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保留肾单位术后患肾进行性萎缩危险因素分析

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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T1 a期68例,T1 b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(x2=6.803,P<0.05)、高血压(x2=12.247,P<0.05)、热缺血时间(WIT)≥ 25 min(x2=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.
Analysis of risk factors for progressive renal atrophy after nephron-sparing surgery
Objective To investigate the progression characteristics and risk factors of chronic re-nal injury after nephron-sparing surgery(NSS).Methods Based on 3D Slicer measurement,the renal pa-renchyma 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 fe-males.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 pro-gressive 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 a-nalysis revealed age ≥60 years(x2=6.803,P<0.05),hypertension(x2=12.247,P<0.05)and warm ischemic time(WIT)≥25 min(x2=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.

Nephron-sparing surgeryRenal parenchyma volumeRisk factors

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、马鑫

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解放军总医院第三医学中心泌尿外科医学部,北京 100039

解放军总医院第一医学中心 肾脏病医学部 解放军肾脏病研究所,北京 100853

南开大学医学院,天津 300071

保留肾单位手术 肾实质体积 危险因素

解放军总医院青年扶持基金项目科技部重点研发专项

22QNFC0962023YFB4706000

2024

中华实验外科杂志
中华医学会

中华实验外科杂志

CSTPCD
影响因子:0.759
ISSN:1001-9030
年,卷(期):2024.41(2)
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