肾周脂肪厚度对预测腹腔镜肾部分切除术手术相关因素价值的研究

Increase perirenal fat predicts perioperative outcome following laparoscopic partial nephrectomy

目的探讨肾周脂肪厚度在预测腹腔镜下肾部分切除术（1aparoscopic partial nephrectomy,LPN）围手术期相关因素中的价值。方法回顾性分析2013年6月至2014年8月由本中心同一位外科医生完成的LPN 90例,结合其他相关资料（肿瘤大小、R.E.N.E.L.评分等）统计分析术前影像学检查测量的肾周脂肪厚度与围手术期参数（手术时间、热缺血时间、术后30d并发症情况）的相关性。结果 90例中术前影像学资料完善的共84例,平均手术时间为（143.93±60.11）min,平均热缺血时间为（24.44±7.68）min。84例中23例（27.4%）在术后30d内出现了不同程度的并发症,其中ClaveinⅠ-Ⅱ级并发症共17例（20.7%）,6例（6.7%）为Ⅲ~Ⅳ级并发症,无Ⅴ级并发症发生。肾周脂肪厚度于不同手术时间组存在显著性差异（P=0.003）;广义线性模型回归分析,肾周脂肪厚度是手术时间的独立影响因素（P〈0.001）,而非LPN热缺血时间以及术后并发症发生的独立影响因素。结论肾周脂肪厚度对于预测LPN手术时间具有价值,对热缺血时间、术后30d并发症发生率及其严重程度的预测尚需进一步研究。

Objective To investigate the perirenal fat in the prediction of laparoscopic partial nephrectomy in perioperative outcomes of value. Methods Retrospective analysis of 2013 June to2014August,laparoscopic completed by the center one single surgeon under laparoscopic partial nephrectomy,the image data of perirenal fat thickness measured before operation,combined with other related factor（tumor size,R.E.N.E.L.score）and perioperative outcomes（perioperative complications,operation time and warm ischemia time）for analysis. Results During the study period were reviewed 90 cases,the preoperative imagine of 84 cases is available,the average operation time was（143.93＋60.11）min,average warm ischemia time was（24.44＋7.68）min,84 cases in 17cases（20.7%）of gradeⅠ-Ⅱ complications occurred within 30 days after the operation,6cases（6.7%）developed gradeⅢ-Ⅳ complications,no gradeⅤ complications.Perirenal fat in different operation time group has significant difference（P=0.003）;regression and generalized linear models,perirenal fat were the independent factors affecting the operation time（P〈0.001）.Factors of perirenal fat is not warm ischemia time,postoperative complications are not independent effect. Conclusions The perirenal fat for partial renal predicts the operation time of LPN.Prediction of warm ischemia time and perioperative complications still need further study.