腹腔镜肾部分切除术后肾萎缩的影响因素分析

Analysis of influencing factors of renal atrophy after laparoscopic partial nephrectomy

目的探讨腹腔镜肾部分切除术后肾萎缩的影响因素,为预防和减少术后肾萎缩的发生提供依据。方法回顾性分析2016年7月至2019年10月该院泌尿外科行腹腔镜肾部分切除术的120例T1期肾癌患者临床资料,根据术后肾萎缩情况分为肾萎缩组和无肾萎缩组。记录两组临床资料,通过单因素和多因素logistic回归分析确定术后肾萎缩的独立影响因素,并通过受试者工作特征(ROC)曲线判断影响因素预测肾萎缩的临界值及其效能。结果与无肾萎缩组比较,肾萎缩组R.E.N.A.L评分更高、热缺血时间更长,残余肾实质体积比(PPV)更低,差异有统计学意义(P<0.05)。logistic回归分析表明PPV(OR=0.010,95%CI:0.001~0.144)为T1期腹腔镜肾部分切除术后肾萎缩的独立影响因素。ROC曲线结果表明当PPV为83.5%可作为腹腔镜肾部分切除术后肾萎缩的预测值,其灵敏度和特异度分别为74.5%和72.2%。结论R.E.N.A.L评分、热缺血时间及PPV与腹腔镜肾部分切除术后肾萎缩发生密切相关,当PPV低于83.5%可能发生术后肾萎缩。

Objective To investigate the influencing factors of renal atrophy after laparoscopic partial nephrectomy and provide basis for preventing and reducing the occurrence of renal atrophy.Methods A total of 120 T1 renal cancer patients underwent laparoscopic partial nephrectomy were enrolled for retrospective analysis in this hospital from July 2016 to October 2019.All the patients were divided into the renal atrophy group and the non-renal atrophy group.The clinical data of all patients were recorded,the independent influencing factors of postoperative renal atrophy were determined by univariate and multivariate logistic regression analysis,and receiver operating characteristic(ROC)curve was made to predict the efficacy of target influencing factors for renal atrophy.Results Compared with the non-renal atrophy group,the renal atrophy group had higher R.E.N.A.L scores,longer warm ischemia time,and lower percent of preserved normal parenchymal volume(PPV),the difference was statistically significant(P<0.05).Furthermore,logistic regression analysis showed that PPV(OR=0.010,95%CI:0.001-0.144)was an independent influencing factor of renal atrophy after laparoscopic partial nephrectomy in patients with T1 renal cancer.ROC curve results demonstrated that a PPV value of 83.5%could be used as a predictor of renal atrophy after laparoscopic partial nephrectomy with the sensitivity of 74.5%and the specificity of 72.2%,respectively.Conclusion The RENAL score,warm ischemic time and PPV are closely related to the renal atrophy after laparoscopic partial nephrectomy,and the renal atrophy may be occurred when PPV is less than 83.5%.