Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, Nagoya University.
Circ J. 2019 Aug 23;83(9):1844-1850. doi: 10.1253/circj.CJ-19-0383. Epub 2019 Jul 17.
The effect of left renal vein division (LRVD) during open surgery (OS) for pararenal and juxtarenal abdominal aortic aneurysm (P/JRAA) on postoperative renal function remains controversial, so we focused on chronic renal decline (CRD) and separately examined renal volume as a surrogate index of split renal function.
The 115 patients with P/JRAA treated with OS from June 2007 to January 2017 were reviewed: 26 patients without LRVD were matched to 27 patients with LRVD according to preoperative chronic kidney disease (CKD) stage and proximal clamp sites. The effect of LRVD on CRD was investigated by a time-to-event analysis. During a median follow-up of 23.5 months, CRD occurred in 5 patients with LRVD and in 4 patients without LRVD. Comparison of freedom from CRD showed no significant difference between the matched groups (P=0.870). The separate renal volumes were evaluated before surgery and at 1 and 2 years of follow-up using CT images from 18 patients with LRVD. At 2 years, the mean renal volume had decreased by 15% in the left kidney and by 9% in the right kidney (P=0.052 and 0.148, respectively), but the left-to-right renal volume ratio showed no significant change (P=0.647).
LRVD had no significant effect on CRD or left renal volume relative to the right renal volume for up to 2 years.
开放手术（OS）治疗腹膜后和肾周腹主动脉瘤（P/JRAA）时，左肾静脉分离（LRVD）对术后肾功能的影响仍存在争议，因此我们关注慢性肾功能下降（CRD），并分别检查肾脏体积作为分肾功能的替代指标。
回顾了 2007 年 6 月至 2017 年 1 月接受 OS 治疗的 115 例 P/JRAA 患者：根据术前慢性肾脏病（CKD）分期和近端夹闭部位，将 26 例无 LRVD 患者与 27 例有 LRVD 患者进行匹配。采用时间事件分析研究 LRVD 对 CRD 的影响。在中位随访 23.5 个月期间，LRVD 组中有 5 例发生 CRD，无 LRVD 组中有 4 例发生 CRD。匹配组间无 CRD 发生率无显著差异（P=0.870）。对 18 例有 LRVD 患者的 CT 图像进行分析，分别于术前、术后 1 年和 2 年评估分侧肾脏体积。2 年后，左肾和右肾的平均肾脏体积分别减少了 15%和 9%（P=0.052 和 0.148），但左肾与右肾体积比无明显变化（P=0.647）。
LRVD 在 2 年内对 CRD 或左肾体积相对于右肾体积无显著影响。
