾0（39．71±11．68）ml／min）、（63．77±20．78）ml／min（其中非术侧（37．83±10．84）ml／min、术侧（25．94±12．17）ml／min），较术前下降14．78％（P〈0．01），其中：啦术侧上升7．72％（P〉005），术侧下降34．68％（P〈001）；术中动脉阻断时间是其主要影响因素；术中血管阻断时间在30min内的患者，术后肾功能恢复优于≥30min者。结论影响LNSS术后24h血肌酐水平主要因素为手术时间，但1周后均可恢复，影响术后3个月GFR主要因素为术中肾动脉阻断时间，术中应注意将其控制在30min内。Objectives To study the factors associated with renal function after laparoscopic nephron - sparing surgery （LNSS） and make the definite safety duration time of renal warm ischemia. Methods Retrospective analysis of 30 patients＇clinical data that underwent LNSS in our hospital was carried out. Preoperative and postoperative renal scintigraphic scan and serum creatinine were performed in all patients. Linear correlation and muhivariate regression model were used to analysis the factors associated with postoperative renal damage. The data in GFR were monitored at the preoperative and 3 months after operation, when the serum creatinine at the preoperative,24 hours（2.4h） and I week after operation. The duration warm isehemia was recorded. Results In these 30 patients 24h after operation,assessed by serum creatinine,the renal function was raised by a mean of 13.66% （ p 〈0.01 ）. Linar correlation and multivariate regression analysis showed that the operation time was the first risk factor of renal damage in 24h. While we found that the mean of serum creatinine was just 7.31% upon the preoperative data（ p 〉 0.05 ）. When we analyze the data by GFR, the study show us that the function of the operated - side kidney was reduced by a mean of 34.68 % （ p 〈 0.01 ） while the non - operated side raised by 7.72% （ p 〉 0.05 ）, and the duration time of warm iscbemia was the first risk factor of postoperative renal damage. There was a significant difference between duration time≥30min and the duration time 〈 30min. Conclusions The LNSS was a safety mean for patients. In order to get the best protection of renal function, we might to control the operation time in 180miu and the duration time in 30min.

关 键 词：肾切除术 肾单位 外科手术 腹腔镜 

分 类 号：R737.11[医药卫生—肿瘤]