热缺血时间对腹腔镜肾部分切除术后肾功能的影响  

Impact of warm ischemia time during partial nephrectomy on laparoscopic postoperative renal function

作　　者：韩松辰 宋宇轩 戴翔 张维宇[1] 杜依青 刘慧鑫[1] 徐涛[1] Han Songchen;Song Yuxuan;Dai Xiang;Zhang Weiyu;Du Yiqing;Liu Huixin;Xu Tao(Department of Urology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院泌尿外科,北京100044

出　　处：《中华泌尿外科杂志》2022年第5期350-354,共5页Chinese Journal of Urology

摘　　要：目的评估热缺血时间(WIT)对腹腔镜肾部分切除术后肾功能的影响。方法回顾性分析2010年1月至2020年10月北京大学人民医院344例接受腹腔镜肾部分切除术患者的临床资料。男240例,女104例;中位年龄57(23~89)岁;中位体质指数25.6(16.7~36.0)kg/m^(2);213例伴高血压病,66例伴糖尿病;92例有吸烟史。术前肌酐中位值73(32~170)μmol/L;术前估算肾小球滤过率(eGFR)中位值95(33~142)ml/(min·1.73m^(2))。肿瘤最大径中位值2.5(7~9)cm。344例均行腹腔镜肾部分切除术,肾动脉阻断方式均为热缺血。使用限制性立方样条回归分析评估WIT与术后eGFR变化百分比[(术后eGFR-术前eGFR)/术前eGFR×100%]的相关性。根据术中WIT将患者分为WIT<20 min组、20 min≤WIT<30 min组和WIT≥30 min组,比较3组的临床资料,并采用协方差分析法对术前eGFR和肿瘤直径进行校正。结果344例均顺利完成手术。术后病理提示透明细胞癌299例,乳头状肾细胞癌22例,嫌色细胞癌11例,其他病理类型12例;病理分期T_(1a)期318例,T1b期18例,≥T_(2a)期8例。344例中WIT<20min组119例,20min≤WIT<30min组146例,WIT≥30min组79例,3组肿瘤最大径[2.1(0.7~5.0)cm与2.8(0.8~6.0)cm与3.0(0.9~9.0)cm]及术后6~12个月eGFR变化百分比[-3.3%(-29.3~43.8)%与-8.5%(-65.0~75.9)%与-9.3%(-42.5~27.7)%]差异均有统计学意义(P<0.05)。限制性立方样条回归分析结果显示,随着WIT增加,术后eGFR变化百分比逐渐下降,在30min后曲线逐渐趋于平稳(R^(2)=0.044,P=0.015)。协方差分析结果显示,对术前eGFR基线和肿瘤最大径进行校正后,WIT<20 min组术后eGFR显著高于20 min≤WIT<30 min组(P=0.009)和WIT≥30 min组(P=0.017)。20 min≤WIT<30 min组与WIT≥30 min组术后eGFR差异无统计学意义(P=0.806)。结论肾部分切除术中,WIT<20min的患者术后eGFR水平高于WIT≥20min患者。而当WIT超过20min后,缺血时间的延长不会造成肾功能的进一步下降。Objective To assess the association between warm ischemia time(WIT)and renal function in patients undergoing laparoscopic partial nephrectomy.Methods A total of 344 patients treated with laparoscopic partial nephrectomy in Peking University People’s Hospital were included.There were 240 males(69.8%)and 104 females(30.2%)with a median age of 57(23-89)years.The median BMI was 25.6(16.7-36.0)kg/m^(2).213 cases(61.9%)were associated with hypertension.There were 66(19.2%)patients with diabetes mellitus.There were 92 cases(26.7%)with smoking history.The median preoperative creatinine was 73(32-170)μmol/L.The median preoperative estimated glomerular filtration rate(eGFR)was 95(33-142)ml/(min·1.73m^(2)).The maximum diameter of the tumor was 2.5(7-9)cm.314(91.3%)patients with renal cancer stage T1.All patients underwent warm ischemia during the operation.The patients were divided into three groups for analysis.Restricted cubic spline regression analysis was used to assess the association between WIT as a continuous variable and percentage change of eGFR.Analysis of covariance was used to compare postoperative eGFR among the three groups,and to adjust for preoperative eGFR and tumor diameter.Results There were statistically significant differences in the percentage change of postoperative eGFR(P=0.009)and tumor diameter(P<0.001)among the three groups.Restricted cubic spline regression analysis showed that with the prolongation of WIT,the percentage change of postoperative eGFR gradually decreased,and the curve began to stabilize after 30 minutes(R^(2)=0.044,P=0.015).The results of covariance analysis showed that after adjusting for baseline preoperative eGFR and tumor size,the effect of WIT on postoperative eGFR was significantly different among the three groups(F=3.864,P=0.022).The postoperative eGFR in the WIT<20 min group was significantly higher than that in 20 min≤WIT<30 min group(P=0.009)and WIT≥30 min group(P=0.017).There was no significant difference in postoperative eGFR between the two groups with longer

关 键 词：肾肿瘤 癌 肾部分切除术 热缺血时间 肾功能 

分 类 号：R737.11[医药卫生—肿瘤]