DDD肾肿瘤评分系统应用于肾肿瘤手术决策的临床分析  

Application of DDD nephrometry score to surgical decision-making for renal tumors

作　　者：张中元[1] 朱军 虞巍[1] 潘喜 谌诚[1] 范宇[1] 韩文科[1] 林健[1] 王刚[1] 宋毅[1] 赵峥[1] 郝金瑞[1] 王鹤[2] 王霄英[2] 张晓春[1] 周利群[1] 李学松[1] Zhang Zhongyuan;Zhu Jun;Yu Wei;Pan Xi;Shen Cheng;Fan Yu;Han Wenke;Lin Jian;Wang Gang;Song Yi;Zhao Zheng;ao Jinrui;Wang HeH;Wang Xiaoying;Zhang Xiaochun;Zhou Liqun;Li Xuesong(Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China;Department of Radiology, Peking University First Hospital, Beijing 100034, China)

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系肿瘤研究中心,100034 [2]北京大学第一医院医学影像科,100034

出　　处：《中华临床医师杂志（电子版）》2019年第2期99-104,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家自然科学基金面上项目(81471546);山东自然科学基金项目(ZR2016HP17);山东省医药卫生科技发展计划项目(2014WS017)

摘　　要：目的 探讨DDD 肾肿瘤评分系统对于肾肿瘤手术的指导意义。方法 选择北京大学第一医院泌尿外科2013 年1 月至2017 年9 月收治2977 例病理诊断为肾细胞癌的患者进行病例回顾,筛选病例资料包含泌尿系增强CT 的患者561 例,收集患者的年龄、性别、手术方式等数据,对其术前CT 或MRI 进行回顾分析并进行RENAL 及DDD(D1 为位于肾内的肿瘤的最长径;D2 为肿瘤边界距离肾髓质或肾窦和集合系统的最短距离;D3 肿瘤距离肾脏动静脉主干的距离)系统评分。将各径线D1、D2、D3 评分与手术方式进行Mann-Whitney 秩和检验方法。进一步使用Mann-Whitney秩和检验方法,比较不同DDD 系统评分与RENAL 评分对手术方式的决策影响。结果 RENAL 及DDD 系统评分均可分为3 组:低度、中度、高度。对于肾部分切除(PN)与肾根治性切除(RN)的比较分析,RENAL 及DDD 系统评分差异具有统计学意义(P < 0.001),评分越低,行肾部分切除术的比率越高。对于腹腔镜肾部分切除术(LPN)与腹腔镜肾根治性切除术(LRN),RENAL 及DDD 系统评分差异具有统计学意义(P < 0.001),评分越低,行腹腔镜部分肾切除的比率越高。对于腹腔镜肾根治切除术(LRN)及开放肾根治切除术(ORN)的比较分析显示,低分组及中分组在使用RENAL 及DDD 系统评分差异均无统计学意义(P 值分别为0.135 和0.602),但是低分组与高分组比较时两评分系统差异均有统计学意义(P 值分别为0.025 和< 0.018),评分越高,行开放肾根治性切除术的比率越高。结论 DDD 肾肿瘤评分系统评分是一种直观简便的描述肾肿瘤解剖特征的综合评估体系,具有良好的稳定性,可以反映肾肿瘤手术的难度,协助临床医师进行肾肿瘤的手术决策。Objective To present a DDD scoring system to access the surgical complexity of Kidney Tumor and assist in Surgical decision-making process. Methods We retrospectively evaluated 561 patients who were histopathologically diagnosed as renal cell carcinoma with available imaging between January 2013 and September 2017. The surgical approaches, as well as RENAL and DDD score, were compared. We review the available English literature last decade relating to the surgical anatomy pertinent to renal mass excision, and established a solid single renal mass scoring system, the DDD. Nephrometry Score, based on the 3 most reproducible and pertinent features that characterize renal tumor critical anatomical attributes. Each feature in our nephrometry score is designated by an English letter, forming the acronym DDD:(D1) iameter (scores tumor size as maximal diameter inside of kidney),(D2) epth of the deepest portion of the tumor with the medulla and collecting system or sinus,(D3)istence shortest from the mass to the main renal vessels. The points of D1, D2 and D3 were summed as DDD score and tumors were stratified into three complexity levels. The relationships between each D variates and the operation method options were tested by the Mann-Whitney rank sum test. The further Mann-Whitney rank sum test was used to compare the different effect of DDD nephrometry score and RENAL score on surgery method choice. The P < 0.05 was considered as significant. Results In this cohort, 383 patients (68.3%) were men and 178 patients (31.7%) were women. The mean age was 57.3 (SD±11.9) years, and the mean BMI was 25.1 (SD±3.5) kg/m2. The mean of D1 was 4.3 (SD±2.0) cm. D2 was 1pt in 50 patients (8.9%), 2pts in 110 patients (19.6%) and 3pts in 401 patients (71.5%). D3 was 1pt in 357 patients (63.6%), 2pts in 33 patients (5.9%) and 3pts in 171 patients (30.5%). There were 36 patients (6.4%), 186 patients (33.2%) and 339 patients (60.4%) in the low, moderate and high group of DDD score, and 140 patients (25.0%), 289 patients (51.5%) and 132

关 键 词：肾细胞癌 手术方式 DDD 评分 RENAL 评分 

分 类 号：R737.11[医药卫生—肿瘤]