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目的:热缺血时间对肾部分切除术后肾功能的影响仍然存在争议,探讨热缺血时间对肾部分切除术后长期肾功能的影响。方法:回顾性研究海德堡大学医学院泌尿外科1984年8月~2011年7月收治75名孤立肾患者实施的83例肾部分切除术,评估热缺血时间、术前肾功能基线水平、切除的正常肾组织体积对术后长期肾功能水平和变化的影响。结果:平均术前肾功能57.41ml/min per 1.73m2,平均热缺血时间为18.04min,平均切除的正常肾组织体积为18.79cm3,平均随访时间69.39个月。多因素分析不同术前肾功能基线水平的各组在术后12个月时差异有统计学意义(P=0.01);围手术期的急性肾衰竭事件明显而持续影响术后的肾功能水平(12个月P=0.001,60个月P=0.03);而热缺血时间各分组和切除的正常肾组织体积与术后肾功能水平无关联。围手术期急性肾衰竭事件在术后12个月时明显影响术后肾功能的变化(P<0.01),切除的正常肾组织体积各组在整个随访期均保持显著差异(12个月P=0.03,36个月P<0.01,60个月P<0.01)。结论:术前肾脏质量和术后肾脏的体积是最重要的术后长期肾功能危险因素,术前肾功能基线水平决定术后肾功能的水平,术后存留的肾脏体积决定术后肾功能恢复的能力;围手术期急性肾衰竭事件是新发现的术后长期肾功能的风险因子;热缺血时间虽然与术后长期肾功能无直接关联,但可以通过增加围手术期急性肾衰竭事件的风险间接影响术后肾功能的水平和恢复能力。
OBJECTIVE: The effects of warm ischemic time on renal function after partial nephrectomy remain controversial, and investigate the effect of warm ischemia on long-term renal function after partial nephrectomy. Methods: A retrospective study of 83 patients who underwent partial nephrectomy in 75 solitary kidney patients from August 1984 to July 2011 in Department of Urology, Heidelberg Medical College of Urology was performed to assess the time of warm ischemia, the baseline preoperative renal function, resection Effect of normal renal tissue volume on long term renal function and postoperative changes. Results: The mean preoperative renal function was 57.41ml / min per 1.73m2, the average warm ischemia time was 18.04min. The average volume of normal renal tissue excised was 18.79cm3 with an average follow-up time of 69.39 months. Multivariate analysis showed that there was significant difference in the baseline levels of preoperative renal function between the two groups at 12 months after operation (P = 0.01). Perioperative acute renal failure significantly affected the postoperative renal function 12 months P = 0.001, 60 months P = 0.03). However, there was no correlation between the volume of normal renal tissue in each group and the number of resected normal renal tissue after thermal ischemia. Perioperative acute renal failure significantly affected postoperative renal function at 12 months (P <0.01). The volume of resected normal renal tissue remained significantly different throughout the follow-up period (P = 0.03, 36 months P <0.01, 60 months P <0.01). Conclusion: Preoperative renal mass and postoperative renal volume are the most important postoperative long-term risk factors for renal function. Preoperative baseline renal function determines the level of postoperative renal function. The postoperative residual volume of kidney determines postoperative renal function recovery Perioperative acute renal failure is a newly discovered risk factor of long-term postoperative renal function. Although the time of warm ischemia is not directly related to long-term postoperative renal function, it can be achieved by increasing the incidence of perioperative acute renal failure Risk indirectly affects postoperative renal function and recovery.