CAJ | 학술논문

目的探讨腹主动脉瘤开放手术中左肾静脉切断(LRVD)对患者术后肾脏功能及总体预后的影响.方法回顾分析中国医科大学附属第一医院2000年1月至2011年12月行开放手术治疗的腹主动脉瘤患者临床资料,分LRVD组和非LRVD组,对两组的30 d死亡率、心脑血管并发症、肺部并发症、术前和术后肌酐值及肾小球率过滤(GFR),术中主动脉阻断时间、失血量、术后重症监护时间、需透析或连续肾脏替代疗法(CRRT)比例等指标做统计学分析.结果 LRVD组患者35例,非LRVD 141例；LRVD组的破裂性腹主动脉瘤比例较非LRVD组高(48.6％比27.7％,P＜0.01),但30 d死亡率(14.3％比7.1％,P＞0.05)和主要并发症率(20.0％比11.3％,P＞0.05)差异无统计学意义；在存活的患者中,两组出院或30 d肌酐和GFR的差异无统计学意义(P＞0.05).结论腹主动脉瘤开放手术中LRVD并不增加患者术后死亡率和近期的肾功能损伤.
목적 탐토복주동맥류개방수술중좌신정맥절단(LRVD)대환자술후신장공능급총체예후적영향.방법 회고분석중국의과대학부속제일의원2000년1월지2011년12월행개방수술치료적복주동맥류환자림상자료,분LRVD조화비LRVD조,대량조적30 d사망솔、심뇌혈관병발증、폐부병발증、술전화술후기항치급신소구솔과려(GFR),술중주동맥조단시간、실혈량、술후중증감호시간、수투석혹련속신장체대요법(CRRT)비례등지표주통계학분석.결과 LRVD조환자35례,비LRVD 141례；LRVD조적파렬성복주동맥류비례교비LRVD조고(48.6％비27.7％,P＜0.01),단30 d사망솔(14.3％비7.1％,P＞0.05)화주요병발증솔(20.0％비11.3％,P＞0.05)차이무통계학의의；재존활적환자중,량조출원혹30 d기항화GFR적차이무통계학의의(P＞0.05).결론 복주동맥류개방수술중LRVD병불증가환자술후사망솔화근기적신공능손상.
Objective To explore the effects of left renal vein division (LRVD) on postoperative renal function and examine the overall prognosis in patients undergoing open repair of abdominal aortic aneurysm (AAA).Methods Retrospective analyses were conducted for the clinical data of AAA patients with open repair at our hospital from January 2000 to December 2011.They were divided into LRVD (n =35) and non-LRVD (n =141) groups.The 30-day mortality,cardiocerebrovascular complications,pulmonary complications,preoperative and postoperative levels of creatinine and glomerular rate filtration (GFR),aortic cross-clamping time,blood loss volume,intensive care duration and dialysis or continuous renal replacement therapy (CRRT) rate were compared between two groups.Results A total of 189 AAA repair were performed.And 13 patients with suprarenal clamping were excluded.The LRVD group had a significant higher proportion of ruptured AAA (48.6％ vs 27.7％,P ＜ 0.01),higher 3-day postoperative creatinine (P ＜ 0.01),longer intensive duration (P ＜ 0.05) and decreased 3-day postoperative GFR (P ＜ 0.01).No significant difference existed in 30-day mortality,incidence of major complications,creatinine or GFR at discharge (P ＞ 0.05).Conclusions LRVD during open surgery of AAA has no effect on the postoperative mortality and renal function.