机器人辅助腹腔镜膀胱癌根治术后肾功能改变的观察  

Longitudinal investigation of changes in kidney function after robot-assisted radical cystectomy plus urinary diversion for bladder cancer

作　　者：郑玮 黄新冕 王帅[1,2] 祁小龙 刘锋[1,2] 张琦 张大宏[1,2] ZHENG Wei;HUANG Xinmian;WANG Shuai;QI Xiaolong;LIU Feng;ZHANG Qi;HANG Dahong(Department of Urology,Zhejiang Provincial People＇s Hospital,Hangzhou,310014,China;Department of Urology,People＇s Hospital of Hangzhou Medical College)

机构地区：[1]浙江省人民医院泌尿外科,杭州310014 [2]杭州医学院附属人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2018年第11期874-878,882,共6页Journal of Clinical Urology

基　　金：浙江省医药卫生科技项目(编号2016KYB009)

摘　　要：目的:观察机器人辅助腹腔镜膀胱癌根治术后肾功能的长期变化。方法:回顾性分析2014年9月～2017年12月行机器人辅助腹腔镜膀胱癌根治术的患者资料。分析术后慢性肾功能不全(CKD)的累积发生率和其独立危险因素。结果:共103例患者,中位随访时间16个月。术前已发生CKD的27例患者中20例(74.1%)观察到术后肾功能恢复。术前未发生CKD的76例患者术后1年和3年CKD累积发生率分别为38.9%和46.5%。不同尿流改道方式术后3年发生CKD的累积发生率分别为:原位回肠新膀胱21.0%,Bricker回肠膀胱82.4%,输尿管皮肤造口61.9%。术前未发生CKD的患者中,术后发生CKD组和未发生CKD组在术前贫血、术前eGFR水平、尿流改道方式、术后短期内eGFR水平方面差异有统计学意义(P<0.05)。其中术前eGFR水平(P=0.046)、尿流改道方式(P=0.002)、术后短期内eGFR水平(P<0.001)为术后发生CKD的独立危险因素。结论:机器人辅助腹腔镜膀胱癌根治性切除联合尿流改道术后发生CKD的情况并不罕见,术前/术后的eGFR水平和尿流改道方式与术后是否发生CKD相关。Objective：To investigate the incidence rate of chronic kidney dysfunction（CKD）among patients who have received robot-assisted radical cystectomy（RARC）after a long time follow-up for bladder cancer.Method：Data of patients who underwent surgery of RARC plus urinary diversion for bladder cancer between Sep.2014 and Dec.2017 were studied.Postoperative rate of CKD and the independent risk factors were analyzed.Result：At last,103 patients were enrolled in this retrospective study.The median follow-up period was 16 months.Twenty（74.1%）patients were observed recovery of kidney function among the 27 patients who had suffered CKD before surgery.The one-year and three-year cumulative incidence of CKD among the 76 patients whose eGFR was normal before surgery was 38.9%and 46.5%.As for different types of urinary diversion,three-year cumulative incidence of CKD was 21.0%,82.4% and 61.9%for orthotopic ileal neobladder,Bricker ileal conduit and cutaneous ureterostomy respectively.Clinical characteristics,including anemia,preoperative eGFR and eGFR value calculated in a short time after operation,were significantly different between CKD group and non-CKD group（P〈0.05）.And the preoperative eGFR（P=0.046）,type of urinary diversion（P=0.002）and eGFR value calculated in a short time after operation（P〈0.001）were the independent risk factors for CKD.Conclusion：The incidence of CKD after RARC was not rare.The indexes of preoperative eGFR,type of urinary diversion and eGFR value calculated in a short time after operation have a close relationship with the incidence of postoperative CKD.

关 键 词：膀胱癌 机器人辅助腹腔镜膀胱癌根治术 尿流改道 肾功能 预后 

分 类 号：R737.14[医药卫生—肿瘤]