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首页> 外文期刊>Urology >Robotic Partial Nephrectomy for Small Renal Masses in Patients With Pre-existing Chronic Kidney DiseaseJulien Guillotreau, Rachid Yakoubi, Jean-Alexandre Long, Joseph Klink,
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Robotic Partial Nephrectomy for Small Renal Masses in Patients With Pre-existing Chronic Kidney DiseaseJulien Guillotreau, Rachid Yakoubi, Jean-Alexandre Long, Joseph Klink,

机译：已有部分慢性肾脏病患者的机器人小肾部分肾切除术Julien Guilloteau，Rachid Yacoubi，Jean-Alexandre Long，Joseph Klink，

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To assess the outcomes of robotic partial nephrectomy in patients with pre-existing chronic kidney disease (CKD).Patients who underwent robotic partial nephrectomy for renal tumors between 2007 and 2011 were identified from our prospectively maintained institutional database. Perioperative as well as short-term oncological and functional outcomes were assessed. A comparative analysis was performed between patients with pre-existing CKD (estimated glomerular filtration rate [eGFR] 15-60 mL/min, group 1, n = 52) and patients with eGFR >60 mL/min (group 2, n = 303).Group 1 patients were older (median 68 vs 57 years, P < .001), with higher American Society of Anesthesiology (ASA) score (3 vs 2, P < .001) and a higher Charlson comorbidity index (7 vs 4, P < .001). Warm ischemia time (WIT) was similar in both groups (18 vs 18 minutes, P = .52). Group 1 had a higher postoperative complication rate (40.4% vs 21.1%, P = .003). Pathologic and oncological data were similar. After a median follow-up of 3 months (interquartile: 1-10), deterioration of eGFR was lower in group 1 patients (-5% vs -12%, P = .004). No endstage renal disease was noted in either group. There was significantly less CKD upstaging in group 1 than in group 2 (11.5% vs 33.9%, P = .001). After multivariate analysis, preoperative eGFR and WIT were independent predictors of latest eGFR. Less than 15% of patients with normal baseline renal function developed CKD stage III or higher.Despite a high risk of surgical complications, robotic partial nephrectomy only marginally affects renal function in patients with pre-existing CKD.
机译：为了评估已经存在的慢性肾脏病（CKD）患者的机器人部分肾切除术的结果。从我们前瞻性维护的机构数据库中，选择了2007年至2011年之间接受机器人部分肾切除术治疗肾脏肿瘤的患者。评估围手术期以及短期的肿瘤和功能结局。已有CKD（估计肾小球滤过率[eGFR] 15-60 mL / min，第1组，n = 52）和eGFR> 60 mL / min（第2组，n = 303）的患者之间进行了比较分析）。第1组患者年龄较大（中位年龄68岁vs 57岁，P <.001），美国麻醉学会（ASA）评分更高（3 vs 2，P <.001），查尔森合并症指数更高（7 vs 4） ，P <.001）。两组的热缺血时间（WIT）相似（18 vs 18分钟，P = 0.52）。第1组术后并发症发生率更高（40.4％vs 21.1％，P = .003）。病理和肿瘤学数据相似。中位随访3个月（四分位数：1-10）后，第1组患者的eGFR恶化程度较低（-5％对-12％，P = .004）。两组均未发现晚期肾病。第1组的CKD升级明显少于第2组（11.5％比33.9％，P = .001）。经过多变量分析，术前eGFR和WIT是最新eGFR的独立预测因子。基线肾功能正常的患者中只有不到15％的患者发展为CKD III级或更高，尽管手术并发症的风险很高，但机器人部分肾切除术仅对既有CKD患者的肾功能产生轻微影响。

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