Section of Urology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA.
J Urol. 2010 May;183(5):1714-8. doi: 10.1016/j.juro.2010.01.007. Epub 2010 Mar 17.
We assessed the influence of renal ischemia on long-term global renal function after laparoscopic partial nephrectomy in patients with 2 functioning kidneys in a large, multicenter cohort.
Collected data included demographic, clinical and surgical characteristics, tumor parameters and renal function outcomes at 4 institutions in a total of 401 patients with 2 functioning kidneys who underwent laparoscopic partial nephrectomy. Renal function was assessed in the immediate postoperative period (days 1 to 3) and at last followup (greater than 1 month) using the estimated glomerular filtration rate calculated by the 4-variable Modification of Diet in Renal Disease equation. Ischemia time and covariates were modeled on the percent change in the estimated glomerular filtration rate using linear regression.
Median ischemia time was 29 minutes (IQR 22, 34). The postoperative change and the last (long-term) change in the estimated glomerular filtration rate were -16% and -11%, respectively. Median time to the last estimated glomerular filtration rate measurement was 13 months (IQR 6, 24). On multivariate analysis shorter ischemia and operative times, external or ureteral irrigation with cold saline and female gender were associated with less postoperative percent change in the estimated glomerular filtration rate. Smaller tumor size and absent diabetes were associated with less of a final percent change in the estimated glomerular filtration rate. Ischemia time was not associated with a percent change in the estimated glomerular filtration rate at last followup.
Within the range of times in these series renal ischemia did not have a clinically significant impact on global renal function in patients with 2 functioning kidneys who underwent laparoscopic partial nephrectomy, as measured by the estimated glomerular filtration rate.
我们评估了在 4 家机构的总共 401 例 2 个功能肾的患者中，腹腔镜肾部分切除术对长期整体肾功能的影响，这些患者均存在 2 个功能肾。
收集的数据包括人口统计学、临床和手术特征、肿瘤参数以及 401 例接受腹腔镜肾部分切除术的 2 个功能肾患者的 4 个机构的肾功能结果。使用 4 变量肾脏病饮食改良公式计算的肾小球滤过率估计值，在术后即刻（第 1 至 3 天）和最后一次随访（大于 1 个月）评估肾功能。使用线性回归对缺血时间和协变量进行建模，以估计肾小球滤过率的百分比变化。
中位缺血时间为 29 分钟（IQR22，34）。术后和最后（长期）肾小球滤过率估计值的变化分别为-16%和-11%。最后一次肾小球滤过率估计值测量的中位数时间为 13 个月（IQR6，24）。在多变量分析中，较短的缺血和手术时间、外部或输尿管冷盐水冲洗以及女性性别与术后肾小球滤过率估计值的百分比变化较小相关。肿瘤较小和无糖尿病与肾小球滤过率估计值的最终百分比变化较小相关。缺血时间与最后一次随访时肾小球滤过率的百分比变化无关。
在这些系列的时间范围内，肾缺血对接受腹腔镜肾部分切除术的 2 个功能肾患者的整体肾功能没有明显的临床影响，这是通过肾小球滤过率估计值来衡量的。
