Li Hung-Keng, Chung Hsiao-Jen, Huang Eric Y, Lin Alex T, Chen Kuang-Kuo
Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2015 Jan;78(1):62-6. doi: 10.1016/j.jcma.2014.09.002. Epub 2014 Oct 24.
Nephron-sparing surgery has become the standard treatment for T1 renal tumors. However, relevant data on the Taiwanese population are lacking, and most of the current literature uses global instead of split renal function (SRF) for postoperative renal function follow-up. We evaluated the postoperative renal function after minimally invasive partial nephrectomy in Taiwanese patients.
We retrospectively reviewed our database from April 2004 to July 2012 and enrolled patients who received laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RPN). The estimated glomerular filtration rate (eGFR) and SRF were calculated as representatives of renal function. The preoperative and 6- and 12-month postoperative renal functions were assessed. Freidman test was used to evaluate pre- and postoperative renal function changes; Wilcoxon test was used for comparing the renal function of each period.
The 6- and 12-month postoperative SRF values were decreased compared with the preoperative values. Multivariate analysis revealed that older age was related to a lower postoperative eGFR, and a longer warm ischemia time was related to a decreased postoperative SRF. Patients with a warm ischemia time of >30 minutes were correlated with a larger mean tumor size, higher "preoperative aspects and dimensions used for an anatomical" score, greater amount of blood loss during the operation, longer postoperative hospital stay, and lower postoperative SRF compared with patients with a warm ischemia time of <30 minutes. Patients in the RPN group had shorter warm ischemia time and higher 6-month postoperative SRF compared with patients in the LPN group.
SRF is more sensitive for postoperative follow-up than eGFR. Longer warm ischemia time is associated with poorer postoperative renal function. RPN is a safe and feasible alternative to LPN.
保留肾单位手术已成为T1期肾肿瘤的标准治疗方法。然而，台湾人群的相关数据匮乏，且目前大多数文献在术后肾功能随访中采用的是整体肾功能而非分肾功能（SRF）。我们评估了台湾患者行微创部分肾切除术后的肾功能。
我们回顾性分析了2004年4月至2012年7月的数据库，纳入接受腹腔镜部分肾切除术（LPN）或机器人辅助部分肾切除术（RPN）的患者。计算估计肾小球滤过率（eGFR）和SRF作为肾功能的代表指标。评估术前以及术后6个月和12个月的肾功能。采用Friedman检验评估术前和术后肾功能变化；采用Wilcoxon检验比较各时期的肾功能。
术后6个月和12个月的SRF值较术前降低。多因素分析显示，年龄较大与术后eGFR较低相关，而热缺血时间较长与术后SRF降低相关。与热缺血时间<30分钟的患者相比，热缺血时间>30分钟的患者平均肿瘤尺寸更大、“术前解剖学方面和尺寸”评分更高、术中失血量更多、术后住院时间更长且术后SRF更低。与LPN组患者相比，RPN组患者的热缺血时间更短且术后6个月的SRF更高。
SRF在术后随访中比分肾功能eGFR更敏感。热缺血时间较长与术后肾功能较差相关。RPN是LPN的一种安全可行的替代方法。
