Sharma Nidhi, O'Hara Jerome, Novick Andrew C, Lieber Michael, Remer Erick M, Herts Brian R
Department of Diagnostic Radiology, Cleveland Clinic, Cleveland 44195, USA.
J Urol. 2008 Apr;179(4):1284-8. doi: 10.1016/j.juro.2007.11.071. Epub 2008 Feb 20.
We assessed the correlation between reduced renal function and parenchymal volume following partial nephrectomy.
In 21 of 42 patients with tumors in a solitary kidney who were enrolled in a study measuring function before and after surgery underwent computerized tomography, and measurement of the glomerular filtration rate and estimated glomerular filtration rate (the latter at baseline and 2 to 6 months) before and after surgery. A segmentation algorithm was used to measure renal parenchymal volume. The percent of renal parenchymal volume loss was correlated with the percent loss in glomerular filtration rate using the Pearson correlation coefficient.
Mean +/- SD net preoperative volume was 284 +/- 67 cc (range 179 to 413) and mean net postoperative volume was 240 +/- 61 cc (range 119 to 346) with an absolute functional volume loss of between 5 and 160 cc. The average percent of parenchymal volume loss was 15% (range -2% to 47%). The mean loss of the measured glomerular filtration rate 3 days postoperatively was 33.9% (range -70.7% to 74.4%) and the estimated glomerular filtration rate 2 to 6 months postoperatively was 19.7 % (-6.0% to 45.5%). There was a low degree of correlation between the percent volume loss and the percent measured glomerular filtration rate loss at 3 days (r = 0.28, p = 0.22). However, there was a moderate degree of correlation between the percent volume loss and the percent estimated glomerular filtration rate loss at 2 to 6 months (r = 0.48, p = 0.03).
In patients with partial nephrectomy the renal parenchymal volume loss correlates best with the renal function loss several months after surgery. Estimates of volume loss may be useful for predicting postoperative renal function when planning partial nephrectomy in patients with a solitary kidney.
我们评估了肾部分切除术后肾功能降低与实质体积之间的相关性。
在42例单肾肿瘤患者中，21例患者参加了一项手术前后肾功能测量的研究，术前行计算机断层扫描，并在手术前后测量肾小球滤过率和估算肾小球滤过率（后者在基线时以及术后2至6个月测量）。使用分割算法测量肾实质体积。使用Pearson相关系数将肾实质体积损失百分比与肾小球滤过率损失百分比进行相关性分析。
术前平均净体积为284±67 cc（范围179至413），术后平均净体积为240±61 cc（范围119至346），绝对功能体积损失在5至160 cc之间。实质体积损失的平均百分比为15%（范围-2%至47%）。术后3天测量的肾小球滤过率平均损失为33.9%（范围-70.7%至74.4%），术后2至6个月估算肾小球滤过率平均损失为19.7%（-6.0%至45.5%）。术后3天体积损失百分比与测量的肾小球滤过率损失百分比之间存在低度相关性（r = 0.28，p = 0.22）。然而，术后2至6个月体积损失百分比与估算肾小球滤过率损失百分比之间存在中度相关性（r = 0.48，p = 0.03）。
在接受肾部分切除术的患者中，肾实质体积损失与术后数月的肾功能损失相关性最佳。在为单肾患者计划肾部分切除术时，体积损失估计可能有助于预测术后肾功能。
