摘要
目的探讨保留肾单位手术(NSS)术后患侧肾脏慢性损伤进展特征及危险因素。方法基于3D Slicer测量分析在解放军总医院泌尿外科行NSS治疗的210例患者术后肾实质体积(RPV)变化特征, RPV萎缩率/年≥5%为萎缩组, <5%为非萎缩组, 萎缩组77例, 男57例, 女20例;肥胖[体重指数(BMI)≥25]48例;高血压38例;肿瘤T分期为T1a期68例, T1b期9例。非萎缩组133例, 男106例, 女27例;肥胖72例;高血压34例;肿瘤T分期为T1a期119例, T1b期14例。多因素Logistic回归分析NSS术后患肾进行性萎缩的独立危险因素。结果 NSS术后首次复查时, 患侧RPV为(140.41±34.73) ml, 术后末次复查时, 下降至(131.29±34.98) ml(t=9.450, P<0.05)。萎缩组77例, 非萎缩组133例, 单因素分析:年龄≥60岁(χ^(2)=6.803, P<0.05)、高血压(χ^(2)=12.247, P<0.05)、热缺血时间(WIT)≥25 min(χ^(2)=8.587, P<0.05)是危险因素。多因素Logistic回归分析:高血压[比值比(OR)=2.246, 95%置信区间(CI):1.186~4.251, P<0.05], WIT≥25 min(OR=2.249, 95%CI:1.150~4.402, P<0.05)是NSS术后患肾进行性萎缩的独立危险因素。结论 NSS术后患侧RPV呈现进行性下降趋势。高血压和WIT≥25 min是NSS术后患肾进行性萎缩的独立危险因素。
Objective To investigate the progression characteristics and risk factors of chronic renal injury after nephron-sparing surgery(NSS).Methods Based on 3D Slicer measurement,the renal parenchyma volume(RPV)of 210 patients who underwent NSS in the Department of Urology,PLA General Hospital were analyzed.The annual RPV atrophy rate≥5%was defined as atrophy group,and<5%was defined as non-atrophy group.There were 77 cases in atrophy group,including 57 males and 20 females.There were 48 cases of obesity[body mass index(BMI)≥25],38 cases of hypertension,68 cases of T1a stage and 9 cases of T1b stage.There were 133 cases in non-atrophy group,including 106 males and 27 females.There were 72 cases of obesity,34 cases of hypertension,119 cases of T1 a stage and 14 cases of T1 b stage.Multivariate Logistic regression analysis was used to analyze the independent risk factors of progressive renal atrophy after NSS.Results The RPV of the affected side was(140.41±34.73)ml at the first follow-up after NSS and decreased to(131.29±34.98)ml(t=9.450,P<0.05)at the last follow-up after NSS.There were 77 cases in the atrophy group and 133 cases in the non-atrophy group.Univariate analysis revealed age≥60 years(χ^(2)=6.803,P<0.05),hypertension(χ^(2)=12.247,P<0.05)and warm ischemic time(WIT)≥25 min(χ^(2)=8.587,P<0.05)were risk factors.Multivariate Logistic regression analysis showed that hypertension[odds ratio(OR)=2.246,95%confidence interval(CI):1.186-4.251,P<0.05]and WIT≥25 min(OR=2.249,95%CI:1.150-4.402,P<0.05)were independent risk factors for progressive renal atrophy after NSS.Conclusion The RPV of the affected side showed a progressive downward trend after NSS.Hypertension and WIT≥25 min were independent risk factors for progressive renal atrophy after NSS.
作者
王雷
陈健文
李怀康
贾通宇
王集琛
欧阳清
赵厚铭
焦启龙
王烁宇
王雷
马鑫
Wang Lei;Chen Jianwen;Li Huaikang;Jia Tongyu;Wang Jichen;Ouyang Qing;Zhao Houming;Jiao Qilong;Wang Shuoyu;Wang Lei;Ma Xin(Department of Urology,Third Medical Center of PLA General Hospital,Beijing 100039,China;Department of Nephrology,First Medical Center of PLA General Hospital,Chinese PLA Institute of Nephrology,Beijing 100085,China;Medical School of Nankai University,Tianjin 300071,China)
出处
《中华实验外科杂志》
CAS
2024年第2期374-377,共4页
Chinese Journal of Experimental Surgery
基金
解放军总医院青年扶持基金项目(22QNFC096)
科技部重点研发专项(2023YFB4706000)。
关键词
保留肾单位手术
肾实质体积
危险因素
Nephron-sparing surgery
Renal parenchyma volume
Risk factors
