改良R.E.N.A.L评分在经后腹腔途径治疗T1b期肾癌的临床意义研究  

Clinical significance of modified R.E.N.A.L score in the treatment of T1b renal carcinoma in the retroperitoneal cavity

作　　者：杨杰[1] 万晓照 郑秀龙[1] 赵洪波[1] Yang fie;Wan Xiaozhao;Zheng Xiulong(Department of Urology,the People＇s Hospital of Pingdu City,Pingdu 266700,China)

机构地区：[1]山东省平度市人民医院泌尿外科,山东平度266700

出　　处：《国际泌尿系统杂志》2018年第6期922-925,共4页International Journal of Urology and Nephrology

摘　　要：目的 对R.E.N.A.L评分系统进行改良,评估其改良在经后腹腔途径治疗T1b期肾癌的临床意义和价值.方法 选取2014年6月至2017年6月本院泌尿外科收治的T1b期肾癌患者63例,根据患者的核磁或肾脏CT、R.E.N.A.L评分系统和改良评分系统分别进行评分,将手术难度分为低度复杂组、中度复杂组和高度复杂组.比较分析各评分系统对手术难度评估的灵敏度、特异度和约登指数,并分析改良R.E.N.A.L评分系统与围手术期结局的关系,从而探讨改良后的评分系统对经后腹腔途径治疗T1b期肾癌的临床意义和价值.结果 R.E.N.A.L评分系统分级与实际手术难度分级之间的差异具有统计学意义（P＜0.05）,但改良R.E.N.A.L评分系统分级与实际手术难度分级之间的差异却不具有统计学意义（P＞0.05）.改良R.E.N.A.L评分系统的灵敏度、特异性、约登指数均明显优于R.E.N.A.L评分系统,两者之间的差异均具有统计学意义（P＜0.05）.经改良R.E.N.A.L评分系统分级后,手术时间、热缺血时间、术中出血量、术后并发症会随着手术的难度的增高而增加,其差异具有统计学意义（P＜0.05）,但住院时间和术后血肌酐与手术的难度无明显关系,其差异不具有统计学意义（P＞0.05）.结论 改良R.E.N.A.L评分系统更适用于经后腹腔镜下肾癌手术的难度分级,且手术的难度分级与手术时间、热缺血时间、术中出血量和术后并发症呈显著相关性.Objective To improve the R.E.N.A.L scoring system and evaluate its clinical significance and value in the treatment of stage T1b renal carcinoma in the posterior intraperitoneal pathway.Methods From June 2014 to June 2017,63 patients with T1b renal cancer were treated in our hospital.According to the patient＇s NMR or renal CT,R.E.N.A.L scoring system and improved scoring system,the scores were scored.The difficulty of operation was divided into low complex group,moderate complex group and highly complex group.A comparative analysis of the scoring system for assessment of the difficulty of operation sensitivity,specificity and Youden index was performed.We also analyzed the relationship between the modified R.E.N.A.L scoring system and perioperative outcomes,so as to explore the clinical significance and value of the improved scoring system in the treatment of T1 b stage renal cell carcinoma via retroperitoneal approach.Results The difference between the grading system of R.E.N.A.L and the grading of operative difficulty was statistically significant （P ＜ 0.05）,but the difference between the modified R.E.N.A.L grading system and the actual operative difficulty grading was not statistically significant （P ＞ 0.05）.The sensitivity,specificity and Youden index of the improved R.E.N.A.L scoring system were significantly better than those of the R.E.N.A.L scoring system,and the difference between them was statistically significant （P ＜ 0.05）.After modified R.E.N.A.L scoring system,the classification,operation time,warm ischemia time,intraoperative bleeding volume,postoperative complications increased with surgery difficulty,the difference was statistically significant （P ＜ 0.05）,but there was no significant difference in postoperative serum creatinine and hospitalization time and surgical difficulty （P ＞ 0.05）.Conclusions The modified R.E.N.A.L scoring system is more suitable for the difficulty grading of retroperitoneal laparoscopic renal cell carcinoma,and the difficulty degree of opera

关 键 词：肾肿瘤 腹腔镜检查 

分 类 号：R737.11[医药卫生—肿瘤]