开放性腹主动脉疾病手术中左肾静脉分离：倾向评分匹配病例对照研究。
Left renal vein division during open surgery of abdominal aortic disease: a propensity score-matched case-control study.
机构信息
Division of Vascular and Thyroid Surgery, First Hospital of China Medical University, China.
出版信息
Eur J Vasc Endovasc Surg. 2013 Aug;46(2):227-31. doi: 10.1016/j.ejvs.2013.04.028. Epub 2013 Jun 3.
OBJECTIVE
To investigate the impact of left renal vein division (LRVD) on the postoperative renal function of abdominal aortic aneurysm (AAA) or aortic occlusive disease (AOD).
METHODS
Between January 2000 and January 2012, 238 patients, including 179 AAAs and 59 AODs underwent open surgery in our institution (patients who required suprarenal aortic clamping were excluded). 49 patients (38 AAAs, 11 AODs) required LRVD during the operation. Patients in the LRVD and non-LRVD groups were matched using propensity score method in a 1:2 ratio. Pre- and postoperative renal function, major complications, in-hospital mortality and long-term renal function were compared. Late survival rate was estimated using the Kaplan-Meier method.
RESULTS
Overall, the LRVD group had a significantly higher male/female ratio (39/10 vs.122/67, p = .045), higher ruptured AAA ratio (36.7% vs. 20.1%, p = .014), higher American Society of Anesthesiologists (ASA) classification 3 (53.1% vs. 30.2%, p = .003), higher co-morbidities of coronary artery disease (51.0% vs. 33.3%, p = .022), higher preoperative shock (22.4% vs. 8.5%, p = .006) and longer operative time (164.2 ± 43 vs. 150.1 ± 41 min, p = .035). With propensity score matching (PSM), 48 patients in the LRVD group and 96 in the non-LRVD group were enrolled in this study. The baseline characteristics were well balanced in the groups (p < .05) after PSM. There were no statistically significant differences in preoperative glomerular filtration rate (GFR, expressed as mL/min/1.73 m(2)) (62.0 ± 13.1 vs. 62.9 ± 12.9, p = .695), and postoperative GFR on day 1 (60.3 ± 13.7 vs. 61.3 ± 13.1, p = .671), day 3 (54.6 ± 16.8 vs. 58.8 ± 14.3, p = .120), day 7 (62.1 ± 16.8 vs. 63.7 ± 13.4 p = .537) and in the long term (>12 months) (62.4 ± 14.0 vs. 64.7 ± 11.8 p = .302). There were no statistically significant differences in in-hospital mortality (6.3% vs. 9.2%, p = .522) and late survival rate estimated by the Kaplan-Meier method (p = .96).
CONCLUSION
LRVD may be a safe maneuver during abdominal aortic surgery as it did not increase the risks of early or late mortality and morbidity.
目的
探讨左肾静脉（LRVD）分离对腹主动脉瘤（AAA）或主动脉闭塞性疾病（AOD）术后肾功能的影响。
方法
2000 年 1 月至 2012 年 1 月，我院对 238 例患者（排除需行肾上主动脉夹闭的患者）进行了开放手术，包括 179 例 AAA 和 59 例 AOD。49 例（38 例 AAA，11 例 AOD）患者术中需要进行 LRVD。采用倾向评分法以 1:2 的比例将 LRVD 组和非 LRVD 组进行匹配。比较术前和术后肾功能、主要并发症、院内死亡率和长期肾功能。采用 Kaplan-Meier 法估计晚期生存率。
结果
总体而言，LRVD 组的男女比例（39/10 比 122/67，p =.045）、破裂性 AAA 比例（36.7%比 20.1%，p =.014）、美国麻醉医师协会（ASA）分级 3 级（53.1%比 30.2%，p =.003）、合并冠状动脉疾病（51.0%比 33.3%，p =.022）、术前休克（22.4%比 8.5%，p =.006）和手术时间（164.2 ± 43 比 150.1 ± 41 分钟，p =.035）均较高。经倾向性评分匹配（PSM）后，LRVD 组 48 例和非 LRVD 组 96 例患者纳入本研究。匹配后两组的基线特征差异无统计学意义（p <.05）。
PSM 后，两组患者术前肾小球滤过率（GFR，以 mL/min/1.73 m² 表示）（62.0 ± 13.1 比 62.9 ± 12.9，p =.695）、术后第 1 天（60.3 ± 13.7 比 61.3 ± 13.1，p =.671）、第 3 天（54.6 ± 16.8 比 58.8 ± 14.3，p =.120）、第 7 天（62.1 ± 16.8 比 63.7 ± 13.4，p =.537）和长期（>12 个月）（62.4 ± 14.0 比 64.7 ± 11.8，p =.302）的 GFR 差异均无统计学意义。两组患者的院内死亡率（6.3%比 9.2%，p =.522）和 Kaplan-Meier 法估计的晚期生存率（p =.96）差异均无统计学意义。
结论
LRVD 可能是一种安全的腹主动脉手术操作，因为它不会增加早期和晚期死亡率和发病率的风险。
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