González-Ginel Ignacio, Hernández-Arroyo Mario, García-Rayo Clara, Gómez-Del-Cañizo Carmen, Rodríguez-Antolín Alfredo, Guerrero-Ramos Félix
Department of Urology, Hospital Universitario 12 de Octubre, 28045 Madrid, Spain.
J Clin Med. 2024 Oct 22;13(21):6305. doi: 10.3390/jcm13216305.
: One of the main objectives of partial nephrectomy is to preserve as much renal function as possible. However, the removal of functioning nephrons and ischemic damage secondary to the clamping of the renal pedicle can be associated with a certain degree of renal function loss. We aim to evaluate the relationship between tumor volume and other factors on renal function in the short term (1-3 months) and long term (6-12 months) in our series of partial nephrectomies. : A retrospective study was conducted on 147 patients who underwent open or laparoscopic partial nephrectomy between 2018 and 2022. Tumor volume was estimated through reconstructions from the computed tomography images. Univariate and multivariate analyses of the data were performed. : The mean age was 58.2 years, with an average glomerular filtration rate (GFR) of 79 mL/min/m. Of all partial nephrectomies, 76.2% were laparoscopic, 57.1% were T1a tumors, and the mean volume was 17 cc. The average ischemia time during surgery was 14.3 min, with a mean hemoglobin loss of 2.8 g/dL in the immediate postoperative period. No significant differences were found either in the short or long term regarding ischemia time ( = 0.57, = 0.32) or tumor volume ( = 0.57, = 0.33). However, in the multivariate analysis, it was observed that the variable with the greatest influence on short-term renal function was perioperative glomerular filtration, while in the long term, ischemia time, age, and tumor volume also had an influence. : Tumor volume is not an independent factor for renal function deterioration in the short or long term. Short-term renal function is primarily determined by perioperative glomerular filtration. Perioperative glomerular filtration, ischemia time, age, and tumor volume can jointly predict long-term renal function.
部分肾切除术的主要目标之一是尽可能保留更多的肾功能。然而,切除有功能的肾单位以及肾蒂夹闭继发的缺血性损伤可能会导致一定程度的肾功能丧失。我们旨在评估在我们的一系列部分肾切除术中,肿瘤体积和其他因素在短期(1 - 3个月)和长期(6 - 12个月)对肾功能的关系。
对2018年至2022年间接受开放或腹腔镜部分肾切除术的147例患者进行了回顾性研究。通过计算机断层扫描图像重建来估计肿瘤体积。对数据进行单因素和多因素分析。
平均年龄为58.2岁,平均肾小球滤过率(GFR)为79 mL/min/m²。在所有部分肾切除术中,76.2%为腹腔镜手术,57.1%为T1a期肿瘤,平均体积为17 cc。手术期间的平均缺血时间为14.3分钟,术后即刻平均血红蛋白损失为2.8 g/dL。在短期或长期内,缺血时间(P = 0.57,P = 0.32)或肿瘤体积(P = 0.57,P = 0.33)均未发现显著差异。然而,在多因素分析中,观察到对短期肾功能影响最大的变量是围手术期肾小球滤过,而在长期内,缺血时间、年龄和肿瘤体积也有影响。
肿瘤体积在短期或长期内并非肾功能恶化的独立因素。短期肾功能主要由围手术期肾小球滤过来决定。围手术期肾小球滤过、缺血时间、年龄和肿瘤体积可共同预测长期肾功能。