肾部分切除术后急性肾损伤及其对手术侧肾脏的远期影响  

Acute kidney injury after partial nephrectomy and its long-term impact on the operated kidney

作　　者：张志凌[1] ZHANG Zhiling(Department of Urology,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心泌尿外科,广东广州510060

出　　处：《现代泌尿外科杂志》2024年第9期766-770,共5页Journal of Modern Urology

摘　　要：肾部分切除术是治疗局限性小肾癌的首选方法,但手术过程中通常需要暂时阻断肾动脉,不可避免地引发缺血再灌注损伤,严重者甚至发生急性肾损伤。肾部分切除术后急性肾损伤的诊断常采用急性肾损伤网络标准(AKIN)和风险、损伤、失败、损失、终末期肾脏疾病标准(RIFLE),但使用总肌酐升高水平来评估单侧肾损伤显然不够准确;另外,肾部分切除术中会丢失部分正常肾组织,也导致血肌酐升高。为避免上述因素对诊断造成干扰,笔者首先改良了孤立肾肾部分切除术后急性肾损伤诊断分级方法,提出了诊断肾部分切除术后的急性肾损伤需要考虑到正常肾组织丢失引起的血肌酐升高。接着采用“极端值法”量化了非孤立肾患者手术侧肾脏急性肾损伤的程度。最后还探讨了急性肾损伤对手术侧肾脏的远期影响以及减轻肾部分切除术中缺血再灌注肾损伤的潜在方法。Partial nephrectomy(PN)is the optimal treatment of localized small renal masses.In most cases,PN is performed with renal artery occlusion to maintain clear visualization,which leads to ipsilateral ischemia reperfusion injury and acute kidney injury(AKI)in severe cases.AKI after PN is generally evaluated with AKIN or RIFLE criteria.However,the increased level of total creatinine is clearly not accurate enough to assess unilateral kidney injury,because unilateral injury and loss of normal renal parenchyma also induce increase of serum creatinine.In order to avoid the interference of the above factors to the diagnosis,we modified AKI criteria in renal cancer patients with solitary kidney and emphasized that the role of parenchymal mass reduction should always be considered during AKI evaluation.We used“Extreme Value Theory”and quantified the degree of AKI in renal cancer patients who have a functional contralateral kidney.Furthermore,we discussed the long-term impact of AKI on the operated kidney and potential methods to alleviate ischemic injury during PN.

关 键 词：肾癌 肾部分切除术 缺血时间 肾功能 急性肾损伤 急性肾损伤网络标准(AKIN) 风险、损伤、失败、损失、终末期肾脏疾病标准(RIFLE) 

分 类 号：R692[医药卫生—泌尿科学]