单中心肾癌外科手术治疗后患者肾功能改变的长期随访观察

Long-term follow-up of patients with renal function changes after renal cell carcinoma surgical treatment in a single center

目的:观察我院单中心肾癌患者外科手术治疗后肾功能不全的发生情况,探讨患者发生肾功能不全的危险因素。方法:回顾性分析2003年1月~2014年11月我院进行肾癌外科手术治疗的患者资料,排除术前肾功能不全,获得术前肾功能正常且有随访的病例资料,以简化MDRD公式估算GFR(estimated GFR,eGFR)代替GFR,eGFR<60ml/(min·1.73 m^2)判断为慢性肾功能不全(chronic kidney dysfunction,CKD),用KaplanMeier分析分析肾癌手术后CKD的发生率,秩和检验、χ~2检验对CKD组与未发生CKD组进行单因素比较,多因素Logistic同归分析判断肾癌外科手术治疗后发生CKD的独立危险因素。结果:根治性肾切除术的67例患者中40例术后肾功能正常,27例患者术后发生了CKD,术后CKD累积发生率为40.3%;保留肾单位手术的41例患者中33例术后肾功能正常,8例患者术后发生了CKD,术后CKD累积发生率为19.5%。结论:年龄、术前GFR、手术方式、术后1周内GFR均为术后出现CKD的危险因素。对于NSS手术来说除上述危险因素外还有术中热缺血时间以及肿瘤的大小也是影响术后出现CKD的危险因素。

Objective： To study the risk factors of renal dysfunction in patients after radical nephrectomy （RN） or partial nephrectomy （PN） by collecting the patients＇ data who recived surgical treatment in our hospital. Method： A retrospective analysis of patients＇ data who recived RN or PN from January 2003 to November 2014 was made. Patients with renal dysfunction before operation were excluded. Chronic kidney dysfunction （CKD） was diagnosed by using modified MDRD formula. The incidence of CKD was analyzed by Kaplan-Meier method. The single factor of CKD and non-CKD were analyzed by rank test and χ^2 test for comparison between CKD group and non-CKD group. The independent risk factor of CKD was analyzed by multivariate logistic regression. Result： Sixty-seven cases underwent RN. Normal renal function was seen in 40 of them after operation, and other 27 cases were found CKD. Postoperative CKD cumulative incidence after RN was 40.3%. On the other hand, 41 cases received nephron-sparing surgery （NSS）. Thirty-three cases experienced normal, renal function after operation, and eight cases were diagnosed as CKD. CKD postoperative cumulative incidence after NSS was 19.5%. Conclusion： Age, preoperative GFR, operation mode, postoperative GFR within one week after operation are the risk factors of CKD after operation. Besides the above risk factors, warm ischemia time and the size of tumos are also considered as risk factors of CKD after NSS.