SPECT肾小球滤过功能显像在肾癌患者中的临床应用分析

Analysis of the clinical application of SPECT - based renal dynamic scintigraphy to evaluate glomerular filtration in patients with renal carcinoma

目的初步探讨单光子发射计算机断层成像（SPECT）肾动态显像测定肾小球滤过率（GFR）在肾癌患者中的临床应用价值。方法回顾性分析51例单侧肾癌患者术前及术后1个月应用SPECT肾动态显像测定GFR的结果。通过比较手术前后健侧肾、患肾及总肾GFR，观察手术后的代偿性变化及不同手术方式对患者肾功能状态的影响。结果肾根治性切除组术前双肾总GFR（72．75±10．85）ml／min，术后总GFR为（55．78±7．41）ml／min，手术前后比较差异有统计学意义（P〈0．05）。肾部分切除组术前双肾总GFR为（67．10±12．05）m]／min，术后双。肾总GFR为（62．33±10．09）ml／min，手术前后比较差异无统计学意义。对于术前健肾GFR〈35ml／min的患者，接受肾根治术者与接受保留肾单位的肾部分切除术的患者相比，更易出现术后肾功能不全加重。结论采用SPECT肾动态显像测定GFR评估肾癌患者分肾功能对手术方案的制定、监测术后肾功能方面有重要临床价值。

Objective To investigate the clinical application of single - photon emission computed tomography （SPECT） based renal dynamic scinfigraphy to evaluate glomerular filtration rate （GFR） in patients with renal carcinoma. Methods Retrospective analysis was performed using thc results of GFR determination from 51 patients with renal carcinoma before and one month after operation by SPECT - based renal dynamic scintigraphy. The GFRs in healthy, diseased, and both kidneys before and after surgery were compared. The effects of compensatory changes and different surgical methods on renal function were observed. Results For the radical resection group, the total GFR was （55.78 ± 7.41 ） ml/min after surgery, which was statistically different from the total GFR （72.75 ± 10.85） ml/min before operation （ P 〈 0.05 ）. For the partial resection group, the total GFR was （ 62.33 ± 10.09 ） ml/min after operation and （67.10± 12.05） mL/min before operation, without statistical difference. For those with 〈 35 mL/min GFR in healthy kidney before operation, radical surgery was more likely to cause deterioration in renal dysfunction, compared with partial resection. Conclusion SPECT - based renal dynamic scintigraphy is useful to assess renal function and facilitate the development of surgical protocols and renal function monitoring after surgery.