腹腔镜保留肾单位手术后急性肾损伤的危险因素分析及临床意义

Risk factors analysis and clinical significance of acute kidney injury after laparoscopic nephron sparing surgery

目的 分析肾脏肿瘤患者行腹腔镜保留肾单位手术(LNSS)后发生急性肾损伤(AKI)的相关危险因素。方法回顾性分析2010年1月—2022年9月在安徽医科大学第二附属医院泌尿外科接受LNSS治疗的442例肾脏患者的临床资料。AKI的诊断标准采用2012年KDIGO指南。根据患者术后是否发生AKI分为AKI组和非AKI组。统计2组患者的一般资料、术前血尿生物标志物数据、肾动脉阻断时间、肿瘤最大径、术后病理结果、RENAL评分等临床资料。采用logistic回归分析术后发生AKI的相关危险因素。结果 术后发生AKI的患者有129例,发生率为29.2%(129/442),其中AKIⅠ期115例(89.2%),Ⅱ期12例(9.3%),Ⅲ期2例(1.5%)。单因素分析结果显示,2组患者体重指数(BMI,P=0.018)、术前合并冠心病(P=0.042)、血清胱抑素C(CysC,P=0.004)、肾动脉阻断时间(P=0.006)、手术时间(P<0.001)、肿瘤最大径(P=0.003)、RENAL评分(P<0.001)比较,差异有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,术前合并冠心病(P=0.042)、血清CysC高(P=0.013)、手术时间长(P=0.004)和RENAL评分高(P<0.001)是术后AKI的独立危险因素。结论 LNSS术后发生AKI的相关危险因素有BMI、术前合并冠心病、血清CysC、肾动脉阻断时间、手术时间、肿瘤最大径、RENAL评分。对于合并以上危险因素的肾脏肿瘤患者,LNSS术前需格外关注并制定应对策略。

Objective To investigate the risk factors of postoperative acute kidney injury(AKI)after laparoscopic nephron sparing surgery(LNSS)in renal tumor patients.Methods Clinical data of 442 patients who received LNSS in Urology Department of the Second Affiliated Hospital of Anhui Medical University from January 2010 to September 2022 were retrospectively analyzed.The diagnosis of AKI according to the 2012 kidney disease improving global outcomes standard.Patients were divided into AKI group and non-AKI group according to whether they had postoperative AKI.Clinical parameters of the two groups were collected,including general data,preoperative blood and urine biomarker data,renal artery clamping time,maximum tumor diameter,pathology results,RENAL score,etc.The risk factors for AKI after LNSS were analyzed by univariate and multivariate logistic regression.ResultssThere were 129 patients with postoperative AKI,with an incidence of 29.2%(129/442),including 115 patients(89.2%)with stage I AKI,12 patients(9.3%)with stage II AKI and 2 patients(1.5%)with stage II AKI.The univariate analysis showed that there were significant differences in body mass index(BMI,P=0.018),preoperative coronary heart disease(P=0.042),serum cystatin C(CysC)level(P=0.004),renal artery clamping time(P=0.006),surgery time(P<0.001),maximum tumor diameter(P=0.003),and RENAL score(P<0.001)between the two groups(all P<0.05).Multivariate logistic regression analysis showed that preoperative coronary heart disease(P=0.042),high serum CysC level(P=0.013),long surgery time(P=0.004)and high RENAL score(P<0.001)were independent risk factors for AKI after LNSS.Conclusion The risk factors of AKI after LNSS include BMI,preoperative coronary heart disease,serum CysC level,renal artery clamping time,surgery time,maximum tumor diameter,and RENAL score.For renal tumor patients with the above risk factors,special attention and coping strategies should be given before LNSS.