使用新颖的工具，对影响部分肾切除（PN）后功能恢复的因素进行更严格的评估，这些工具允许分析更多的患者并提高评估实质体积损失的精度，从而揭示了继发因素（如缺血）的潜在影响。在进行PN（2012-14）的1140名患者中，有影像学和血清肌酐水平的670人（59％）符合纳入标准。恢复-缺血定义为同侧肾功能得到保存的GFR除以实质体积得到保存。通过Spectrum-Score评估急性肾损伤，该评分可量化暴露于缺血条件下的急性同侧肾功能障碍的程度，而这种障碍在对侧肾时可能被掩盖。采用多元回归分析以识别Spectrum-Score和恢复-缺血的预测因素。麻醉前热/冷/零缺血患者分别为409/189/72人，其中冷缺血和热缺血的中位缺血时间分别为30（IQR=25-42）和22（IQR=18-28）分钟。全局术前GFR和新基线GFR（NBGFR）的中位数分别为78（IQR=63-92）和69（IQR=54-81）毫升/分钟/1.73平方米。同侧肾的术前GFR和NBGFR的中位数分别为40（IQR=33-47）和31（IQR=24-38）毫升/分钟/1.73平方米。功能恢复与保留实质体积密切相关（r=0.83，p<0.01）。与PN相关的同侧肾GFR中位数下降为7.8（IQR=4.5-12）毫升/分钟/1.73平方米，其中81%的损失是由实质的丢失掉导致。冷/热/零缺血组的中位恢复-缺血分别为96（IQR=90-102）％，95（IQR=89-101）％和97（IQR=91-102）％。Spectrum-Score的独立预测因素是缺血时间，肿瘤复杂度和术前全局GFR。恢复-缺血的独立预测因素是胰岛素依赖性糖尿病，难治性高血压，热缺血和Spectrum-Score。PN后功能恢复的主要决定因素是实质体积的保留。更加稳健和严谨的评估使我们能够确定继发因素，包括合并症、增加的肿瘤复杂度和缺血相关因素，它们也独立地与功能恢复不良相关，但总体而言，它们的影响要小得多。本文受版权保护。版权所有。

To provide a more rigorous assessment of factors affecting functional recovery after partial nephrectomy (PN) using novel tools that allow for analysis of more patients and improved accuracy for assessment of parenchymal volume loss, thereby revealing the potential impact of secondary factors such as ischemia.Of 1140 patients managed with PN (2012-14), 670(59%) had imaging and serum creatinine levels before and after PN necessary for inclusion. Recovery-from-Ischemia was defined as ipsilateral GFR saved normalized by parenchymal volume saved. Acute kidney injury was assessed through Spectrum-Score, which quantifies the degree of acute ipsilateral renal dysfunction due to exposure to ischemia that would otherwise be masked by the contralateral kidney. Multivariable regression was used to identify predictors of Spectrum-Score and Recovery-from-Ischemia.409/189/72 patients had warm/cold/zero ischemia, respectively, with median ischemia times for cold and warm of 30 (IQR=25-42) and 22 (IQR=18-28) minutes, respectively. Median global preoperative GFR and new baseline GFR (NBGFR) were 78 (IQR=63-92) and 69 (IQR=54-81) ml/min/1.73m2 , respectively. Median ipsilateral preoperative GFR and NBGFR were 40 (IQR=33-47) and 31 (IQR=24-38) ml/min/1.73m2 , respectively. Functional recovery correlated strongly with parenchymal volume preserved (r=0.83, p<0.01). Median decline in ipsilateral GFR associated with PN was 7.8 (IQR=4.5-12) ml/min/1.73m2 with loss of parenchyma accounting for 81% of this loss. Median Recovery-from-Ischemia was similar across the cold/warm/zero ischemia groups at 96 (IQR=90-102), 95 (IQR=89-101), and 97 (IQR=91-102)%, respectively. Independent predictors of Spectrum-Score were ischemia time, tumor complexity, and preoperative global GFR. Independent predictors of Recovery-from-Ischemia were insulin-dependent DM, refractory-hypertension, warm ischemia and Spectrum-Score.The main determinant of functional recovery after PN is parenchymal volume preservation. A more robust and rigorous evaluation allowed us to identify secondary factors including comorbidities, increased tumor complexity, and ischemia-related factors that also independently associated with impaired recovery, although altogether these were much less impactful.This article is protected by copyright. All rights reserved.