Analysis Of Related Factors Affecting The Recovery Of Renal Function After Retroperitoneal Laparoscopic Partial Nephrectomy

Objective: To explore the related factors affecting the recovery of residual renal function after laparoscopic partial nephrectomy and the changes of renal function with time after laparoscopic partial nephrectomy.Methods: According to the inclusion criteria,it is planned to collect about 50 patients who underwent laparoscopic partial nephrectomy in our department in September2018 and January 2020.The main collected data include: gender,age,hypertension,diabetes,smoking,drinking,preoperative renal GFR results,creatinine,BMI,RENAL score,PADUA score,CCI score,ASA score,operation time,warm ischemia time(WIT),intraoperative blood loss,volume of removed kidney and tumor,surgical suture level,surgical pneumoperitoneum pressure,pathological type,postoperative drainage,postoperative complications,kidney GFR,serum creatinine and serum cystatin C and other related indicators of 1 week,3 months,6 months,9 months,12 months after surgery.The above data was used to preliminarily evaluate the related factors that affect the function of the residual kidney after laparoscopic partial nephrectomy and the changes in renal function after the operation.Results:In this study,50 patients successfully completed the operation,no conversion to open or to radical renal surgery.The total operation time was(65 ±201)min,and the average operation time was(122.51 ±25.86)min.The clamping time of renal artery was 28.32 ±7.62 min.The diameter of the tumor was about 3.441.43 cm.The GFR of kidney before operation and 3 months,6 months,9 months and 12 months after operation were 41.98 ±7.80,26.18 ±8.19,29.93 ±9.42,30.78 ±8.61,32.15±8.30 m L/min,respectively.The results of univariate analysis showed that body mass index,warm ischemia time,patient age,ASA score,preoperative GFR,intraoperative nephrectomy volume and R.E.N.A.L score were the possible factors affecting postoperative renal function.The results of multiple regression analysis showed that age,body mass index,warm ischemia time,preoperative renal function and resected renal volume were significant factors affecting postoperative renal function.All patients were followed up for 12 to 16 months,there was no recurrence or metastasis.All patients survived tumor-free.Conclusion:1.Age,preoperative GFR,warm ischemia time and intraoperative nephrectomy volume are independent predictors of postoperative renal function.2.The volume of surgically resected kidney is the main factor affecting renal function after operation.3.The clamping time of renal artery during laparoscopic partial nephrectomy should be kept within 30 min.4.Warm ischemia time is a secondary factor affecting postoperative renal function.5.The renal function decreased to the lowest at 3 months after operation,then began to increase slowly,and the renal function tended to be stable at 12 months.The renal function of the healthy side increased to the highest point 3 months after operation,and the renal function of the healthy side decreased slowly with time and gradually stabilized at 12 months.The total renal function decreased to the lowest at 3 months after operation,then increased slowly,and gradually stabilized at 12 months...