机器人辅助腹腔镜膀胱癌根治术后肾功能改变的观察

郑玮; 黄新冕; 王帅; 祁小龙; 刘锋; 张琦; 张大宏

doi:10.13201/j.issn.1001-1420.2018.11.006

机器人辅助腹腔镜膀胱癌根治术后肾功能改变的观察

- 1. 浙江省人民医院泌尿外科(杭州, 310014);
- 2. 杭州医学院附属人民医院泌尿外科
基金项目:
浙江省医药卫生科技项目 (编号2016KYB009)

详细信息

通讯作者: 张大宏,E-mail:zhangdahong88@163.com

中图分类号: R737.14

收稿日期: 2018-04-25

Longitudinal investigation of changes in kidney function after robot-assisted radical cystectomy plus urinary diversion for bladder cancer

- 1. Department of Urology, Zhejiang Provincial People's Hospital, Hangzhou, 310014, China;
- 2. Department of Urology, People's Hospital of Hangzhou Medical College

More Information

Corresponding author: ZHANG Dahong, E-mail: zhangdahong88@163.com

Received Date: 25 April 2018

摘要

摘要: 目的:观察机器人辅助腹腔镜膀胱癌根治术后肾功能的长期变化。方法:回顾性分析2014年9月~2017年12月行机器人辅助腹腔镜膀胱癌根治术的患者资料。分析术后慢性肾功能不全(CKD)的累积发生率和其独立危险因素。结果:共103例患者,中位随访时间16个月。术前已发生CKD的27例患者中20例(74.1%)观察到术后肾功能恢复。术前未发生CKD的76例患者术后1年和3年CKD累积发生率分别为38.9%和46.5%。不同尿流改道方式术后3年发生CKD的累积发生率分别为:原位回肠新膀胱21.0%,Bricker回肠膀胱82.4%,输尿管皮肤造口61.9%。术前未发生CKD的患者中,术后发生CKD组和未发生CKD组在术前贫血、术前eGFR水平、尿流改道方式、术后短期内eGFR水平方面差异有统计学意义(P<0.05)。其中术前eGFR水平(P=0.046)、尿流改道方式(P=0.002)、术后短期内eGFR水平(P<0.001)为术后发生CKD的独立危险因素。结论:机器人辅助腹腔镜膀胱癌根治性切除联合尿流改道术后发生CKD的情况并不罕见,术前/术后的eGFR水平和尿流改道方式与术后是否发生CKD相关。
- 膀胱癌 /
- 机器人辅助腹腔镜膀胱癌根治术 /
- 尿流改道 /
- 肾功能 /
- 预后
Abstract: Objective: To investigate the incidence rate of chronic kidney dysfunction (CKD) among patients who have received robot-assisted radical cystectomy (RARC) after a long time follow-up for bladder cancer.Method: Data of patients who underwent surgery of RARC plus urinary diversion for bladder cancer between Sep.2014 and Dec.2017 were studied.Postoperative rate of CKD and the independent risk factors were analyzed.Result: At last, 103 patients were enrolled in this retrospective study.The median follow-up period was 16 months.Twenty (74.1%) patients were observed recovery of kidney function among the 27 patients who had suffered CKD before surgery.The one-year and three-year cumulative incidence of CKD among the 76 patients whose eGFR was normal before surgery was 38.9%and 46.5%.As for different types of urinary diversion, three-year cumulative incidence of CKD was 21.0%, 82.4% and 61.9%for orthotopic ileal neobladder, Bricker ileal conduit and cutaneous ureterostomy respectively.Clinical characteristics, including anemia, preoperative eGFR and eGFR value calculated in a short time after operation, were significantly different between CKD group and non-CKD group (P<0.05).And the preoperative eGFR (P=0.046), type of urinary diversion (P=0.002) and eGFR value calculated in a short time after operation (P<0.001) were the independent risk factors for CKD.Conclusion: The incidence of CKD after RARC was not rare.The indexes of preoperative eGFR, type of urinary diversion and eGFR value calculated in a short time after operation have a close relationship with the incidence of postoperative CKD.
- bladder cancer /
- robot-assisted radical cystectomy /
- urinary diversion /
- kidney function /
- prognosis

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