临床分期为cT1a肾肿瘤术后出现慢性肾脏病的危险因素分析  

Risk factors for chronic kidney disease after curative surgery in patients with cT1a renal tumors

作　　者：邬嘉波[1] 郑祥毅[2] 陈炳[1] 

机构地区：[1]浙江省舟山医院泌尿外科,浙江舟山316000 [2]浙江大学医学院附属第一医院泌尿外科,浙江杭州310003

出　　处：《中国现代医生》2013年第23期38-41,共4页China Modern Doctor

基　　金：浙江省自然科学基金(LY12H05006)

摘　　要：目的分析和探讨临床分期为cT1a的肾肿瘤患者术后出现慢性肾脏病(chronic kidney disease,CKD)的危险因素。方法统计和分析2004年10月～2011年10月期间212例术前临床分期为cT1a的肾肿瘤患者,分为根治性肾切除术(radical nephrectomy,RN)组(n=115)和肾脏肿瘤部分切除术(partial nephrectomy,PN)组(n=97),观察两组术后肾功能的变化。用MDRD法来估计肾小球率过滤。其中CKD定义为肾小球率过滤<60 mL/(min.1.73 m2),持续3个月及以上。结果 RN组共115例患者,PN组共97例患者。术后平均随访32.2(1.5～84)个月,共有80例(37.7%)患者出现了CKD,其中RN组69例(60%),PN组11例(11.3%)。RN组5年未出现CKD的无疾病生存率(disease-free survival,DFS)为22.1%,PN组DFS为52.4%,差异有统计学意义(P<0.01)。糖尿病患者共22例,其中14例(63.6%)术后出现CKD,行RN术12例,行PN术2例。糖尿病组5年DFS为14.3%,高于无糖尿病组(37.8%),差异有统计学意义(P<0.01)。Cox多因素分析提示年龄,糖尿病,手术方式,术前肾小球滤过率,高血压为肾肿瘤患者术后出现CKD的独立因素。结论对于临床分期为cT1a期的,尤其是高龄或伴有糖尿病的肾肿瘤患者,应尽可能行保留肾单位手术以降低术后出现CKD的风险。Objective To analyze the risk factors associated with newly developed chronic kidney disease （CKD） af- ter curative surgery in patients with cTla kidney tumors. Methods From October 2004 to October 2011, we investi- gated 212 patients undergoing partial nephrectomy （PN） or radical nephrectomy （RN） for renal tumors, of size ≤4 cm, with normal contralateral kidney. The glomerular filtration rate （GFR） was calculated using the modification of diet in renal disease formula （MDRD）. CKD was defined as GFR 〈 60 mL/（min. 1.73 ㎡）, with an interval of at least 3 months after the procedure. Results A total of 115 and 97 patients were included in the RN and PN groups. A total of 80 （37.7%） patients developed CKD, 69（60%） underwent radical nephrectomy and 11 （11.3%） underwent partial nephrec- tomy. The 5-year probability of absence of CKD （disease-free survival, DFS） with the RN group and the PN group was 22.1% and 52.4%, respectively （P 〈 0.01）. Among 22 patients with diabetes, 14（63.6%） developed CKD： 12 patients underwent radical nephrectomy and 2 patients underwent partial nephrectomy. The 5-year probability of DFS with and without diabetes was 14.3% and 37.8%, respectively （P 〈 0.01）. The multivariate analysis showed that age, hypertension, type of operation, preoperative GFR, and diabetes were associated with the development of CKD. Conclusion The re- sults of this study show that nephron-sparing surgery for cTla kidney tumors should be attempted to prevent CKD in all eligible patients, especially those with diabetes or hypertension.

关 键 词：肾肿瘤 慢性肾脏病 危险因素 

分 类 号：R737.11[医药卫生—肿瘤] R730.6[医药卫生—临床医学]