腹腔镜下肾部分切除术后出现急性肾损伤的影响因素分析

Analysis of influencing factors of acute kidney injury after laparoscopic partial nephrectomy

目的探讨腹腔镜下肾部分切术后出现急性肾损伤的影响因素。方法回顾性分析2019年1月至2022年4月郑州大学第一附属医院泌尿外科收治的79例接受腹腔镜下肾部分切除术(LPN)的肾细胞癌(RCC)患者的临床资料,按照术后是否发生急性肾损伤(AKI)分为AKI组(n=20),和非AKI组(n=59)。通过病历系统收集患者年龄,性别,体质量指数(BMI),合并疾病(高血压、糖尿病),术前尿酸、尿素氮、热缺血时间(WIT)、肿瘤最大径以及术前、术后48 h内血清肌酐(Scr)等临床资料。采用单因素、多因素Logistic回归分析LPN术后AKI的发生因素,并采用受试者工作特征(ROC)曲线分析危险因素对LPN术后AKI发生的预测价值。结果79例接受LPN的RCC患者中,术后诊断为AKI的有20例(25.3%)。AKI组和非AKI组年龄(t=2.149,P=0.036)、BMI(t=2.221,P=0.029)、术前尿素氮(Z=3.734,P<0.001)、WIT(Z=4.300,P<0.001)、肿瘤最大径(Z=3.191,P<0.001)、术前Scr(t=3.628,P=0.001)、术后48 h内的Scr(t=8.474,P<0.001)比较差异均有统计学意义。而多因素logistic回归分析结果显示,WIT(P<0.001)、BMI(P=0.021)是LPN术后发生AKI的独立危险因素。ROC曲线分析结果示,BMI、WIT的截断值依次为25.15 kg/m 2、25.50 min,曲线下面积分别为0.651、0.822。结论BMI和WIT是LPN术后发生AKI的危险因素,并且具有一定的预测价值。

Objective To investigate the influential factors of acute kidney injury after laparoscopic partial nephrectomy.Methods The clinical data of 79 patients with renal cell carcinoma(RCC)treated with laparoscopic partial nephrectomy(LPN)admitted to the First Affiliated Hospital of Zhengzhou University from January 2019 to April 2022 were retrospectively analyzed.According to the occurrence of postoperative acute kidney injury(AKI),the patients were divided into the AKI group(n=20)and the non-AKI group(n=59).Clinical data such as age,sex,body mass index(BMI),co-morbidity(hypertension,diabetes),preoperative uric acid,urea nitrogen,warm ischemia time(WIT),maximum tumor diameter,serum creatinine(Scr)before and within 48 h after surgery were collected through the medical record system.Univariate and multivariate Logistic regression were used to analyze the risk factors for AKI after LPN,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of risk factors for AKI after LPN.Results Twenty(25.3%)of the 79 RCC patients treated with LPN were diagnosed with AKI after surgery.There were statistically significant differences in the age(t=2.149,P=0.036),BMI(t=2.221,P=0.029),preoperative urea nitrogen(Z=3.734,P<0.001),WIT(Z=4.300,P<0.001),maximum tumor diameter(Z=3.191,P<0.001),preoperative Scr(t=3.628,P=0.001),and postoperative Scr within 48 h after surgery(t=8.474,P<0.001).Multiple logistic regression analysis showed that WIT(P<0.001)and BMI(P=0.021)were independent risk factors for AKI after LPN surgery.ROC curve analysis results showed that the cut-off values of BMI and WIT were respectively 25.15 kg/m 2 and 25.50 min,and the area under the curve were respectively 0.651 and 0.822.Conclusion BMI and WIT are the risk factors for AKI after LPN surgery,and have the certain predictive value.