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目的探讨高龄患者肾切除后留存肾的功能状态。方法采用放射性核素肾动态显像法测定24例70岁以上高龄患者(高龄组)和20例21～59岁亲体移植供肾者(对照组)肾小球滤过率(GFR)和有效肾血浆流量(ERPF),螺旋CT扫描计算肾脏体积。检测手术前后的血清肌酐(Cr)值。结果与术前比较,高龄组术后GFR值增加了24.5%(P<0.01),ERPF值增加了11.6%(P<0.05)。留存肾重量术后较术前略有增加。对照组术前双肾GFR、ERPF均明显高于高龄组(P<0.01)。高龄组中术后有8例逐渐出现肾功能不全,其中2例发展为尿毒症;对照组术后肾功能均正常。结论高龄患者在一侧肾切除术后,留存肾照样可以代偿性增长,但其代偿能力要比年轻者差。
Objective To investigate the functional status of renal retained after nephrectomy in elderly patients. Methods The radionuclide renal dynamic imaging was used to measure the glomerular filtration rate (GFR) and effective kidneys (control group) in 24 elderly patients over 70 years old (advanced age group) and 20 age-matched 21 ~ 59 years old parental donor kidneys Plasma flow (ERPF), spiral CT scan to calculate kidney volume. Serum creatinine (Cr) was measured before and after surgery. Results Compared with preoperative, GFR of advanced age group increased by 24.5% (P <0.01) and ERPF increased by 11.6% (P <0.05). Survival renal weight after surgery slightly increased compared with preoperative. The GFR and ERPF in control group were significantly higher than those in advanced age group (P <0.01). There were 8 cases of progressive renal insufficiency in the elderly group, of which 2 cases developed uremia; the control group had normal renal function. Conclusion In elderly patients with renal nephrectomy, retained renal can still compensatory growth, but its compensatory capacity is worse than younger.