99Tcm-DTPA肾动态显像在根治性肾切除术中的应用价值

Application value of renal dynamic imaging in radical nephrectomy

  • 摘要:
    目的通过99Tcm-DTPA肾动态显像测定总肾及分肾肾小球滤过率(GFR),评价其在根治性肾切除术中的应用价值。
    方法 60例根治性肾切除术患者术前行99Tcm-DTPA肾动态显像,定量测得总肾及分肾GFR。依据肾脏肿瘤直径大小分为≥ 4 cm组和 < 4 cm组,以了解术前患者GFR降低与肿瘤大小的相关性。采用t检验进行两组GFR水平的比较。单因素及多因素回归分析寻找术后肾功能不全的预测因子。
    结果肿瘤 < 4 cm组患侧平均GFR为(52.94±8.57)mL/min,≥ 4 cm组患侧平均GFR为(45.78±13.27)mL/min,两组术前患侧GFR水平的差异有统计学意义(t=2.152,P < 0.05)。术前总GFR水平、术前健侧GFR水平的差异均无统计学意义(t=1.852、1.255,均P>0.05)。术后新出现肾功能不全的比例为21.6%,单因素及多因素logistic回归分析结果发现,术前健侧GFR降低(OR=3.6,P < 0.05)、术前总肾GFR降低(OR=5.64,P < 0.05)是术后肾功能不全的独立危险因素。
    结论采用99Tcm-DTPA肾动态显像可以定量评价分肾和总肾GFR,对肾脏肿瘤患者术前指导及术后肾功能不全的预测有重要的临床意义。

     

    Abstract:
    Objective To evaluate the clinical value of total and half glomerular filtration rate (GFR) measured through 99Tcm-DTPA renal dynamic imaging during radical nephrectomy.
    Methods The total and half GFRs of 60 patients with renal tumors were measured and analyzed through renal dynamic imaging prior to surgery. The patients were divided into two groups in accordance with renal tumor diameter (≥ 4 cm or < 4 cm). Then, the correlation between decreased preoperative GFR and tumor size was determined. Univariate and multivariate analyses were performed to detect the predictors of renal insufficiency for the evaluation of the clinical value of total and half GFRs in operated patients.
    Results The average GFR of the affected kidney in the group with tumors less than 4 cm in diameter was (52.94±8.57) mL/min, whereas that of the group with tumors greater than 4 cm in diameter was (45.78±13.27) mL/min. The preoperative GFR of the affected side (t=2.152, P < 0.05) of the two groups were significantly different. Meanwhile, the preoperative GFR of the unaffected side and total kidney of the two groups were not significantly different (t=1.852, 1.255, both P>0.05). The ratio of postoperative new renal insufficiency was 21.6%. Univariate and multivariate analyses showed that the decreased preoperative GFR of the unaffected side (OR=3.6, P < 0.05) and total kidney (OR=5.64, P < 0.05) are independent risk factors of postoperative renal insufficiency.
    Conclusion Total and half renal functions determined through renal dynamic imaging are clinically valu-able in the preoperative direction and evaluation of renal insufficiency.

     

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