Huang Y X, Zou X P, Zhang Z L, Ning K, Luo X, Xiong L B, Peng Y L, Zhou Z H, Dong P, Guo S J, Han H, Zhou F J
Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China.
Zhonghua Wai Ke Za Zhi. 2023 Dec 1;61(12):1099-1103. doi: 10.3760/cma.j.cn112139-20230228-00086.
To analyze the factors relative to the short-term preservation of ipsilateral renal function after partial nephrectomy. The clinical data of 83 patients who were treated with partial nephrectomy from December 2014 to December 2019 in the Department of Urology, Sun Yat-sen University Cancer Center were retrospectively analyzed. There were 54 males and 29 females, aging ( (IQR)) 49 (17) years (range: 27 to 74 years). The ischemia time in operation was 25 (18) minutes (range: 10 to 67 minutes). Emission computed tomography scan and CT scan were performed before (within 1 month) and after (3 to 12 months) surgery. The volume of the ipsilateral and contralateral kidney was measured on the basis of preoperative and postoperative CT scans. The glomerular filtration rate (GFR) specifically in each kidney was estimated by emission computed tomography. Recovery from ischemia is determined by the formula: GFR preservation/volume saved×100%. Linear regression was used to explore the factors ralative to the short-term preservation of ipsilateral renal function after partial nephrectomy. The GFR preservation of the ipsilateral kidney was 80.9 (25.2) % (range: 31.0% to 109.4%). The volume loss of the kidney resulted in a decrease of 12.0% (5.8 ml/(min×1.96 m)) of GFR, while the ischemic injury resulted in a decrease of 6.5% (2.5 ml/(min×1.96 m)) of GFR. The volume saved from the ipsilateral kidney was 87.1 (12.9) % (range: 27.0% to 131.7%). Recovery from ischemia was 93.5 (17.5) % (range:44.3% to 178.3%). In multivariate analysis, GFR preservation of the ipsilateral kidney was significantly correlated with the volume saved of the ipsilateral kidney (=0.383, 95%: 0.144 to 0.622, =0.002). It was not related to the ischemia time (=0.046, 95%:-0.383 to 0.475, =0.831). In the condition of limited ischemic time, in the short term ipsilateral renal function after partial nephrectomy is mainly determined by the loss of kidney volume, while ischemic injury only plays a minor role.
分析部分肾切除术后同侧肾功能短期保留的相关因素。回顾性分析2014年12月至2019年12月在中山大学肿瘤防治中心泌尿外科接受部分肾切除术的83例患者的临床资料。其中男性54例，女性29例，年龄（四分位间距）49（17）岁（范围：27至74岁）。手术缺血时间为25（18）分钟（范围：10至67分钟）。术前（1个月内）和术后（3至12个月）均行发射计算机断层扫描和CT扫描。根据术前和术后CT扫描测量同侧和对侧肾脏的体积。通过发射计算机断层扫描估计每个肾脏的肾小球滤过率（GFR）。缺血恢复情况由公式计算：GFR保留率/保留体积×100%。采用线性回归分析部分肾切除术后同侧肾功能短期保留的相关因素。同侧肾脏的GFR保留率为80.9（25.2）%（范围：31.0%至109.4%）。肾脏体积减少导致GFR下降12.0%（5.8 ml/（min×1.96 m）），而缺血损伤导致GFR下降6.5%（2.5 ml/（min×1.96 m））。同侧肾脏保留体积为87.1（12.9）%（范围：27.0%至131.7%）。缺血恢复率为93.5（17.5）%（范围：44.3%至178.3%）。多因素分析显示，同侧肾脏的GFR保留率与同侧肾脏保留体积显著相关（=0.383，95%可信区间：0.144至0.622，=0.002）。与缺血时间无关（=0.046，95%可信区间：-0.383至0.475，=0.831）。在缺血时间有限的情况下，部分肾切除术后短期内同侧肾功能主要取决于肾脏体积的减少，而缺血损伤仅起次要作用。
