Natural history of chronic renal insufficiency after partial and radical nephrectomy
Natural history of chronic renal insufficiency after partial and radical nephrectomy
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DOI：
10.1016/s0090-4295(02)01501-7
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发表时间：
2002-06-01
期刊：
影响因子：
2.1
通讯作者：
Russo, P
中科院分区：
文献类型：
--
作者：
McKiernan, J;Simmons, R;Russo, P
目标.比较肾部分切除术（PN）和根治性肾切除术（RN）后新发慢性肾功能不全的发生率。肾肿瘤的选择性PN旨在保护肾功能;然而，对移植供体的研究表明，单侧肾切除术后也能维持正常的肾功能。我们回顾性地比较了1989年至2000年期间所有接受PN或RN治疗4 cm或以下肾肿瘤且对侧肾脏正常的患者。肌酐衰竭定义为血清肌酐值大于2.0 mg/dL。比较两组肾功能不全的危险因素，包括糖尿病、高血压、美国麻醉医师学会评分、年龄、术前肌酐和吸烟史。采用卡方检验和Mann-Whitney U检验比较两组患者，采用Kaplan-Meier法比较两组患者的肌酐衰竭率。173例患者在RN后符合分析标准，117例患者在PN后符合分析标准（中位随访时间为25个月）。PN和RN的5年无复发率分别为96.4%和98.6%（P > 0.05）。RN和PN的平均术前血清肌酐分别为1.0 mg/dL（范围0.4 - 1.4）和0.98（范围0.6 - 1.5）（P = 0.4，无显著性）。两组间肾功能不全危险因素的发生率无差异。RN组和PN组的平均术后血清肌酐分别为1.5 mg/dL（范围0.8 - 3.8）和1.0 mg/dL（范围0.5 - 1.9）（P
Objectives. To compare the incidence of newly developed chronic renal insufficiency after partial nephrectomy (PN) and radical nephrectomy (RN). Elective PN for renal tumors is intended to preserve renal function; however, studies of transplant donors suggest normal renal function is also maintained after unilateral nephrectomy.Methods. We retrospectively compared all patients undergoing PN or RN for renal tumors 4 cm or less in the presence of a normal contralateral kidney from 1989 to 2000. Creatinine failure was defined as a serum creatinine value greater than 2.0 mg/dL. Risk factors for renal insufficiency, including diabetes, hypertension, American Society of Anesthesiologists score, age, preoperative creatinine, and history of smoking tobacco, were compared between the two groups. We compared the two groups using the chi-square and Mann-Whitney U tests and the creatinine failure rates using the Kaplan-Meier method.Results. One hundred seventy-three patients met the criteria for analysis after RN and 1 17 did so after PN (median follow-up 25 months). The 5-year freedom from recurrence rate was 96.4% and 98.6% for PN and RN, respectively (P > 0.05). The mean preoperative serum creatinine was 1.0 mg/dL (range 0.4 to 1.4) and 0.98 (range 0.6 to 1.5) for RN and PN, respectively (P = 0.4, not significant). The incidence of risk factors for renal insufficiency did not differ between the two groups. The mean postoperative serum creatinine in the RN and PN groups was 1.5 mg/dL (range 0.8 to 3.8) and 1.0 mg/dL (range 0.5 to 1.9), respectively (P