本文選題：腎癌根治術(shù)　切入點(diǎn)：腎功能不全　出處：《蘇州大學(xué)》2014年碩士論文

【摘要】：四十多年以來，，腎癌根治術(shù)已作為腎癌的標(biāo)準(zhǔn)治療方式并取得良好的腫瘤療效。但隨著時(shí)間的推移，關(guān)于健側(cè)腎臟的腎功能變化越來越得到重視，是漸進(jìn)性改善還是損害，結(jié)論不一，同時(shí)諸多臨床預(yù)后因素如糖尿病、高血壓、年齡等因素對腎功能的影響力大小也未知，本研究旨在分析腎癌根治術(shù)后患者腎功能的總體恢復(fù)趨勢，并定量分析不同預(yù)后因素對腎功能的影響。 研究目的：評估腎癌根治術(shù)后臨床因素對腎功能的影響以及腎功能的變化趨勢，探討根據(jù)不同的預(yù)后因素篩查出術(shù)后慢性腎病的高危人群，對臨床治療方案的制定提供參考。 研究方法：收集蘇州大學(xué)附屬第一醫(yī)院自2007年開始腎癌根治患者，經(jīng)嚴(yán)格的入組標(biāo)準(zhǔn)篩選后，分析185例腎癌根治術(shù)后的病人，通過連續(xù)監(jiān)測術(shù)后的血漿肌酐，用腎臟病飲食調(diào)整研究公式（MDRD）計(jì)算得出eGFR，以線性混合模型分析術(shù)后eGFR的連續(xù)變化，以多因素回歸分析術(shù)后腎功能變化的危險(xiǎn)因素。 結(jié)果：1、到隨訪截止，總體患者術(shù)后腎功能在持續(xù)恢復(fù)狀態(tài)，直線斜率為0.099（95%CI：0.07~0.13），表示每月恢復(fù)0.099mL·min-1·(1.73m2)-1。2、分析不同臨床因素對腎功能恢復(fù)的影響時(shí)，表明術(shù)前存在糖尿病，高血壓及高齡（65歲），術(shù)后出現(xiàn)eGFR下降或維持在恒定水平，無明顯改善。3、腎功能預(yù)后良好因素包括：低齡，無高血壓、無糖尿病。 結(jié)論：1、腎癌根治術(shù)后腎功能隨訪6年期間一直處于恢復(fù)狀態(tài)。2、術(shù)后腎功能的變化受多種因素的影響，治療方式的選擇是應(yīng)將諸多因素考慮在內(nèi)，需充分評估后確定治療方案。
[Abstract]:For more than 40 years, radical nephrectomy has been the standard treatment for renal cell carcinoma and has achieved good curative effect. However, over time, more and more attention has been paid to the change of renal function of healthy kidney, whether it is progressive improvement or damage. At the same time, the influence of many clinical prognostic factors such as diabetes, hypertension and age on renal function is unknown. The purpose of this study is to analyze the general recovery trend of renal function after radical nephrectomy. The effects of different prognostic factors on renal function were analyzed quantitatively. Objective: to evaluate the influence of clinical factors on renal function and the trend of renal function after radical nephrectomy, and to find out the high risk population of chronic nephropathy according to different prognostic factors, and to provide reference for the formulation of clinical treatment. Methods: 185 patients with renal cell carcinoma were collected from the first affiliated Hospital of Suzhou University in 2007. After screening by strict criteria, 185 patients with renal cell carcinoma after radical nephrectomy were analyzed, and the plasma creatinine levels were continuously monitored. The eGFR was calculated by the formula of diet adjustment in kidney disease. The continuous changes of eGFR were analyzed by linear mixed model and the risk factors of renal function were analyzed by multivariate regression analysis. Results at the end of follow-up, the renal function of the overall patient was in a sustained state of recovery, with a linear slope of 0.09995% 0.07 / 0.13, which indicated that 0.099mL min-1 was restored to 1.73 m ~ (-2) -1.2 per month. The analysis of the effects of different clinical factors on the recovery of renal function showed that diabetes existed before operation. EGFR decreased or maintained at a constant level after operation. There was no significant improvement in renal function. The prognostic factors of renal function included: low age, no hypertension, no diabetes. Conclusion: the renal function has been recovering during the follow-up period of 6 years after radical nephrectomy. The changes of renal function after operation are affected by many factors. The choice of treatment mode should take many factors into account, and the treatment plan should be determined after full evaluation.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.11

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 傅辰生,方藝,徐少偉,丁小強(qiáng);腎穿刺患者高血壓狀況的橫斷面研究[J];中國臨床醫(yī)學(xué);2005年01期

2 潘柏年,徐仁方,郭曉,何志嵩,楊勇,張曉春,周利群,郝金瑞,那彥群,薛兆英,郭應(yīng)祿;腎癌525例臨床分析[J];中華泌尿外科雜志;2000年03期

3 全國eGFR課題協(xié)作組;;MDRD方程在我國慢性腎臟病患者中的改良和評估[J];中華腎臟病雜志;2006年10期

4 胡廷軍;鐘遠(yuǎn);;上海男性老年人群中心性肥胖與代謝綜合征的患病特點(diǎn)[J];中國老年學(xué)雜志;2008年07期

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