恶性肾肿瘤手术中的急性肾损伤及其预测因素

K. Pozdnyakov, S. Rakul, R. Eloev, K. A. Lukinov
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摘要

目的分析我们自己对接受肾脏肿瘤手术治疗(肾部分切除术(PN)和根治性肾切除术(RN))的患者术后早期病程的结果,并确定发生急性肾损伤(AKI)的风险因素。研究共纳入 399 例患者,其中 276 例(69.17%)接受了肾部分切除术,123 例(30.83%)接受了肾根治术。根据疾病的临床分期,PN 组和 RN 组患者的分布情况如下:cT1a 组分别为 160 例(91.95%)和 14 例(8.05%),cT1b 组分别为 99 例(61.11%)和 63 例(38.89%),cT2a 组分别为 17 例(26.98%)和 46 例(73.02%)。手术采用开腹(1.0%)、腹腔镜(39.35%)和机器人辅助(59.65%)入路。根据KDIGO标准,通过术前和术后1-3天血清肌酐和肾小球滤过率的变化评估AKI。结果显示,cT1a-cT2a 期肾癌手术治疗后的 AKI 总发生率为 27.57%。RN后的AKI发生率为65.04%,PN后为11.23%。在 cT1a、cT1b、cT2a 期,经过保肾手术和根治术后,这一指标分别为 9.37%、11.11%、29.41% 和 71.43%、63.49%、65.22%。温缺血时间低于 15 分钟和 20 分钟时,AKI 发生率分别不超过 8.3% 和 13.2%。结论。为了保护肾功能,PN是手术治疗cT1-cT2a期肾脏肿瘤的首选手术。RN 术后观察到的 AKI 发生率是 PN 术后的 6 倍。在统计学上,PN术后发生AKI的重要预测因素包括:患者最初是否患有慢性肾病、肿瘤大小、手术时间超过190分钟、使用的肾缺血类型以及温热缺血时间超过25分钟。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acute kidney injury and its predictors in surgery of malignant kidney tumors
Aim. To analyze our own results of the course of early postoperative period in patients who underwent surgical treatment of kidney tumors: partial nephrectomy (PN) and radical nephrectomy (RN) and to identify risk factors for the development of acute kidney injury (AKI).Materials and methods. The study included 399 patients, of which 276 patients (69.17 %) underwent PN, 123 (30.83 %) underwent RN. According  to the clinical stage of the disease, patients in the PN and RN groups were distributed as follows: cT1a – 160 (91.95 %) and 14 (8.05 %), cT1b – 99 (61.11 %) and 63 (38.89 %) and cT2a – 17 (26.98 %) and 46 (73.02 %), respectively. Operations were performed with open (1.0 %), laparoscopic (39.35 %) and robot-assisted (59.65 %) accesses. AKI was evaluated by the changes in serum creatinine and glomerular filtration rate before surgery and 1–3 days after in accordance with KDIGO criteria.Results. The overall incidence of AKI after surgical treatment  for kidney cancer at stages cT1a–cT2a was 27.57 %. The incidence of AKI after RN was 65.04 %, after PN – 11.23 %. At stages cT1a, cT1b, cT2a, after nephron-sparing surgery and radical treatment, this indicator was 9.37; 11.11; 29.41 % and 71.43; 63.49; 65.22 %, respectively. For warm ischemia time below 15 and 20 minutes, AKI incidence did not exceed 8.3 and 13.2 %, respectively. For warm ischemia time >30 min, a dramatic increase in AKI incidence was observed.Conclusion. To preserve kidney function, PN is the operation of choice in surgical treatment of kidney tumors at stages cT1–cT2a. After RN, AKI development was observed 6 times more often than after PN. The following statistically significant predictors of AKI after PN were identified: presence of initial chronic kidney disease in patients, tumor size, operative time above 190 minutes, type of kidney ischemia used, and warm ischemia time above 25 minutes.
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