肾癌患者微创根治术后肾功能改变的动态观察

The dynamic observation of changes in renal function after laparoscopic radical nephrectomy

目的：探讨腹腔镜肾癌根治术后肾功能的变化趋势及影响因素。方法：320例肾癌患者行腹腔镜肾癌根治术后失访34例,286例患者进行统计分析。随访期间患者估计肾小球滤过率（estimated glomerular filtration rate,eGFR）的变化采用回归分析,患者预后的影响因素行多因素logistic回归分析。结果：术后第3、6、9、12、24、36、48、60个月,患者eGFR值为72.8、73.6、74.2、74.8、75.3、76.2、76.5、78.3 ml/min·（1.73 m^2）^-1;术后3个月时,eGFR为最低点,随后开始逐渐升高。术后2、3、4、5、6年,逐年分层回归的斜率β值为0.129、0.117、0.096、0.093、0.088,呈逐年恢复态势。年龄（≤50岁：χ^2=8.753,P〈0.05;51-65岁：χ^2=4.474,P〈0.05）、高血压（χ^2=4.837,P〈0.05）、糖尿病（χ^2=5.536,P〈0.05）是腹腔镜肾癌根治术肾癌患者预后的影响因素。结论：腹腔镜肾癌根治术后患者的肾功能呈恢复趋势,其中低龄、不伴有高血压与糖尿病的患者肾功能恢复良好。

Objective： To investigate the variation trend and influence factors of renal function after laparoscopic radical nephrectomy. Methods： Three hundred and twenty patients with renal cancer after laparoscopic radical nephrectomy were followed up and34 cases were lost,thereby 286 cases were analyzed in the present study. The changes of estimated glomerular filtration rate（ eGFR）were analyzed by hierarchical regression analysis,and their influence factors were analyzed by the multivariate logistic regression analysis. Results： The levels of eGFR were 72. 8,73. 6,74. 2,74. 8,75. 3,76. 2,76. 5,78. 3 ml·min^-1·（ 1. 73m^2）-1at 3,6,9,12,24,36,48 and 60 months after laparoscopic radical nephrectomy. The level of eGFR was the lowest at 3 months after laparoscopic radical nephrectomy,then gradually rose. It suggested the level of eGFR increased with time increasing. The slopes（ β） for the relationship between the eGFR and the time were 0. 129,0. 117,0. 096,0. 093 and 0. 088 at 2,3,4,5 and 6 years after laparoscopic radical nephrectomy. The influence factors of the changes in renal function after laparoscopic radical nephrectomy were age（ ≤50 years old： χ^2= 8. 753,P〈0. 05; 51-65 years old： χ^2= 4. 474,P〈0. 05）,hypertension（ χ^2= 4. 837,P〈0. 05） and diabetes（ χ^2= 5. 536,P〈0. 05）. Conclusions： The renal function is in a recovery trend during the follow up after laparoscopic radical nephrectomy. The renal function recovers well when patients are young without diabetes or hypertension.