机器人辅助腹腔镜根治性膀胱切除术+体内或体外尿流改道术后的肾功能变化及其危险因素分析  

Analysis of renal function changes and associated risk factors following robot assisted radical cystectomy with intracorporeal or extracorporeal urinary diversion

作　　者：王昊 王文帝 方昌华 赵康康 陈天一 张成伟 张士伟[1] 郭宏骞[1] 张古田[1] Wang Hao;Wang Wendi;Fang Changhua;Zhao Kangkang;Chen Tianyi;Zhang Chengwei;Zhang Shiwei;Guo Hongqian;Zhang Gutian(Department of Urology,Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;?Department of Urology,Nanjing Drum Tower Hospital,Medical School of Southeast University,Nanjing 210003,China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,南京210008 [2]东南大学医学院南京鼓楼医院泌尿外科,南京210003

出　　处：《微创泌尿外科杂志》2024年第4期265-272,共8页Journal of Minimally Invasive Urology

摘　　要：目的:评估膀胱癌患者行机器人辅助腹腔镜根治性膀胱切除术(RARC)+体内或体外尿流改道(UD)术后的肾功能变化及其危险因素。方法:回顾性分析2016年5月至2021年8月在南京大学医学院附属鼓楼医院行RARC+UD的266例膀胱癌患者的临床资料,其中男232例,女34例,平均年龄(67.4±9.4)岁,原位新膀胱84例,回肠膀胱182例。通过估算的肾小球滤过率(eGFR)评估患者术后长期肾功能变化。采用Logistic回归评估肾功能损伤的危险因素。结果:根据尿流改道过程中肠管处理的手术入路不同,将266例患者分为体外尿流改道(ECUD)组(79例)和体内尿流改道(ICUD)组(187例)。ECUD组与ICUD组的平均手术时长比较差异无统计学意义(P=0.080);ICUD组平均手术估计失血量[(303.5±116.5)ml]少于ECUD组[(379.8±233.2)ml],差异有统计学意义(P=0.007)。ECUD组术后第1、2、3年的平均eGFR分别为(92.3±26.5)、(90.4±26.5)、(88.1±28.3)ml/(min·1.73m^(2)),ICUD组分别为(98.9±23.3)、(97.3±23.3)、(95.7±23.5)ml/(min·1.73m^(2)),两组比较差异均有统计学意义(P值分别为0.042、0.034、0.037)。随访期内共有112例(42.1%,112/266)患者出现长期肾功能损伤,其中12例(4.5%,12/266)进展至慢性肾脏病(CKD)3B期及以上,ECUD组9例(11.4%)、ICUD组3例(1.6%),两组比较差异有统计学意义(P<0.001)。根据术后随访期间是否发生长期肾功能损伤将患者分为肾损伤组和未发生肾损伤组,对两组患者的临床资料进行单因素分析,年龄(P=0.007)、手术入路(P<0.001)、输尿管肠吻合口狭窄(P<0.001)、病理分期T3期及以上(P<0.001)、术后肾积水(P=0.006)、估计出血量(P=0.007)因素差异均有统计学意义;多因素分析显示不同手术入路(OR=0.24,95%CI:0.12~0.46,P<0.001)、输尿管肠吻合口狭窄(OR=4.37,95%CI:1.32~14.45,P=0.016)、病理分期T3期及以上(OR=6.21,95%CI:3.20~12.07,P<0.001)为术后发生长期肾功能损伤的独立危险因素。随访期内共30例(11.3%)患�Objective:To analyze renal function changes and associated risk factors in bladder cancer patients underwent robot assisted radical cystectomy(RARC)with intracorporeal or extracorporeal urinary diversion(UD).Methods:The clinical data of 266 patients with bladder cancer who underwent RARC+UD in Drum Tower Hospital Affiliated to Nanjing University Medical School from May 2016 to August 2021 were retrospectively analyzed.There were 232 males and 34 females,the average age were(67.4±9.4)years,84 cases of orthotopic neobladder(ON)and 182 cases of ileal conduit(IC).Long-term changes in renal function postoperatively were assessed via estimated glomerular filtration rate(eGFR).Logistic regression was utilized to identify risk factors for renal function injury.Results:The patients were divided into extracorporeal urinary diversion(ECUD)group and intracorporeal urinary diversion(ICUD)group based on different surgical approaches to bowel handling during urinary diversion.The average operative duration between the two groups had no significant difference(P=0.080),with less average estimated blood loss in the ICUD group[(303.5±116.5)ml]than that in the ECUD group[(379.8±233.2)ml],the difference was statistically significant(P=0.007).The eGFR at 1,2 and 3 years postoperatively in the ECUD group were(92.3±26.5),(90.4±26.5)and(88.1±28.3)ml/(min·1.73 m^(2)),respectively;and in the ICUD group were(98.9±23.3),(97.3±23.3)and(95.7±23.5)ml/(min·1.73 m^(2)),respectively,and there were all statistically significant differences between the two groups(P=0.042,0.034,0.037).During the follow-up period,a total of 112 patients(42.1%,112/266)experienced long-term renal function injury,with 12 cases(4.5%,12/266)progressing to chronic kidney disease(CKD)3B or above,including 9 cases(11.4%)in the ECUD group and 3 cases(1.6%)in the ICUD group,showing statistically significant difference(P<0.001).Patients were categorized into renal injury group and non-renal injury group based on the presence or absence of long-term renal function inju

关 键 词：膀胱癌 机器人辅助腹腔镜根治性膀胱切除术 尿流改道 急性肾损伤 慢性肾脏病 

分 类 号：R737.14[医药卫生—肿瘤] R699.5[医药卫生—临床医学]