高龄患者肾切除术后留存肾功能状态

Renal function status of residual kidney after nephrectomy in the elderly

目的探讨高龄患者肾切除后留存肾的功能状态。方法采用放射性核素肾动态显像法测定24例70岁以上高龄患者(高龄组)和20例21～59岁亲体移植供肾者(对照组)肾小球滤过率(GFR)和有效肾血浆流量(ERPF),螺旋CT扫描计算肾脏体积。检测手术前后的血清肌酐(Cr)值。结果与术前比较,高龄组术后GFR值增加了24.5%(P<0.01),ERPF值增加了11.6%(P<0.05)。留存肾重量术后较术前略有增加。对照组术前双肾GFR、ERPF均明显高于高龄组(P<0.01)。高龄组中术后有8例逐渐出现肾功能不全,其中2例发展为尿毒症;对照组术后肾功能均正常。结论高龄患者在一侧肾切除术后,留存肾照样可以代偿性增长,但其代偿能力要比年轻者差。

Objective To follow up the renal function status of residual kidney after nephrectomy in the elderly.Methods In 24 patients aged over 70 years old（group A） and 20 cases aged 21 to 59 years old underwent nephrectomy,glomerular filtration rate（GFR） and effective renal plasma flow（ERPF） were detected using radionuclide dynamic renal imaging and kidney volume was calculated using helical CT scan.Serum creatinine（SCr） was detected before and after surgery.ResultsCompared to before,GFR and ERPF of residual kidney after nephrectomy in group A were increased by 24.5%（P0.01） and 11.6%（P0.05）,respectively.The weight of residual kidney was increased a little.GFR and ERPF before surgery were higher in group B than those in group A（P0.01）.Renal dysfunction in group A occurred in 8 patients,of whom 2 cases developed renal failure.Conclusion In aged patients underwent nephrectomy,the residual kidney is able to have compensatory renal growth,but the ability of compensation is much lower than that in the youngers.