根治性膀胱切除及尿流改道术后长期肾功能损害影响因素分析

Predictors for long-term renal function impairment following urinary diversion after radical cystectomy

目的:探讨根治性膀胱切除及尿流改道术后患者长期肾功能损害的影响因素。方法:回顾性分析我院泌尿外科2005年1月~2012年5月行根治性膀胱切除术及尿流改道术(UD)患者156例,其中原位新膀胱术组56例,回肠膀胱术组68例,输尿管皮肤造口术组32例,中位随访时间89(60~130)个月。Logistic回归分析影响肾功能损害的危险因素。收集患者的年龄、性别、术前术后肾小球滤过率(eGFR)、术前体重指数、高血压、糖尿病、泌尿系结石、术后肾积水、术后是否发生泌尿系感染等指标。结果:156例患者中,平均eGFR从(90.4±19.4)ml·min^(-1)·1.73m^(-2)下降至(71.2±19.4)ml·min^(-1)·1.73m^(-2),发生肾功能损害比例为41.7%,其中原位新膀胱术组25例,回肠膀胱术组27例,输尿管皮肤造口术组13例。多因素Logistic回归分析显示,高血压、糖尿病是术后肾功能损害的独立预测因素(均P<0.05),而年龄、尿流改道术式并非其独立预测因素。结论:根治性膀胱切除及尿流改道术后肾功能损害的发生率较高,合并高血压、糖尿病的患者术后更容易发生肾功能损害。应特别注意对潜在高危患者采取有效干预措施,以保护患者的术后肾功能。

Objective：To evaluate the predictors associated with long-term renal function impairment following urinary diversion（UD）after radical prostatectomy.Method：A total of 156 patients（56 neobladder substitution,68 ileal conduit and 32 cutaneous ureterostomy）who underwent UD after radical prostatectomy from January 2005 to May 2012 in our center were retrospectively reviewed.The median follow-up period was 89（range,60-130）months.Age,gender,preoperative and postoperative estimated glomerular filtration rate,the history of hypertension,diabetes,urinary calculi,hydronephrosis and urinary infection were collected.Univariate and multivariate logistic regression were used to analyze the predictors for renal function impairment.Result：The median eGFR values decreased from（90.4±19.4）ml·min-1·1.73 m-2 to（71.2±19.4）ml·min-1·1.73 m-2.The renal function impairment was observed in 65 patients（41.7%）.Renal function impairment was observed in 25,27 and 13 patients in the neobladder substitution,ileal conduit and cutaneous ureterostomy groups,respectively.Multivariate logistic regression analysis demonstrated that hypertension and diabetes mellitus were associated with renal function impairment.However,age and the type of UD were not associated with renal function impairment.Conclusion：Hypertension and diabetes were the independent predictors associated with long-term renal function impairment,so effective intervention measures should be necessary for those high risk patients in order to protect their renal function.