肾部分切除术后术侧近期肾功能保留的相关因素分析

Relation factor analysis for the short-term preservation of ipsilateral renal function after partial nephrectomy

目的探讨肾部分切除术后术侧近期肾功能保留的相关因素。方法回顾性收集2014年12月至2019年12月在中山大学肿瘤防治中心泌尿外科接受肾部分切除手术的83例患者的临床资料。男性54例,女性29例,年龄[M(IQR)]49(17)岁(范围:27~74岁)。术中肾缺血时间25(18)min(范围:10~67 min)。患者于术前1个月内和术后3~12个月进行核素肾图扫描和CT扫描。基于CT扫描数据测量患者手术前后分肾肾组织体积,基于核素肾图结果计算分肾肾小球滤过率(GFR)。计算保留肾组织从缺血中恢复程度(术侧GFR保留率/术侧肾组织体积保留率×100%)。利用线性回归分析术侧近期肾功能保留的相关因素。结果术侧GFR保留率为80.9(22.5)%(范围:31.0%~109.4%),损失的GFR中,肾组织丢失造成的占12.0%[绝对值5.8 ml/(min×1.96 m^(2))],缺血损伤仅占6.5%[绝对值2.5 ml/(min×1.96 m^(2))]。术侧肾组织体积保留率为87.1(12.9)%(范围:27.0%~131.7%)。保留肾组织从缺血中恢复程度为93.5(17.5)%(范围:44.3%~178.3%)。多因素分析结果显示,术侧GFR保留率与术侧肾组织体积保留率呈正相关(β=0.383,95%CI:0.144~0.622,P=0.002),与缺血时间无关(β=0.046,95%CI:-0.383~0.475,P=0.831)。结论在有限的缺血时间下,肾部分切除术后近期术侧肾功能损失主要由肾组织丢失引起,缺血损伤只起次要作用。

Objectives To analyze the factors relative to the short-term preservation of ipsilateral renal function after partial nephrectomy.Methods The clinical data of 83 patients who were treated with partial nephrectomy from December 2014 to December 2019 in the Department of Urology,Sun Yat-sen University Cancer Center were retrospectively analyzed.There were 54 males and 29 females,aging(M(IQR))49(17)years(range:27 to 74 years).The ischemia time in operation was 25(18)minutes(range:10 to 67 minutes).Emission computed tomography scan and CT scan were performed before(within 1 month)and after(3 to 12 months)surgery.The volume of the ipsilateral and contralateral kidney was measured on the basis of preoperative and postoperative CT scans.The glomerular filtration rate(GFR)specifically in each kidney was estimated by emission computed tomography.Recovery from ischemia is determined by the formula:GFR preservation/volume saved×100%.Linear regression was used to explore the factors ralative to the short-term preservation of ipsilateral renal function after partial nephrectomy.Results The GFR preservation of the ipsilateral kidney was 80.9(25.2)%(range:31.0%to 109.4%).The volume loss of the kidney resulted in a decrease of 12.0%(5.8 ml/(min×1.96 m^(2)))of GFR,while the ischemic injury resulted in a decrease of 6.5%(2.5 ml/(min×1.96 m^(2)))of GFR.The volume saved from the ipsilateral kidney was 87.1(12.9)%(range:27.0%to 131.7%).Recovery from ischemia was 93.5(17.5)%(range:44.3%to 178.3%).In multivariate analysis,GFR preservation of the ipsilateral kidney was significantly correlated with the volume saved of the ipsilateral kidney(β=0.383,95%CI:0.144 to 0.622,P=0.002).It was not related to the ischemia time(β=0.046,95%CI:-0.383 to 0.475,P=0.831).Conclusion In the condition of limited ischemic time,in the short term ipsilateral renal function after partial nephrectomy is mainly determined by the loss of kidney volume,while ischemic injury only plays a minor role.