摘要
目的探讨孤立肾肾癌行肾部分切除术后肾功能的变化。方法回顾分析19992008年因孤立肾肾癌在笔者医院行热缺血肾部分切除术患者手术前后血肌酐水平的变化情况。结果共有9例患者,其中一侧肾切除后(3年8年3个月)对侧肾癌6例,先天或其他疾病导致的孤立肾肾癌3例。多发肿瘤者3例(2、2及6枚),单发者6例,肿瘤大小0.37.0cm(中位数2cm)。9例术中行常温下肾动脉阻断,阻断时间1436min(中位数25min)。肾动脉阻断前和开放后静脉滴注20%甘露醇250ml。随访3个月7.5年(中位数4.5年)。术前血肌酐水平67119μmol/L(中位数98μmol/L),术后血肌酐水平均有不同程度的升高,17天(中位2天)到最高点(术前水平的1.117.84倍),然后逐渐下降。根据RIFLE标准,6例患者出现急性肾损伤,其中2例Risk,4例Failure。血肌酐升高最明显者为1例双肾癌根治性左肾切除术后3年、行免疫治疗+索拉非尼靶向治疗者,术中热缺血14min,术后第7天肌酐到达最高点,3个月后降至正常范围;阻断肾动脉36min者术后第2天血肌酐水平升高至术前4.55倍,第17天后降至正常范围。有3例术后血肌酐达到低于术前的水平(2例无急性肾损伤及1例Risk者),其余6例血肌酐水平在手术17天3年后降至正常范围。结论孤立肾肾癌行肾部分切除术,25min之内的热缺血是安全的;靶向治疗可能影响肾脏对热缺血的耐受,但肾功能仍可恢复。
Objective To evaluate the changes of renal function after partial nephrectomy for renal cell carcinoma of solitary kidney under warm ischemia （WI）. Methods A retrospective analysis of preoperative and postoperative serum creatinine levels of partial ne- phrectomy for renal cell carcinoma of solitary kidney in our hospital between 1999 and 2008 was made. Results There were totally 9 pa- tients. In which 6 cases were-renal cell carcinoma after contralateral nephrectomy （3 -8 years and 3 months） , 3 cases were congenital or other diseases caused contralateral nephrarctia. Three cases were multiple tumors （2, 2 and 6） , and the median tumor size was 2cm （ range 0.3 - 7.0cm）. All operations were under WI, the median WI time was 25 mid （ range 14 - 36mid）. Median follow - up was 4.5 years （range 3 months -7.5 years）. The median preoperative serum creatinine level was 98 μmol/L（ range 67 -119p^mol/L）. The serum creatinine levels elevated in varying degrees after operations, the median time to the highest point （ 1.11 - 7.84 times of the preoperative levels） was 2 days （range 1 -7days） post operation, and then gradually declined. According to RIFLE standard, 6 cases of patients were acute kidney injury, including 2 cases of Risk, 4 cases of failure. Serum ereatinine increased most obviously was in 1 case of bilateral renal cell carcinoma, which had radical left nephrectomy 3 years ago, neoadjuvant immune and sorafenib therapy was taken. The warm ischemia time was 14 minutes. At the seventh day post operation, creatinine level reached the highest point, 3 months later it declined to normal range. In the ease of occlusion of renal artery for 36 minutes, the serum creatinine level was up to 4.55 times of preoperative day at the second day post operation, and fifteen days later it returned to normal range. There were 3 cases of postoperative serum creatinine was below the preoperative level （2 patients without acute kidney injury and 1 case of risk）, the serum creatinine levels of oth
出处
《医学研究杂志》
2013年第6期191-193,共3页
Journal of Medical Research
关键词
孤立肾
肾细胞癌
保留肾单位手术
热缺血
肾功能
Solitary kidney
Renal cell carcinoma
Nephron sparing surgery
Warm ischemia
Renal function
