代谢综合征对后腹腔镜保留肾单位手术围术期指标及术后肾功能的影响

Effect of metabolic syndrome on perioperative indicators and postoperative renal function in retroperitoneal laparoscopic nephron-sparing surgery

目的探讨代谢综合征(MS)对后腹腔镜保留肾单位手术(RLNSS)围术期指标及术后肾功能的影响。方法回顾性分析该院2014年1月至2020年8月行RLNSS的129例肾肿瘤患者的临床资料,将患者分为MS组(41例)与非MS组(88例),比较两组术前、术中、术后指标及术后1年内不同时间点肾小球滤过率(GFR)。结果MS组术前准备时间、手术时间及腹膜后引流管保留时间长于非MS组(P<0.05)。MS组美国麻醉医师协会(ASA)分级大于或等于3级患者比例、肾周脂肪粘连患者比例及肾恶性肿瘤患者比例高于非MS组(P<0.05)。MS组术后第1、4、7天血清GFR低于非MS组(P<0.05)。两组术后14 d内血清GFR组间总体均数不同,MS组低于非MS组(P=0.030)。多因素回归分析显示,MS是ASA分级大于或等于3级(OR=4.211,95%CI:1.381~12.838,P=0.011)、肾周脂肪粘连(OR=10.154,95%CI:3.215~32.075,P<0.001)、术前准备时间(β=2.581,P<0.001)、手术时间(β=39.004,P=0.003)及术后第4、7天血清GFR(β=-12.970、-11.693,P=0.012,0.021)的独立影响因素。结论MS对RLNSS患者的ASA分级、肾周脂肪粘连、术前准备时间、手术时间等围术期指标及术后早期肾功能有不利影响。

Objective To investigate the effect of metabolic syndrome(MS)on perioperative indicators and postoperative renal function in retroperitoneal laparoscopic nephron-sparing surgery(RLNSS).Methods The clinical data of 129 patients with renal tumor who underwent RLNSS in this hospital from January 2014 to August 2020 were retrospectively analyzed,and the participants were divided into the MS group(41 cases)and the non-MS group(88 cases).The preoperative,intraoperative,and postoperative indicators and glomerular filtration rate(GFR)at different time points within one year after RLNSS were compared between the two groups.Results Preoperative preparation time,operation time and retention time of retroperitoneal drainage tube in the MS group were longer than those in the non-MS group(P<0.05).The proportion of American Society of Anesthesiologists(ASA)classification≥3,adherent perinephric fat,and malignant tumor in the MS group were higher than those in the non-MS group(P<0.05).The serum GFR of the MS group was lower than that of the non-MS group at the time of 1,4 and 7 d after RLNSS(P<0.05).The over mean serum GFR levels between the two groups were different within 14 days after surgery,and the level in MS group was lower than that in non-MS group(P=0.030).Multiple regression analysis presented that MS was the independent predictor of ASA classification≥3(OR=4.211,95%CI:1.381-12.838,P=0.011),adherent perinephric fat(OR=10.154,95%CI:3.215-32.075,P<0.001),preoperative preparation time(β=2.581,P<0.001),operation time(β=39.004,P=0.003),serum GFR at the time of 4 d and 7 d after RLNSS(β=-12.970,-11.693,P=0.012,0.021).Conclusion MS adversely affected perioperative indicators including ASA classification,adherent perinephric fat,preoperative preparation time and operation time,as well as postoperative early renal function in patients undergoing RLNSS.