根治性膀胱切除术和尿流改道术后急性肾损伤：预测因素和相关发病率。
Acute kidney injury following radical cystectomy and urinary diversion: predictors and associated morbidity.
机构信息
Urology and Nephrology Center, Mansoura University, Egypt.
出版信息
Int Braz J Urol. 2018 Jul-Aug;44(4):726-733. doi: 10.1590/S1677-5538.IBJU.2017.0283.
INTRODUCTION
Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients.
MATERIALS AND METHODS
We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses.
RESULTS
Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI.
CONCLUSIONS
AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.
介绍
重大手术后急性肾损伤（AKI）与显著的发病率和死亡率相关。我们旨在报告在一个大的患者队列中根治性膀胱切除术术后 AKI 的发生率、预测因素和相关合并症。
材料和方法
我们对在一个三级转诊中心接受开放性根治性膀胱切除术的 1000 名患者进行了回顾性分析。根据 RIFLE 标准（风险、损伤和衰竭），使用围手术期血清肌酐测量来定义 AKI。使用单变量和多变量分析确定手术后 AKI 的预测因素。
结果
在 988 名可评估患者中，46 名（4.7%）发生 AKI。根据 RIFLE 标准，AKI-风险、AKI-损伤和 AKI-衰竭分别发生在 26 名（2.6%）、9 名（0.9%）和 11 名（1.1%）患者中。多变量分析显示，行肾输尿管切除术联合膀胱切除术（比值比 [OR]：4.3；95%置信区间 [CI]：1.3-13.6；p=0.01）和发生高级别并发症（OR：3.8；95% CI 1.9-7.2；p<0.0001）与 AKI 独立相关。
结论
AKI 是根治性膀胱切除术后的一种显著发病率，在常规膀胱切除术发病率评估中应包括该术语。
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