目的：探讨腹腔镜下肾部分切除术不同热缺血时间对术后早期肾功能的影响，明确肾脏热缺血的安全时间。方法选择于2013年1月至2015年6月行腹腔镜下肾部分切除术的98例单发性肾癌患者，按照术中热缺血时间（WIT）的不同分为3组：A 组39例（WIT <20 min）；B 组36例（20 min≤WIT <30 min）；C 组23例（WIT≥30 min）。观察并比较三组患者术前及术后2周、1月、3月的肾小球滤过率（GFR）值以及99m Tc - DTPA 肾动态显像法测定的肾小球滤过率（sGFR）值的变化，并观察三组患者肾功能的变化。回归性分析肾功能损害的影响因素。结果3组患者术后2周、1个月及3个月患肾 sGFR 较术前均有不同程度的下降，C 组患者下降趋势较 A 组和 B 组显著，差异有统计学意义（ P <0.05）。3组术后总肾 GFR 比较，C 组下降程度明显高于 A、B 组，差异有统计学意义（ P <0.05）。多因素分析发现热缺血时间是术后早期肾功能损害的独立危险因素（ P <0.05）。结论腹腔镜下肾部分切除术术中热缺血时间是肝癌患者术后肾功能损害的独立危险因素，术中越长的 WIT 对肾功能的损害越严重。%Objetive To assess the effect of variable durations of warm ischemia on renal function early after laparoscopic partial nephrec-tomy(LPN)and make the definite safety duration of renal warm ischemia. Methods 98 patients with the renal tumors from Jan 2013 to Jun 2015 were selected. They were divided into two groups based on warm ischemic time:group A(39 cases)with warm ischemic time less than 20 min, group B(36 cases)with warm ischemic time more than 20 min and less than 30 min,group C(23 cases)with warm ischemic time more than 30 min. Clinical parameters,the single glomerular filtration rates(sGFR)were compared before the operation and after 3 and 12 months in order to observe the effects on renal function,and influence factors predicting the renal function impairment by regression. Results The sGFR of 3 groups were significantly different among pre - operation at 2week ,1 and 3 months after the operation,the sGFR decreased greater in group C than that in group A and B. The decreased value of the total renal GFR in group C was greater than that in group A and B. The multivariate regression analysis revealed that warm ischemia duration was the independent risk factor of the early renal injury. Conclusion Renal warm ischemia time during lap-aroscopic partial nephrectomy is an independent predictor of postoperative renal function impairment of the operated kidney. For the LPN operation, the longer of the WIT,the more serious of renal function damage.
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