ABC评分系统在腹腔镜下肾部分切术中的应用评价  

The application of arterial based complexity （ABC） scoring system to access the complication of laparoscopic partial nephrectomy

作　　者：刘希高[1] 梁晓凌 颜京都 孟力维 周尊林[1] 

机构地区：[1]山东大学齐鲁医院泌尿外科,济南250012

出　　处：《中华泌尿外科杂志》2017年第5期357-361,共5页Chinese Journal of Urology

摘　　要：目的评价ABC评分系统对于腹腔镜下肾部分切术复杂程度的预测意义。方法回顾性分析2013年1月至2015年11月70例于我院行腹腔镜下肾部分切术（laparoscopic partial nephrectomy，LPN）的单侧肾肿瘤患者的临床资料。男53例（75.7%），女17例（24.3%）。年龄44～61岁，平均52岁。体重指数25～32 kg/m2，平均28 kg/m2。术前血肌酐60.5～81.0 μmol/L，平均70.5μmol/L。其中经腹膜后腔入路43例，经腹腔入路27例。肿瘤位于左侧38例，右侧32例。由本院4名不同年资影像科医师（主任医师、主治医师各1名，住院医师2名）分别对70例患者的术前腹部增强CT重新阅片，采用ABC评分系统进行等级评分（分为1、2、3S、3H共4个等级）。以主任医师的ABC评分作为标准，不同医师之间的评级一致性通过Kappa值评估，计算每2名评分者评分完全匹配的百分比。采用Logistics回归分析评价ABC评分系统评分等级与术中热缺血时间、术中出血量以及手术时间之间的关系。结果70例患者的手术时间为100～180 min，平均147 min。术中热缺血时间为15～37 min，平均24 min。术中出血量为50～380 ml，平均210 ml。住院时间11～21 d，平均16 d。术后2例发生尿瘘。术后病理检查回报肿瘤最大径1.8～3.0 cm，平均2.5 cm。病理类型包括肾透明细胞癌65例，肾透明细胞癌伴囊性变2例，肾嫌色细胞癌2例，右肾孤立性纤维瘤1例。本组70例患者的ABC评分等级分别为1级15例，2级29例，3S级17例，3H级9例。4名医师两两配对后的评分等级分布均有较高一致性，平均Kappa值＝0.492。4名医师两两配对后的评分结果完全匹配的平均比例为65.0%，评分结果相差≤1个等级的平均比例为98.6%。Logistics回归分析结果显示ABC评分系统的不同评分等级与术中热缺血时间、出血量显著相关（P〈0.05），而与手术时间无相关性（P〉0.05）。结论ABC评分系统对LPN的�Objective To access the efficacy of the arterial based complexity （ABC） scoring system in predicting complexity of LPN. Methods A total of 70 patients underwent laparoscopic partial nephrectomy from January 2013 to November 2015 were enrolled in the retrospective analysis. Among those patients, 53（75.7% ） were males and 17（24.3% ） were females. Their mean age was 52 years, ranged from 44 to 61 years. The average BMI was 28 kg/m2 , ranged from 25 to 32 kg/m^2. Before operation , the average creatinine was 70.5 μmol/L, ranged from 60.5 to 81.0 μmo]/L. 43 patients accepted the procedure via retro - peritoneal approach and 27 patients accepted the procedure via peritoneal approach. 38 tumor located in the left kidney and 32 tumor located in the fight kidney. By using ABC scoring system, four readers independently scored contrast-enhanced computed tomography images of 70 patients who underwent laparoscopic partial nephrectomy. Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of readers. Logistics regression was used to evaluate the association between reference scores and ischemia time, estimated blood loss, operation time. Results The operative duration ranged from 100 to 180 min, mean 147 min. The mean ischemic time ranged from 15 to 37 min, mean 24 min. The average blood loss was 210 ml （ranging 50 -380 ml）. The mean hospitalization was 16 days （ranging 11 -21 days） . The urine leakage was noticed in 2 patients after the operation. The size of tumor ranged from 1.8 to 3.0 em, mean 2.5 cm. The pathological classification included renal cell carcinoma in 65 cases, renal cell carcinoma with cystic changing in 2 eases, renal chromophobe cell careinoma in 2 eases, right renal solitary fibroma in 1 case. Based on the ABC scoring System, 15 eases were in 1 degree, 29 eases were in 2 degree, 17 eases were in 3S degree and 9 cases were in 3H degree. Pairwise comparisons of readers＇ score assignments were significantly correlate

关 键 词：肾肿瘤 肾肿瘤评分 观察者差异 腹腔镜下 肾部分切除术 

分 类 号：R737.11[医药卫生—肿瘤]