CAJ | 학술논문

目的：：分析腹腔镜肾部分切除(LPN)术后体质指数(BMI)变化对肾功能的影响.方法：回顾性分析同一术者(张旭)行 LPN 术后不同随访阶段(1年,3年和5年)的病例资料共204例(1年组90例,3年组66例和5年组48例).比较各组临床资料,肿瘤特性,手术资料和肾功能变化；运用单因素和多因素分析显示影响术后肾功能改变的因素.结果：三组病例临床资料、肿瘤学特性和围手术期预后方面差异无统计学意义.尽管随访时各组 BMI 差异无统计学意义(P ＝0.857),但随访前后 BMI 变化差值及变化率之间差异有统计学意义(P ＝0.008和 P ＝0.015),BMI 的变化呈上升趋势.三组在手术时间,热缺血时间和术中失血量方面差异有统计学意义(P ＝0.010,P ＝0.027和 P ＝0.021).三组术前肾功能没有明显差异,而随访时肌酐(sCr)和评估的肾小球滤过率(eGFR)差异有统计学意义(P ＝0.012和 P ＝0.001),eGFR 的下降趋势较 sCr 的变化更加明显.对BMI、sCr 和 eGFR 的变化差值分别进行组间比较可见术后5年组的变化最明显.相对于单因素分析结果,多因素分析发现仅有5年组(P ＜0.001)、BMI 的变化差值(P ＝0.039)和术前 eGFR(P ＜0.001)是预示术后 eGFR改变的显著因素.结论：术后 BMI 的上升将导致 LPN 患者肾功能下降. LPN 术后对长期随访的患者需要警惕体重升高引起的肾功能改变,并及时采取干预措施.
목적：：분석복강경신부분절제(LPN)술후체질지수(BMI)변화대신공능적영향.방법：회고성분석동일술자(장욱)행 LPN 술후불동수방계단(1년,3년화5년)적병례자료공204례(1년조90례,3년조66례화5년조48례).비교각조림상자료,종류특성,수술자료화신공능변화；운용단인소화다인소분석현시영향술후신공능개변적인소.결과：삼조병례림상자료、종류학특성화위수술기예후방면차이무통계학의의.진관수방시각조 BMI 차이무통계학의의(P ＝0.857),단수방전후 BMI 변화차치급변화솔지간차이유통계학의의(P ＝0.008화 P ＝0.015),BMI 적변화정상승추세.삼조재수술시간,열결혈시간화술중실혈량방면차이유통계학의의(P ＝0.010,P ＝0.027화 P ＝0.021).삼조술전신공능몰유명현차이,이수방시기항(sCr)화평고적신소구려과솔(eGFR)차이유통계학의의(P ＝0.012화 P ＝0.001),eGFR 적하강추세교 sCr 적변화경가명현.대BMI、sCr 화 eGFR 적변화차치분별진행조간비교가견술후5년조적변화최명현.상대우단인소분석결과,다인소분석발현부유5년조(P ＜0.001)、BMI 적변화차치(P ＝0.039)화술전 eGFR(P ＜0.001)시예시술후 eGFR개변적현저인소.결론：술후 BMI 적상승장도치 LPN 환자신공능하강. LPN 술후대장기수방적환자수요경척체중승고인기적신공능개변,병급시채취간예조시.
Objective:To evaluate the effect of postoperative change of body mass index (BMI)on renal function after laparoscopic partial nephrectomy (LPN).Methods:A retrospective analysis on 204 patients who had undergone LPN by the same laparoscopic surgeon (Xu Zhang)in different follow-up periods (90 patients in one-year group,66 in three-year group,and 48 in five-year group)was performed.Patient demographics,tumor characteristics,opera-tive outcomes,and renal functions were compared.Univariate and multivariate analyses were performed to show pre-dicting factors for the change value of estimated glomerular filtration rates (eGFR).Results:The patients were fol-lowed up for a median period of 1 7 months in the one-year group,41.5 months in three-year group,and 65 months in the five-year group.There were no significant differences among the three groups with respect to patient demo-graphics,tumor characteristics,and perioperative outcomes.Although there were no differences observed in follow-up BMI (P = 0. 8 5 7 ),there were significant differences regarding BMI change value and ratio among the groups (P = 0. 0 0 8 and P = 0. 0 1 5 ).And there was a trend towards rising of BMI in the three groups (0. 5 9 ,0. 6 7 and 0.86 kg/m2 respectively).The one-year group had faster operative time (91.46 ± 25.57 ) min, (P =0.010),shorter warm ischemia time (1 7.81 ± 5.98)min,(P = 0.027 ),and less estimated blood loss (30.5 ± 28.86)mL,(P =0.021)than the other groups.Comparison of preoperative renal function did not show a statistical-ly significan difference among the three groups for serum creatinine (sCr)and eGFR;however,these effects reached statistically significant difference in sCr (P = 0.012 )and eGFR (P = 0.001 )during follow-up period,and the change trend in eGFR more obvious than in sCr.The five-year group showed a statistically significant difference com-pared with one-year/three-year groups in the change value of BMI (P =0.012/P =0.041 ),sCr (both P <0.001 ) and eGFR (both P < 0.001 ).Univariate analyses showed five-year group (P < 0.001 ),age (P = 0.003 ),BMI change value and ratio (P =0.026 and P =0.048),age-adjusted CCI (P =0.020),R.E.N.A.L.score (P =0.049), preoperative eGFR (P <0.001)and warm ischemia time (P =0.039)as statistically significant predictive factors for the eGFR change value.In contrast,multivariate analyses showed that only five-year group (P < 0.001 ),BMI change value (P =0.039)and preoperative eGFR (P <0.001)had a statistically significant predictive factor for the eGFR change value.Conclusions:The increase of BMI was associated with declines in kidney function in a cohort of LPN patients.Clinicians should vigilantly monitor and timely intervene in elevated body weight patients for evidence of early kidney function decline in the long-term follow-up after LPN.