摘要：
Objective:To study the changes of renal function after unilateral radical nephrectomy,and to explore the influencing factors associated with declines in renal function.Methods:All the patients who were treated with unilateral radical nephrectomy for renal malignant neoplasms in Chinese PLA General Hospital from January 2011 to December 2015 were retrospectively analyzed.Patients with the data of estimated glomerular filtration rates [eGFR≥60 ml · min-1 · 1.73 m-2] before the operation and patients who were followed up for more than 3 months after the operation were enrolled into the study.According to the last eGFR,patients were divided into two groups [eGFR ＜ 60 ml · min-1 · 1.73 m-2 and eGFR≥60 ml · min-1 · 1.73 m-2].The rate of descent of the post-operation eGFR was measured and the demographics,tumor types and operative methods were analyzed.The univariate and multivariate analyses were performed to show influencing factors.Results:94 patents were enrolled into the study.Before the operation,the eGFR of 55 (58.5％) patients were more than 90 ml · min-1 · 1.73 m-2,and the other 39 (41.5％) patients were at 60 ～ 89 ml · min-1 · 1.73 m-2.After the operation and following up for 3-50 months,the eGFR of 33 patients dropped below 60 ml · min-1 · 1.73 m-2.Univariate analyses showed that there were no significant differences in gender(P =0.718),follow-up time (P =0.592),body mass index (BMI)(P =0.769),complicated with diabetes(P =0.959),tumor pathological types (P =0.826) and tumor sides (P =0.084) between these two groups.There were significant differences in age (P ＜ 0.001),preoperative eGFR (P ＜ 0.001),complicated with hypertension (P =0.002) and operative methods (P =0.024).Multivariate analyses showed that age (OR =1.195,P ＜ 0.001) and preoperative eGFR (OR =0.952,P =0.047) were associated with the declines in renal function.Conclusion:The renal function should be monitored before and after unilateral radical nephrectomy.Older age and lower preoperative eGFR were two independent risk factors associated with declines in renal function after unilateral nephrectomy.%目的:观察我院因肾脏恶性肿瘤行单侧根治性肾切除术后患者肾功能的变化情况,探讨肾功能下降的影响因素.方法:回顾性分析我院2011年1月～2015年12月因肾脏恶性肿瘤行单侧根治性肾切除术的患者94例.入选标准:术前用CKD-EPI公式估算的eGFR≥60 ml·min-1·1.73m-2,术后观察3个月以上.分析术后肾功能的变化情况及影响肾功能下降的因素.根据末次随访时eGFR,分为eGFR＜ 60 ml·min-1·1.73 m-2和eGFR≥60 ml·min-1·1.73 m-2两组.比较两组的临床资料、肿瘤特性、手术方式,运用单因素和多因素分析影响术后肾功能下降的因素.结果:94例单肾切除患者,术前eGFR≥90 ml·min-1.1.73 m-255例(58.5％),eGFR=60～89 ml·min-1.1.73 m-239例(41.5％).随访3 ～ 50月,33例(35.1％)出现肾功能下降至eGFR＜ 60 ml·min-1·1.73 m-2.单因素分析结果显示,两组病例在性别(P=0.718)、随访时间(P=0.592)、体质指数(BMI) (P =0.769)、是否合并糖尿病(P =0.959)、肿瘤病理类型(P=0.826)及肿瘤侧别(左侧或右侧,P=0.084)方面差异无统计学意义.而在年龄(P ＜0.001)、术前eGFR水平(P＜0.001)、是否合并高血压(P =0.002)、手术方式(微创或开放,P=0.024)方面差异有统计学意义.根据单因素分析结果,选取有统计学差异的指标进行多因素Logistic回归分析,结果显示年龄(OR=1.195,P＜0.001)和术前eGFR水平(OR=0.952,P =0.047)与术后肾功能下降相关.结论:单肾切除前后宜检测肾功能.年龄大、术前eGFR低是术后eGFR下降的独立危险因素.
