Factors Influencing Renal Function Of Operated Kindey After Partial Nephrectomy

Partial nephrectomy has been a standard therapeutic method of small renal tumor nowadays.Open partial nephrectomy has achieved coequal treatment effectiveness compared to radical nephrectomy in treatment of small renal neoplasm.Partial nephrectomy can cure small renal cancer.Meanwhile,renal function can be reserved and incidence rate of kidney insufficiency can be decreased.Renal function of operated kindey can be recuperarted after partial nephrectomy on most patients.But in a few of patients,kindey function was impaired or lost.So to study and research with influential factors of operated kindey after partial nephtectomy will be important in recovery of renal function.Most factors may influence renal function after partial nephrectomy,such as:age,sex,concomitant diseases,renal function before operation, intraoperative renal ischemia time, localization and size of renal tumor,hemodynamics variance in operation ie. hypotension for instance,the depth of excisional normal renal parenchyma ,and so on.These factors had been reserched in this study . Age,clamping time and preoperative GFR of operated kindey were the main facters influencing renal function after partial nephrectomy using methods of statistics.Hemodynamics should be stabilized in operation and renal ischemia time should be reduced as far as possible in old patients.Protectant drugs of kindey can be used in the operation. The negative effects can be cut down with these methods.With the development of laparoscopic techniques in recent years,laparoscopic partial nephrectomy has been utilized to treat small renal cancer and achieved the destination of minimally invasive therapy. Further study would be carried out about inflencing factors of operated kindey under laparoscopic surroundings.Objective To investigate the main factors predicting functional outcomes of operated kindey after partial nephrectomy(PN).Methods From October 2007 to July 2009,37 patients underwent open partial nephrectomy.There were 3 patients of bilateral renal cancers.Glomerular filtration rate(GFR) of the renal units with tumor from99mTc-Diethylenetetramine pentaacetic acid(99mTc-DTPA) renal scan was measured preoperatively and 3 months postoperatively.PN was performed by renal artery clamping alone in all patients. Patient, tumor and perioperative characteristics with respect to changes in GFR of operated kidney had been analyzed .Statistical analysis was performed using the Student t test and multivariate linear regression analysis.Results Operation time was 80～195min,mean(122.51±25.86)min.Mean of clamping time was (24.51±8.05)min.Mean of tumor sizes was (3.62±0.76)cm. Mean preoperative GFR and postoperative GFR after 3 months were (47.19±6.85) ml/min and (30.4±8.87) ml/min, respectively. Reduction and percent reduction in GFR were (16.79±6.35) ml/min and 34%,respectively. At followup of 3～21 months,there were no recurrence or metastasis.All patients were alive. On multivariate analysis, Age,clamping time of renal artery and preoperative GFR of operated kindey were significant with p value 0.004,0.000,0.000, respectively.Conclusions Age,clamping time and preoperative GFR of operated kindey were the main facters influencing renal function after PN.