| Objective: By observing the perioperative clinical data of patients undergoing retroperitoneal laparoscopic partial nephrectomy,to explore: 1.The related factors affecting renal function after RLPN and the relative safe range of warm ischemia.2.To explore the application value of R.E.N.A.L scoring system and DDD scoring system in RLPN.Methods: 1.The clinical data of 62 patients who underwent RLPN in the Department of Urology,affiliated Hospital of Guizhou Medical University from September 2016 to December 2018 were retrospectively analyzed.There were 34 males and 28 females.The patients were followed up for 12 months.According to WIT,the patients were divided into three groups: group A,group B and group C.glomerular filtration rate,renal volume and renal cortical thickness were studied before and after follow-up.2.According to the preoperative imaging data,the renal tumor was quantitatively scored by R.E.N.A.L and DDD scoring system.According to the score,the patients were divided into three groups: low group(4-6),middle group(7-9),high score(10-12).DDD score: low group(3-4),middle group(5-7),high score(≥8).The operation time,WIT,intraoperative blood loss and hospital stay were compared.Data statistical software IBMSPSS23.0 was used for statistical analysis,variance analysis was used to analyze the changes of GFR at each follow-up time node before and after operation,the changes of renal volume and renal cortex thickness at each follow-up time node before and after operation,and the clinical data of each group of scoring system.Univariate and multiple linear regression analysis were used to analyze the factors affecting renal function after operation.Results: 1.62 patients were followed up for 12 months.The 15-20 min of group A was(18.5 ±1.1),B(21-25min: 23.2 ±1.4),C(26-30min: 27.4 ±1.5).There was no significant difference in GFR among the three groups before operation.one month after operation,the GFR of the affected side decreased in varying degrees compared with that of the affected side before operation,and the GFR in group B and C was significantly lower than that in group A(P<0.05).The GFR of the affected side in group A decreased 1 month after operation compared with that before operation,and the difference was statistically significant(P<0.05).In the);B group,the GFR of the affected side decreased 1 month and 3 months after operation,and the difference was statistically significant(P<0.05).In group C,the GFR of the affected side decreased at 1 month,3 months,6 months,9 months and 12 months after operation,compared with those before operation,and the difference was statistically significant(P<0.05).2.There was no significant difference in preoperative renal volume among the three groups.The follow-up nodes of postoperative renal volume in the three groups were significantly higher than those before operation(P > 0.05),and the renal volume retention ratio was(86±3.3)%.3.There was no significant difference in the thickness of renal cortex among the three groups before operation,there was no significant difference in the thickness of renal cortex between group A and group B at each follow-up time after operation,and the thickness of renal cortex in group C was significantly lower than that before operation 1 month after operation.the difference was statistically significant(P<0.05),and the renal cortex retention ratio was(89±2.8)%.4.Multivariate linear analysis showed that WIT,PFVP and preoperative GFR were the influencing factors of early postoperative renal function decline.5.In the R.E.N.A.L grouping,the analysis of variance showed that there was only significant difference in operation time among the three groups: the low score(4-6),the middle score(7-9)and the high score(10-12).6.In the DDD grouping,the analysis of variance showed that there were significant differences in WIT,operation time,intraoperative blood loss and postoperative renal GFR among the three groups(P < 0.05).The results showed that there were significant differences among the three groups in terms of WIT,operation time,intraoperative blood loss and postoperative renal GFR(1 month)among the low group(3-4),the middle group(5-7)and the high group(≥8).Conclusion: 1.20 min may be the most suitable blocking time for WIT,WIT is more than 25 minutes,the renal cortex may atrophy slightly about 1 month after operation.2.The level of GFR,WIT and PFVP before operation may be the three factors affecting the function of kidney after operation.3.The clinical application value of R.E.N.A.L scoring system is limited,and DDD scoring system can accurately evaluate surgical risk,which is of reference value. |
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