论文部分内容阅读
目的:分析腹腔镜肾部分切除(LPN)术后体质指数(BMI)变化对肾功能的影响。方法:回顾性分析同一术者(张旭)行LPN术后不同随访阶段(1年,3年和5年)的病例资料共204例(1年组90例,3年组66例和5年组48例)。比较各组临床资料,肿瘤特性,手术资料和肾功能变化;运用单因素和多因素分析显示影响术后肾功能改变的因素。结果:三组病例临床资料、肿瘤学特性和围手术期预后方面差异无统计学意义。尽管随访时各组BMI差异无统计学意义(P=0.857),但随访前后BMI变化差值及变化率之间差异有统计学意义(P=0.008和P=0.015),BMI的变化呈上升趋势。三组在手术时间,热缺血时间和术中失血量方面差异有统计学意义(P=0.010,P=0.027和P=0.021)。三组术前肾功能没有明显差异,而随访时肌酐(sCr)和评估的肾小球滤过率(eGFR)差异有统计学意义(P=0.012和P=0.001),eGFR的下降趋势较sCr的变化更加明显。对BMI、sCr和eGFR的变化差值分别进行组间比较可见术后5年组的变化最明显。相对于单因素分析结果,多因素分析发现仅有5年组(P<0.001)、BMI的变化差值(P=0.039)和术前eGFR(P<0.001)是预示术后eGFR改变的显著因素。结论:术后BMI的上升将导致LPN患者肾功能下降。LPN术后对长期随访的患者需要警惕体重升高引起的肾功能改变,并及时采取干预措施。
Objective: To analyze the effect of laparoscopic partial nephrectomy (LPN) on renal function after the change of body mass index (BMI). Methods: A total of 204 cases (90 cases in 1-year group, 66 cases in 3-year group and 5 years in 5 years) were retrospectively analyzed in the same surgeon (Zhang Xu) at different follow-up stages of LPN (1 year, 3 years and 5 years) Group of 48 cases). The clinical data, tumor characteristics, operative data and changes of renal function in each group were compared. The factors influencing the postoperative renal function changes were analyzed by single factor and multivariate analysis. Results: There was no significant difference in clinical data, oncology characteristics and perioperative prognosis between the three groups. Although there was no significant difference in BMI between the two groups at follow-up (P = 0.857), there was a significant difference between before and after follow-up (P = 0.008 and P = 0.015), and the change of BMI was on the rise . There was significant difference between the three groups in operation time, warm ischemia time and intraoperative blood loss (P = 0.010, P = 0.027 and P = 0.021). There were no significant differences in preoperative renal function between the three groups, but the differences of creatinine (sCr) and glomerular filtration rate (eGFR) at follow-up were statistically significant (P = 0.012 and P = 0.001) The change is even more obvious. The changes of BMI, sCr and eGFR differences were compared between the two groups showed the most obvious changes after 5-year group. Compared with univariate analysis, multivariate analysis showed that only 5-year group (P <0.001), BMI changes (P = 0.039) and preoperative eGFR (P <0.001) were significant predictors of postoperative eGFR changes . Conclusion: The rise of postoperative BMI will lead to the decline of renal function in patients with LPN. Patients with long-term follow-up after LPN need to be alert to changes in renal function caused by weight gain and to take timely interventions.