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目的:分析后腹腔镜下保留肾单位肾部分切除术后患肾肾功能的影响因素。方法:回顾性分析2011年5月~2013年10月本院收治的45例行后腹腔镜下肾部分切除术肾癌患者的临床资料,采用99mTc-DTPA肾核素扫描评估术前及术后3月术侧肾的肾小球滤过率(GFR)。结果:手术时间100~240min,平均(135±33.21)min。肾动脉阻断时间(20.01±7.35)min,肿瘤大小(3.05±1.24)cm。术前及术后3月术肾GFR分别是(46.53±6.35)、(32.22±4.65)ml/min。术侧肾术后GFR下降(15.36±2.36)ml/min,与术前相比下降约34%。经随访1月-2年,无复发及转移病例,患者全部无瘤生存。影响手术前后血肌酐水平变化的相关因素主要为手术时间、阻断时间、气流量、术中失血量(P<0.05);影响手术前后GFR水平变化的相关因素主要为阻断时间、气流量、手术时间(P<0.01)。术前肾功能情况、缺血时间和肿瘤最大径是术侧肾功能下降程度的独立预测因子;术前肾功能情况和肿瘤最大径是总体肾功能下降程度的独立预测因子。结论:后腹腔镜下保留肾单位肾部分切除术后患肾肾功能的影响因素包括术前肾功能、手术时间、肾动脉阻断时间、气流量、术中失血量、肿瘤大小等。
Objective: To analyze the influencing factors of renal function and renal function after retroperitoneal laparoscopic nephron nephrectomy. Methods: The clinical data of 45 patients undergoing laparoscopic partial nephrectomy in our hospital from May 2011 to October 2013 were retrospectively analyzed. 99mTc-DTPA nephron scintigraphy was used to evaluate the effect of preoperative and postoperative March renal glomerular filtration rate (GFR). Results: The operation time was 100 ~ 240min, with an average of (135 ± 33.21) min. Renal artery occlusion time (20.01 ± 7.35) min, tumor size (3.05 ± 1.24) cm. Preoperative and postoperative March renal GFR were (46.53 ± 6.35), (32.22 ± 4.65) ml / min. The GFR decreased after operation (15.36 ± 2.36) ml / min, which was about 34% lower than that before operation. After a follow-up of January to 2 years, no recurrence and metastasis, all patients with tumor-free survival. The main factors influencing the change of serum creatinine before and after surgery were operation time, occlusion time, air flow and intraoperative blood loss (P <0.05). The related factors influencing the change of GFR before and after surgery were blocking time, air flow, Operation time (P <0.01). Preoperative renal function, ischemic time and maximum diameter of the tumor were independent predictors of the degree of renal function decline; preoperative renal function and maximum diameter of the tumor were independent predictors of overall renal function decline. Conclusions: The factors influencing renal function after laparoscopic nephron nephrectomy include preoperative renal function, operation time, renal artery occlusion time, air flow, intraoperative blood loss, tumor size and so on.