Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
J Urol. 2011 Jul;186(1):53-8. doi: 10.1016/j.juro.2011.03.021. Epub 2011 May 14.
We assessed the change in unilateral renal function after laparoscopic partial nephrectomy to determine factors affecting the course and factors predicting the postoperative glomerular filtration rate decrease.
From prospectively collected data on 116 patients who underwent laparoscopic partial nephrectomy we evaluated the glomerular filtration rate of the operated kidney using diethylenetriaminepentaacetic acid scans done preoperatively, and 3 months, and 1, 2 and 3 years postoperatively. Kidney volume was measured from the arterial phase of dynamic computerized tomography of the kidney done before and 3 months postoperatively to calculate the volume reduction. We analyzed clinicopathological and operative factors with the potential to influence the perioperative glomerular filtration rate decrease.
In all patients the glomerular filtration rate was significantly decreased by 3 months postoperatively. It remained significantly lower compared to preoperative function despite the trend toward progressive recovery, which was noted until 3 years postoperatively. Recovery in individuals was significantly influenced by patient age (less than 55 vs 55 years or greater), medical comorbidities, tumor size (less than 2.5 vs 2.5 cm or greater), kidney volume reduction (less than 20% vs 20% or greater) and collecting system repair at surgery. Independent determinants of postoperative renal function were the preoperative glomerular filtration rate (β = 0.410, 95% CI 0.424-1.084; p <0.001), the percent of renal parenchymal volume reduction (β = 0.273, 95% CI 0.168-0.766; p = 0.003) and pelvicalyceal system repair (β = 0.284, 95% CI 2.960-15.788; p = 0.005).
Function of the kidney undergoing laparoscopic partial nephrectomy progressively recovers after a significant decrease immediately after surgery. Although recovery differs according to patient age, comorbidities and tumor size, factors that independently predicted the postoperative glomerular filtration rate decrease were the renal parenchymal volume reduction and pelvicalyceal system repair.
我们评估了腹腔镜肾部分切除术后单侧肾功能的变化，以确定影响病程的因素和预测术后肾小球滤过率下降的因素。
我们从前瞻性收集的 116 例行腹腔镜肾部分切除术患者的数据中，使用术前、术后 3 个月以及术后 1、2 和 3 年的二乙三胺五乙酸扫描评估手术肾脏的肾小球滤过率。术前和术后 3 个月的肾脏动态计算机断层扫描测量肾脏动脉期的肾脏体积，以计算体积减少。我们分析了有潜力影响围手术期肾小球滤过率下降的临床病理和手术因素。
在所有患者中，术后 3 个月肾小球滤过率均显著下降。尽管术后存在逐渐恢复的趋势，但与术前功能相比，仍显著降低，这种趋势一直持续到术后 3 年。个体的恢复明显受患者年龄（<55 岁与≥55 岁）、合并症、肿瘤大小（<2.5cm 与≥2.5cm）、肾脏体积减少（<20%与≥20%）和手术中集合系统修复的影响。术后肾功能的独立决定因素是术前肾小球滤过率（β=0.410，95%置信区间 0.424-1.084；p<0.001）、肾实质体积减少百分比（β=0.273，95%置信区间 0.168-0.766；p=0.003）和肾盂系统修复（β=0.284，95%置信区间 2.960-15.788；p=0.005）。
腹腔镜肾部分切除术后肾脏功能在术后立即显著下降后逐渐恢复。尽管恢复情况因患者年龄、合并症和肿瘤大小而异，但独立预测术后肾小球滤过率下降的因素是肾实质体积减少和肾盂系统修复。
