术前解剖特征分类评分系统在T1期肾肿瘤术式选择中的应用  

Significance of the PADUA nephrometry scoring system in determining the operative method for T1 stage renal tumour

作　　者：刘勇[1] 姜德田 毛昕[1] 钟修龙[1] 王洪[1] 纪建磊 宋树欣[1] 

机构地区：[1]青岛大学医学院附属医院泌尿外科,266000

出　　处：《中华泌尿外科杂志》2014年第10期734-738,共5页Chinese Journal of Urology

摘　　要：目的 探讨术前解剖特征分类（preoperative aspects and dimensions used for an anatomical,PADUA）评分系统在T1期肾肿瘤术式选择中的应用价值. 方法 回顾性分析2010年1月至2012年12月122例行手术治疗的T1期肾肿瘤患者的临床资料.男84例,女38例.年龄21～81岁,平均51岁.体质指数（22.8±3.9） kg/m2.肿瘤位于左肾63例,右肾59例;直径为（3.6±1.3）cm.T1a期78例,T1b期44例.行保留肾单位手术77例,根治性肾切除术45例.T1a期患者中行保留肾单位手术56例,根治性肾切除术22例;T1b期行保留肾单位手术21例,根治性肾切除术23例.将患者术前CT检查的肾解剖学特征行PADUA系统评分,分析其与术式的关系. 结果 本组122例的PADUA评分低、中、高度复杂肿瘤分别为24、62、36例.在PADUA评分低、中、高复杂程度中根治性肾切除术例数分别为2例（8.3％）、19例（30.6％）、24例（66.7％）,保留肾单位手术例数分别为22例（91.7％）、43例（69.4％）、12例（33.3％）.77例保留肾单位手术中,PADUA评分低、中、高复杂程度的腹腔镜下手术分别为18、25、2例,开放手术分别为4、18、10例.不同PADUA评分程度下的保留肾单位手术和根治行肾切除术例数（x2 =23.16,P＜0.01）及开放式和腹腔镜下保留肾单位手术例数（x2=13.57,P＜0.01）比较差异均有统计学意义.PADUA评分中的肿瘤直径（HR=2.79;95％ CI,1.29 ～6.02;P＜0.01）、外凸率（HR=3.82;95％CI,1.77～8.09;P＜0.01）、沿纵轴位置（HR=4.00; 95％ CI,1.83～8.72;P＜0.01）、与集合系统关系（HR=15.11;95％ CI,5.95 ～ 38.35;P＜0.01）、与肾窦关系（HR=103.13;95％ CI,21.85 ～486.81;P＜0.01）、内外侧（HR=3.50;95％CI,1.61～7.59;P＜0.01）均与术式有相关性,其中肿瘤与肾窦关系的相关系数最高（r-0.70）. 结论 PADUA评分系统对指导T1期肾肿瘤手术方式的选择有重要意义,低度复杂肿瘤首选保留肾单位手术,中度复杂肿瘤应尽可能行Objective To evaluate the efficacy of preoperative aspects and dimensions used for an anatomical （PADUA） scores in determining the surgical approach for T1 stage renal masses.Methods From Jan 2010 to Dec 2012,clinical data of 122 cases （76 males and 46 females）,who underwent surgery for T1 stage renal masses,were collected retrospectively.The mean age was 51 years（range 21-81） and mean body mass index was （22.8±3.9） kg/m2.Sixty-three tumors were found in left kidney and 59 in right kidney.Among them,78 patients were diagnosed as T1a stage and 44 patients were T1b stage.In patients with T1a stage,56 received nephron sparing surgery （NSS） and 22 received radical nephrectomy （RN）.In patients with T1b stage,21 received NSS and 23 received RN.The PADUA nephrometry score was analyzed to evaluate their relationships to surgical type and the approach of NSS.Results According to the PADUA nephrometry score,the number of low risk,middle risk and high risk patients were 24,62,26,respectively.Inlow risk group,middle risk group and high risk group,the proportion of RN and NSS was 8.3%/ 91.7%,30.6%/69.4%,66.7%/33.3%.In 77 patients received NSS,the unmber of laparoscopic NSS and open NSS was 18 ∶ 4,25 ∶ 18,2 ∶ 10,respectively.The PADUA nephrometry score was significantly associated with the type of surgery （x2 =23.16,P〈0.01）,and the NSS approach （x2 =13.57,P〈0.01）.Tumor size （HR =2.79 ; 95% CI,1.29-6.02 ; P〈 0.01）,percentage of tumor deepening into the kidney （HR =3.82; 95%CI,1.77-8.09; P〈0.01）,longitudinal （HR=4.00;95%CI,1.83-8.72; P〈0.01）,tumor relationships with renal sinus（HR=103.13; 95%CI,21.85-486.81 ; P〈0.01）,tumor relationships with urinary collecting system （HR =15.11 ; 95% CI,5.95-38.35 ; P〈 0.01）,rim tumor location （HR =3.50 ; 95% CI,1.61-7.59; P〈0.01） were closely related with surgery approach.The correlation coefficients of relationship with renal sinus was highest （r=0.70）.Conclusions The PADUA nephrometry score provides a simple,us

关 键 词：肾肿瘤 术前解剖特征分类评分系统 保留肾单位手术 

分 类 号：R737.11[医药卫生—肿瘤]