【摘要】：目的：探討影響后腹腔鏡保留腎單位術（RLNSS）術后患腎功能恢復的主要因素，并檢測RLNSS術式的安全性，，為改進RLNSS手術操作提供相應的理論依據(jù)。 方法：回顧性分析南昌大學第一附屬醫(yī)院泌尿外科2011年10月至2013年12月間實施的54例RLNSS臨床資料。術前及術后3月應用99mTc-DTPA（99m锝-二乙三胺五乙酸）單光子發(fā)射計算機斷層（SPECT）腎動態(tài)顯像技術測定患腎腎小球濾過率（GFR）的變化。應用t檢驗、方差分析和多元線性回歸分析影響術后腎功能恢復的可能因素。 結果：納入的54例腎腫瘤均順利完成手術，無一術中中轉開腹。腫瘤大小1.5-7.2cm（4.54±1.53）。手術時間35-120min（57.09±14.09）。術中熱缺血時間0-42min（23.60±6.77）。術中估計出血量30-250ml（74.10±48.93）。術前及術后3月術腎GFR分別為24.20-62.32（46.50±9.62）ml/min、11.23-57.45（28.79±12.71）ml/min。術腎術后GFR下降（17.70±7.04）ml/min，較術前術腎下降38.06%。多元回歸示：術前術腎GFR（p=0.048）、腫瘤直徑（P=0.001）、熱缺血時間（p=0.012）對腎功能影響有統(tǒng)計學意義。 結論：術前患腎GFR、腫瘤直徑、熱缺血時間是影響后腹腔鏡保留腎單位術后患腎功能的關鍵因素。
[Abstract]:Aim: to investigate the main factors affecting the recovery of renal function after retroperitoneal laparoscopic renal sparing surgery (RLNSS) and to evaluate the safety of RLNSS procedure in order to provide theoretical basis for improving the operation of RLNSS. Methods: the clinical data of 54 patients with RLNSS from October 2011 to December 2013 in the first affiliated Hospital of Nanchang University were analyzed retrospectively. The changes of glomerular filtration rate (GFR) were measured by single photon emission computed tomography (99mTc-DTPA) single photon emission computed tomography (SPECT) before and 3 months after operation. T-test, variance analysis and multiple linear regression analysis were used to analyze the possible factors affecting the recovery of renal function after operation. Results: all 54 cases of renal tumors were successfully operated, none of them were converted to open surgery. Tumor size 1.5-7.2cm (4.54 鹵1.53). The operation time was 35-120min (57.09 鹵14.09). The time of warm ischemia during operation was 0-42min (23.60 鹵6.77). The estimated intraoperative blood loss (30-250ml) was 74.10 鹵48.93). The renal GFR was (24.20 鹵62.32) ml/min,11.23-57.45 (46.50 鹵9.62) ml/min,11.23-57.45 (28.79 鹵12.71) ml/min. before and 3 months after operation. The decrease of GFR after operation was (17.70 鹵7.04) ml/min, which was 38.06% lower than that before operation. Multiple regression analysis showed that the renal function was significantly affected by pre-operative renal GFR (p < 0. 048), tumor diameter (P < 0. 001) and warm ischemia time (p < 0. 012). Conclusion: the diameter of renal GFR, tumor and the time of warm ischemia are the key factors affecting renal function after retroperitoneal laparoscopic nephrectomy.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.11

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