CAJ | 학술논문

目的探讨根治性肾切除与肾部分切除术后伤口引流液的肌酐水平以及手术前后血肌酐水平的变化情况,观察肾癌不同术式对肾功能的影响,并探讨伤口引流液肌酐的异常对判断术后尿瘘发生的意义.方法收集2012年3月至2012年7月间手术的肾癌患者共65例,其中根治性肾切除34例,肾部分切除31例,所有患者均在术后24 h内测定血肌酐水平、伤口引流液肌酐水平,并在术后3个月复查血肌酐情况.分析行两种不同术式后血肌酐水平的变化及伤口引流液肌酐水平的差异.结果根治性肾切除术组术后伤口引流液肌酐水平明显低于血肌酐[(99.94±21.10) μmol/L比(114.61±25.09) μmol/L,P=0.000].肾部分切除术后发生尿瘘1例(2.9％),其术后血肌酐及引流液肌酐水平分别为107 μmol/L、686 μmol/L；其余30例肾部分切除术后伤口引流液肌酐水平也明显低于血肌酐水平[(92.90±26.21) μmol/L比(99.83±28.77) μmol/L,P=0.021].肾部分切除术后血肌酐水平明显低于根治性肾切除术(P=0.035),但伤口引流液肌酐水平与根治性肾切除组无差异(P=0.239).3个月后肾部分切除组血肌酐水平明显低于肾根治性切除组[(81.43±12.82) μmol/L比(106.53±21.73) μmol/L,P=0.001].结论肾癌术后引流液肌酐水平明显低于血肌酐,引流液肌酐升高对判断肾部分切除术后尿瘘有帮助；肾癌患者肾部分切除术后肾功能恢复良好.
목적 탐토근치성신절제여신부분절제술후상구인류액적기항수평이급수술전후혈기항수평적변화정황,관찰신암불동술식대신공능적영향,병탐토상구인류액기항적이상대판단술후뇨루발생적의의.방법 수집2012년3월지2012년7월간수술적신암환자공65례,기중근치성신절제34례,신부분절제31례,소유환자균재술후24 h내측정혈기항수평、상구인류액기항수평,병재술후3개월복사혈기항정황.분석행량충불동술식후혈기항수평적변화급상구인류액기항수평적차이.결과 근치성신절제술조술후상구인류액기항수평명현저우혈기항[(99.94±21.10) μmol/L비(114.61±25.09) μmol/L,P=0.000].신부분절제술후발생뇨루1례(2.9％),기술후혈기항급인류액기항수평분별위107 μmol/L、686 μmol/L；기여30례신부분절제술후상구인류액기항수평야명현저우혈기항수평[(92.90±26.21) μmol/L비(99.83±28.77) μmol/L,P=0.021].신부분절제술후혈기항수평명현저우근치성신절제술(P=0.035),단상구인류액기항수평여근치성신절제조무차이(P=0.239).3개월후신부분절제조혈기항수평명현저우신근치성절제조[(81.43±12.82) μmol/L비(106.53±21.73) μmol/L,P=0.001].결론 신암술후인류액기항수평명현저우혈기항,인류액기항승고대판단신부분절제술후뇨루유방조；신암환자신부분절제술후신공능회복량호.
Objective To investigate the creatinine level of wound drainage and the changes of serum creatinine after radical nephrectomy or partial nephrectomy in patients with renal cell carcinoma,to explore the feasibility of testing creatinine level to predict urine leakage after surgery and to compare the influence on rcnal function after different kinds of operations.Methods 65 patients data were analyzed,in which 31 patients had undergone partial nephrectomy and 34 had radical nephrectomy for renal cell carcinoma from March 2012 to July 2012.The level of creatinine in serum and wound drainage were detected within 24 hours after surgery.Also,the serum creatinine were redetected 3 months later.Results The creatinine level of wound drainage were significantly lower than that in serum in both groups [(99.94±21.10) μmol/L vs (114.61± 25.09) μmol/L,P =0.000].Urine leakage was observed in only one patient (2.9 ％) after partial nephrectomy,which his level of creatinine in serum and wound drainage was 107 μmol/L and 686μmol/L,respectively.The other 30 patients' creatinine level of wound drainage were also significantly lower than serum after partial nephrectomy [(92.90±26.21) μmol/L vs (99.83±28.77) μmol/L,P =0.021).Although the level of creatinine in the wound drainage was not significantly different between these two groups (P =0.239),the serum creatinine was statistical lower in partial nephrectomy group than that of radical nephrectomy group (P =0.035).Also,after three months,the partial nephrectomy group had a lower level of serum creatinine [(81.43±12.82) μmol/L vs (106.53±21.73) μmol/1,P =0.001].Conclusion Partial nephrectomy has advantages in protecting renal function when compared with radical nephrectomy.The level of creatinine in wound drainage is significantly lower than serum.The level of creatinine in wound drainage is a predictive indicator for diagnosing urine leakage.