[1]晁流,刘宁,甘卫东,等.保留肾单位术与根治性肾切除术对肾功能影响的比较[J].中华腔镜泌尿外科杂志(电子版),2017,11(06):393-397.[doi:10.3877/cma.j.issn.1674-3253.2017.06.009 ]
　Chao Liu,Liu Ning,Gan Weidong,et al.Comparison of the postoperative renal function between nephron-sparing surgery and radical nephrectomy[J].,2017,11(06):393-397.[doi:10.3877/cma.j.issn.1674-3253.2017.06.009 ]
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保留肾单位术与根治性肾切除术对肾功能影响的比较()
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中华腔镜泌尿外科杂志(电子版)[ISSN:1006-6977/CN:61-1281/TN]

卷:
11
期数:
2017年06期
页码:
393-397
栏目:
临床研究
出版日期:
2017-11-30

文章信息/Info

Title:
Comparison of the postoperative renal function between nephron-sparing surgery and radical nephrectomy
作者:
晁流1; 2; 刘宁1; 甘卫东1; 蔡维奇2; 郭宏骞1
210008 南京，南京大学医学院附属鼓楼医院泌尿外科1；223800 江苏，南京鼓楼医院集团宿迁市人民医院泌尿外科2
Author(s):
Chao Liu1; 2;  Liu Ning1;  Gan Weidong1;  Cai Weiqi2;  Guo Hongqian1.
Department of Urology, Suqian People's Hospital, Jiangsu 223800, China
关键词:
肾细胞肿瘤;  肾切除术;  肾功能
DOI:
10.3877/cma.j.issn.1674-3253.2017.06.009
摘要:
目的 比较保留肾单位手术和根治性肾切除手术治疗早期局限性肾癌术后肾功能的变化，同时探讨不同的肾功能指标在临床中的指导作用。方法回顾性分析了南京鼓楼医院2013 年6 月至2014 年10 月期间63 例早期肾肿瘤患者的临床资料和术后随访资料。35 例患者接受保留肾单位术（保肾组），28 例患者行根治性肾切除术（根治组），所有的患者均随访满两年，随访期间患者的血肌酐、尿酸、估算肾小球滤过率、胱抑素C、尿微量白蛋白及尿β2 微球蛋白被搜集并记录下来。结果 63 例患者术后肾功能均有不同程度的变化，术后早期肾功能的损伤表现更为明显。随着随访时间的延长，大部分患者肾功能可逐渐恢复。保肾组术后急性肾功能不全的发生率为34%，根治组急性肾功能不全的发生率为79%，两组差异具有统计学意义（P<0.01）。术后总体随访结果显示估测肾小球滤过率、胱抑素C 及β2 微球蛋白变化差异具有统计学意义（P<0.05），而血肌酐、尿酸及尿微量白蛋白差异无统计学意义。虽然两组的尿酸及微量白蛋白水平差异无统计学意义，但保肾组的平均水平低于根治组。在术后肾功能异常的早期检测方面，各指标的独立检测阳性率均较低，尤其是血肌酐、尿酸及估测肾小球滤过率等传统肾功能指标。当各指标互相联合后，肾功能异常的检测阳性率明显提高，保肾组及根治组的联合检测阳性率分别达37.1% 和71.4%。结论 在早期局限性肾肿瘤的治疗中，保留肾单位手术较根治性手术对患者肾功能的损伤更小。胱抑素C、尿微量白蛋白、尿β2 微球蛋白对于发现术后肾功能的早期异常更敏感，可与肌酐、尿酸、估测肾小球滤过率起协同作用。

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备注/Memo

备注/Memo:
基金项目：国家自然科学基金面上项目（81572512，81572519）
通讯作者：甘卫东，Email:gwd@nju.edu.cn
更新日期/Last Update: 2017-12-25