腹主动脉瘤开放手术中左肾静脉切断对患者术后肾功能的影响

Effects of left renal vein division on postoperative renal function during open repair of abdominal aortic aneurysm

目的探讨腹主动脉瘤开放手术中左肾静脉切断（LRVD）对患者术后肾脏功能及总体预后的影响。方法回顾分析中国医科大学附属第一医院2000年1月至2011年12月行开放手术治疗的腹主动脉瘤患者临床资料，分LRVD组和非LRVD组，对两组的30d死亡率、心脑血管并发症、肺部并发症、术前和术后肌酐值及肾小球率过滤（GFR），术中主动脉阻断时间、失血量、术后重症监护时间、需透析或连续肾脏替代疗法（CRRT）比例等指标做统计学分析。结果LRVD组患者35例，非LRVD141例；LRVD组的破裂性腹主动脉瘤比例较非LRVD组高（48．6％比27．7％，P〈0．01），但30d死亡率（14．3％比7．1％，P〉0．05）和主要并发症率（20．0％比11．3％，P〉0．05）差异无统计学意义；在存活的患者中，两组出院或30d肌酐和GFR的差异无统计学意义（P〉0．05）。结论腹主动脉瘤开放手术中LRVD并不增加患者术后死亡率和近期的肾功能损伤。

Objective To explore the effects of left renal vein division （LRVD） on postoperative renal function and examine the overall prognosis in patients undergoing open repair of abdominal aortic aneurysm （AAA）. Methods Retrospective analyses were conducted for the clinical data of AAA patients with open repair at our hospital from January 2000 to December 2011. They were divided into LRVD （ n = 35） and non-LRVD （n = 141 ） groups. The 30-day mortality, cardiocerebrovascular complications,pulmonary complications, preoperative and postoperative levels of creatinine and glomerular rate filtration （GFR） , aortic cross-clamping time, blood loss volume, intensive care duration and dialysis or continuous renal replacement therapy （CRRT） rate were compared between two groups. Results A total of 189 AAA repair were performed. And 13 patients with suprarenal clamping were excluded. The LRVD group had a significant higher proportion of ruptured AAA （48.6% vs 27.7% , P 〈 0. 01 ）, higher 3-day postoperative creatinine （ P 〈 0. 01 ）, longer intensive duration （ P 〈 0. 05 ） and decreased 3-day postoperative GFR （ P 〈 0. 01 ）. No significant difference existed in 30-day mortality, incidence of major complications, ereatinine or GFR at discharge （ P 〉 0. 05 ）. Conclusions LRVD during open surgery of AAA has no effect on the postoperative mortality and renal function.