机器人辅助部分肾切除术治疗慢性肾脏病患者：短期和长期肾功能结局的客观测量。

Robotic Partial Nephrectomy in Patients with Chronic Kidney Disease: Objective Measurement of Short- and Long-Term Renal Functional Outcomes.

机构信息

1 Department of Urology, Saint Joseph University , Beirut, Lebanon .

2 Department of Urology, Johns Hopkins Hospital , Baltimore, Maryland.

出版信息

J Endourol. 2018 Jul;32(7):630-634. doi: 10.1089/end.2018.0151.

DOI:10.1089/end.2018.0151

PMID:29848053

Abstract

BACKGROUND

Minimal literature informs the use of robotic partial nephrectomy (RPN) in patients with chronic kidney disease (CKD). Therefore, we evaluated the renal functional outcomes in CKD patients undergoing RPN.

METHODS

We reviewed a prospective database of patients undergoing RPN 2010 to 2015 and identified 182 patients who had preoperative and postoperative nuclear renal scintigraphy (at 2 and 12 months postop). Preoperative and 12-month postoperative eGFR (mL/min/1.73 m, by MDRD) were calculated. CKD was defined as eGFR ≤60 mL/min/1.73 m (CKD stages III and IV). Changes in creatinine, eGFR, and split function on mercaptoacetyltriglycine (MAG)-3 scan were compared by baseline CKD status. Correlations between pre- and postoperative eGFR were calculated.

RESULTS

Of 182 patients, 30 (16.5%) had baseline CKD. Preoperative eGFR was 48.5 and 99.0 in CKD and non-CKD patients, respectively (p < 0.001). From preoperation to 12 months postoperation, eGFR decreased by 2.8 and 1.1 mL/min/1.73 m, respectively (p = 0.6). On MAG-3 scan, the contribution of the surgical kidney to overall renal function decreased by 5.0% and 4.8% (p = 0.9) in the CKD and non-CKD cohorts, respectively. When comparing renal scans at 2 and 12 months postoperation, in both groups the surgical kidney significantly recovered (both p < 0.001) and the patterns of kidney function recovery was similar in both groups (CKD +2.0%, non-CKD +1.4%, p = 0.6). On long-term follow-up (>2 years), eGFR did not change significantly in either the CKD or non-CKD group (-2.8 vs -1.1 mL/min/1.73 m, p = 0.6). On pathology, tumors were more frequently malignant in CKD vs non-CKD patients (93.3% vs 73.2%, p = 0.02) and of higher Fuhrman Grade (grade ≥3: 49.7% vs 28.1%, p < 0.001).

CONCLUSION

RPN is a reasonable treatment option in patients with CKD, as it did not lead to a greater decline in renal function contributed by the surgical kidney. The patterns of kidney function recovery after surgery are similar between patients with and without CKD.

摘要

背景

关于慢性肾脏病（CKD）患者行机器人辅助部分肾切除术（RPN）的应用，相关文献报道较少。因此，我们评估了 CKD 患者行 RPN 后的肾功能结果。

方法

我们回顾了 2010 年至 2015 年接受 RPN 的患者的前瞻性数据库，并确定了 182 例术前和术后均行核肾闪烁扫描（术后 2 个月和 12 个月）的患者。术前和术后 12 个月的估算肾小球滤过率（MDRD 法，mL/min/1.73m2）。CKD 的定义为 eGFR≤60mL/min/1.73m2（CKD III 期和 IV 期）。根据基线 CKD 状态比较 MAG-3 扫描时血肌酐、eGFR 和分肾功能的变化。计算术前和术后 eGFR 之间的相关性。

结果

182 例患者中，30 例（16.5%）基线时患有 CKD。CKD 和非 CKD 患者的术前 eGFR 分别为 48.5 和 99.0（p<0.001）。从术前到术后 12 个月，eGFR 分别下降 2.8 和 1.1mL/min/1.73m2（p=0.6）。在 MAG-3 扫描中，手术肾对整体肾功能的贡献分别下降 5.0%和 4.8%（p=0.9），CKD 和非 CKD 队列。比较术后 2 个月和 12 个月的肾脏扫描，两组手术肾均明显恢复（均 p<0.001），两组的肾功能恢复模式相似（CKD+2.0%，非 CKD+1.4%，p=0.6）。在长期随访（>2 年）中，CKD 组和非 CKD 组的 eGFR 均无显著变化（-2.8 与-1.1mL/min/1.73m2，p=0.6）。在病理方面，CKD 患者的肿瘤更常为恶性（93.3%比 73.2%，p=0.02），且 Fuhrman 分级更高（≥3 级：49.7%比 28.1%，p<0.001）。