后腹腔镜下保留肾单位肾部分切除术后肾功能的影响因素分析  

Protection after Laparoscopic Partial Nephrectomy in Renal Units Reserved Postoperative Renal Function

作　　者：钟林[1] 王娟英[1] 宋斌[1] 杨帆[1] 许志斌[1] 罗丹[1] 张静[2] 付强[1] 

机构地区：[1]第四军医大学唐都医院泌尿外科,陕西西安710038 [2]第四军医大学唐都医院临床实验与检验输血科,陕西西安710038

出　　处：《现代生物医学进展》2014年第27期5264-5266,共3页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81001141)

摘　　要：目的：分析后腹腔镜下保留肾单位肾部分切除术后患肾肾功能的影响因素。方法：回顾性分析2011年5月~2013年10月本院收治的45例行后腹腔镜下肾部分切除术肾癌患者的临床资料,采用99mTc-DTPA肾核素扫描评估术前及术后3月术侧肾的肾小球滤过率（GFR）。结果：手术时间100~240min,平均（135±33.21）min。肾动脉阻断时间（20.01±7.35）min,肿瘤大小（3.05±1.24）cm。术前及术后3月术肾GFR分别是（46.53±6.35）、（32.22±4.65）ml/min。术侧肾术后GFR下降（15.36±2.36）ml/min,与术前相比下降约34%。经随访1月-2年,无复发及转移病例,患者全部无瘤生存。影响手术前后血肌酐水平变化的相关因素主要为手术时间、阻断时间、气流量、术中失血量（P〈0.05）;影响手术前后GFR水平变化的相关因素主要为阻断时间、气流量、手术时间（P〈0.01）。术前肾功能情况、缺血时间和肿瘤最大径是术侧肾功能下降程度的独立预测因子;术前肾功能情况和肿瘤最大径是总体肾功能下降程度的独立预测因子。结论：后腹腔镜下保留肾单位肾部分切除术后患肾肾功能的影响因素包括术前肾功能、手术时间、肾动脉阻断时间、气流量、术中失血量、肿瘤大小等。Objective： To study the influencing factors of renal function of affected side renal after retroperitoneoscopy partial nephrectomy retaining nephron. Methods： The clinical data of 45 patients with kidney cancer who were admitted from May 2011 to October 2013 and had taken laparoscopic partial nephrectomy were retrospectively analyzed. The kidney glomerular filtration rate（GFR）of affected side renal before and 3 months after operation was assessed using 99mTc-DTPA renal scintigraphy. Results： The operation time was 100~240min, on average（135±3.21） min. Renal artery occlusion time was（20.01±7.35） min. Tumor size was（3.05±1.24）cm. GFR of affected side renal before and 3 months after operation respectively were（46.53±6.35） and（32.22±4.65） ml/min. GFR of affected side renal declined（15.36±2.36） ml/min after surgery, and decreased by 34% compared with pre-operation. During a 1 month-2years follow-up visit, all patients survived with tumor-free and there was no recurrence and metastasis. The operation time, renal artery occlusion time, gas flow and blood loss volume intraoperative were the main influence factors of serum creatinine level before and after operation（P〈0.05）. The renal artery occlusion time, gas flow and operation time were the main influence factors of GFR level before and after operation（P〈0.01）. Renal function before surgery, ischemia time and tumor＇s largest diameter were independent predictors of the decline degree of total kidney function. Conclusion： The renal function before surgery, operation time, renal artery occlusion time, gas flow, blood loss volume intraoperative and tumor size were the influencing factors of kidney function of affected side renal after retroperitoneoscopy partial nephrectomy retaining nephron.

关 键 词：保留肾单位 肾功能保护 后腹腔镜 

分 类 号：R692.9[医药卫生—泌尿科学]