摘要目的 探讨腹腔镜肾部分切除术(LPN)中热缺血时间(WIT)对肾功能的影响.方法 采用前瞻性研究的方法,分析2010年1月至2012年12月39例T1期肾癌行LPN治疗患者的临床及手术资料,其中男性24例,女性15例,平均年龄(58±10)岁,体重指数(27±3)kg/m2.患者手术时间(132±12)min,肾脏WIT(29±8)min,术中出血量(278±37) ml.观察患者术前及术后3、12个月时术侧肾脏单侧肾小球滤过率(sGFR)值,比较患者肾功能的变化,并寻找肾功能损害的独立危险因子.结果 39例患者术后3、12个月时患侧肾sGFR值分别为(26.8±5.6) ml/min和(28.6±5.6) ml/min,与术前基础值[(31.9±6.3)ml/min]比较差异有统计学意义(F=4.882、5.511,P＜0.01).术后3、12个月sGFR值与WIT呈明显负相关关系(r=-0.569,P=0.000;r=-0.448,P=0.004).术前sGFR值(β=0.260,95％ CI:0.089～0.431)和WIT(β=0.369,95％ CI:0.189 ～0.555)是患侧肾功能损害的独立危险因子(P＜0.05).WIT在30 min以内时对肾功能影响相对较小,随着WIT的延长,患肾功能及总体肾功能损害程度明显增加(F=22.128、20.552,P=0.000).结论 LPN术中越长的WIT对肾功能的损害越严重.测定患侧肾sGFR可准确评估LPN患者术后肾功能损害程度.应尽力将术中WIT控制在30 min以内.

abstractsObjective To assess the effects of warm ischaemia time (WIT) on renalfunction after laparoscopic partial nephrectomy (LPN) for renal masses in patients.Methods From January 2010 to December 2012,39 patients treated with LPN for a single T1 renal tumor were enrolled in this prospective study.There were 24 male and 15 female patients.Their age was (58 ± 10) years old,and their body mass index was (27±3) kg/m2.The mean operation time was (132 ± 12) minutes,and the mnean WIT was (29 ± 8) minutes.Clinical parameters,thc single glomerular filtration rates (sGFR) were compared before the operation and after 3 and 12 months in order to observer the effects on renal function and find the factors predicting the renal function impairment.Results There were significant differences between 3,12 months after the operation ((26.8 ± 5.6) ml/min and (28.6 ± 5.6) ml/min,respectively) and preoperation ((31.9 ± 6.3) ml/min) in sGFR (F =4.882 and 5.51 l,both P ＜ 0.05).And there were significant negative correlations between the sGFR in 3 and 12 months after the operation and WIT (r =-0.569,P =0.000 and r =-0.448,P =0.004).The preoperative sGFR (β =0.260,95％ CI:0.089-0.431) and WIT (β =0.369,95％ CI:0.189-0.555) were independent predictors for function decline of the operated kidney (both P ＜ 0.05).The analysis showed that the effects of WIT within 30 minutes on renal function is relatively small.Longer WIT was associated with lower postoperative sGFR values (F =22.128 and 20.552,both P =0.000).Conclusions For the LPN operation,the longer of the WIT,the more serious of renal function damage,sGFR is an accurate measurement to assess the renal damage.Every effort should be made to minimise WIT during LPN,and the limit of 30 minutes should be not exceeded.