Choi Yong Sun, Park Yong Hyun, Kim Yong-June, Kang Seok Ho, Byun Seok-Soo, Hong Sung-Hoo
Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Int Urol Nephrol. 2014 Apr;46(4):681-6. doi: 10.1007/s11255-013-0534-8. Epub 2013 Sep 27.
To evaluate which factors affecting changes in postoperative renal function after conducting radical nephrectomy or partial nephrectomy.
Data on patients who underwent operations for renal cell carcinoma between 2000 and 2010 at multiple institutions were collected. Patient characteristics including preoperative estimated glomerular filtration rate (EGFR) were investigated, and types of surgery and postoperative results were evaluated. Renal insufficiency was defined as an EGFR <60 ml/min/1.73 m(2). Cox proportional hazard regression analysis was used to investigate which factors were associated with chronic renal insufficiency after surgery.
A total of 2,454 patients were included for evaluation; 1,502 patients underwent radical nephrectomy, whereas 952 patients underwent partial nephrectomy. The mean follow-up period was 44.48 ± 27.04 months (range, 12-120 months). Factors affecting EGFR were age, diabetes, hypertension, surgical procedure, and preoperative creatinine level (p < 0.001). Factors affecting postoperative renal insufficiency were age, surgical procedure, serum creatinine level, and EGFR.
The risk for developing post-nephrectomy renal insufficiency in patients who underwent radical nephrectomy was higher than those who underwent partial nephrectomy. Factors affecting post-nephrectomy renal insufficiency were age, preoperative serum creatinine level, and preoperative EGFR. In addition to radical nephrectomy, patient >58 years with a preoperative serum creatinine >1.03 mg/ml, and EGFR <73 ml/min/1.73 m(2) had a higher probability of developing post-nephrectomy chronic renal insufficiency.
评估根治性肾切除术或部分肾切除术后影响肾功能变化的因素。
收集2000年至2010年间多家机构接受肾细胞癌手术患者的数据。调查患者特征，包括术前估计肾小球滤过率（EGFR），并评估手术类型和术后结果。肾功能不全定义为EGFR<60 ml/min/1.73 m²。采用Cox比例风险回归分析来研究哪些因素与术后慢性肾功能不全相关。
共有2454例患者纳入评估；1502例患者接受了根治性肾切除术，而952例患者接受了部分肾切除术。平均随访期为44.48±27.04个月（范围12 - 120个月）。影响EGFR的因素有年龄、糖尿病、高血压、手术方式和术前肌酐水平（p<0.001）。影响术后肾功能不全的因素有年龄、手术方式、血清肌酐水平和EGFR。
接受根治性肾切除术的患者发生肾切除术后肾功能不全的风险高于接受部分肾切除术的患者。影响肾切除术后肾功能不全的因素有年龄、术前血清肌酐水平和术前EGFR。除根治性肾切除术外，年龄>58岁、术前血清肌酐>1.03 mg/ml且EGFR<73 ml/min/1.73 m²的患者发生肾切除术后慢性肾功能不全的概率更高。
