【摘要】：目的：探討影響后腹腔鏡保留腎單位術(shù)（RLNSS）術(shù)后患腎功能恢復(fù)的主要因素，并檢測(cè)RLNSS術(shù)式的安全性，，為改進(jìn)RLNSS手術(shù)操作提供相應(yīng)的理論依據(jù)。 方法：回顧性分析南昌大學(xué)第一附屬醫(yī)院泌尿外科2011年10月至2013年12月間實(shí)施的54例RLNSS臨床資料。術(shù)前及術(shù)后3月應(yīng)用99mTc-DTPA（99m锝-二乙三胺五乙酸）單光子發(fā)射計(jì)算機(jī)斷層（SPECT）腎動(dòng)態(tài)顯像技術(shù)測(cè)定患腎腎小球?yàn)V過率（GFR）的變化。應(yīng)用t檢驗(yàn)、方差分析和多元線性回歸分析影響術(shù)后腎功能恢復(fù)的可能因素。 結(jié)果：納入的54例腎腫瘤均順利完成手術(shù)，無一術(shù)中中轉(zhuǎn)開腹。腫瘤大小1.5-7.2cm（4.54±1.53）。手術(shù)時(shí)間35-120min（57.09±14.09）。術(shù)中熱缺血時(shí)間0-42min（23.60±6.77）。術(shù)中估計(jì)出血量30-250ml（74.10±48.93）。術(shù)前及術(shù)后3月術(shù)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(shù)腎術(shù)后GFR下降（17.70±7.04）ml/min，較術(shù)前術(shù)腎下降38.06%。多元回歸示：術(shù)前術(shù)腎GFR（p=0.048）、腫瘤直徑（P=0.001）、熱缺血時(shí)間（p=0.012）對(duì)腎功能影響有統(tǒng)計(jì)學(xué)意義。 結(jié)論：術(shù)前患腎GFR、腫瘤直徑、熱缺血時(shí)間是影響后腹腔鏡保留腎單位術(shù)后患腎功能的關(guān)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(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.11

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