基于R.E.N.A.L.评分系统分析T1期肾癌行腹腔镜下保留肾单位手术  

Analysis of R.E.N.A.L. nephrometry score in laparoscopic nephron sparing surgery for T1renal cell carcinoma

作　　者：秦诗沅 王亮 杨航 曹文峰 李沙丹 赵友光 刘吉文 周婷婷 冷太平 QIN Shiyuan;WANG Liang;YANG Hang;CAO Wenfeng;LI Shadan;ZHAO Youguang;LIU Jiwen;ZHOU Tingting;LENG Taiping(Department of Urology,the General Hospital of Western Theater Command,Chengdu,610083,China)

机构地区：[1]西部战区总医院泌尿外科,成都610083

出　　处：《临床泌尿外科杂志》2020年第4期264-269,共6页Journal of Clinical Urology

摘　　要：目的:探讨R.E.N.A.L.评分系统对于T1期肾癌行腹腔镜下保留肾单位肾癌根治术(laparoscopic partial nephrectomy,LPN)的临床意义及应用价值。方法:回顾分析我科2013年5月~2018年12月共102例行LPN治疗T1期肾癌患者的临床资料。根据术前影像资料对患者行R.E.N.A.L.评分,将其分为低、中、高分组,比较术前及术后3个月血肌酐值的变化,分析各组间手术时间、热缺血时间、出血量、围手术并发症等的关系。结果:102例患者中,低、中、高组患者分别为64、35、3例,各组术前和术后3个月血肌酐值的变化比较差异无统计学意义(P>0.05),低分组与中分组患者在性别、年龄、BMI、肿瘤直径大小、手术时间、中转开放率及并发症差异无统计学意义(P>0.05),低分组中热缺血时间、出血量和术后住院天数明显低于中分组,差异有统计学意义(P<0.05)。结论:R.E.N.A.L.评分系统是评估肾肿瘤解剖复杂程度的重要手段,基于R.E.N.A.L.评分系统能有效评估T1期肾癌行LPN治疗的难度和效果,为制定手术方案和指导术中操作提供参考依据。Objective: To investigate the clinical significance and application value of R.E.N.A.L. nephrometry score(RNS) for laparoscopic partial nephrectomy(LPN) in patients with T1renal cell carcinoma. Method: The clinical data of 102 patients with T1renal cell carcinoma who received LPN from May 2013 to December 2018 were retrospectively analyzed. According to RNS, the patients were divided into low, medium and high groups. The change of serum creatinine value before and after surgery was compared in each group. The operation time, warm ischemia time, blood loss and perioperative complications were also compared among groups. Result: Among the 102 patients, the patients in the low, middle and high groups were 64, 35 and 3, respectively. There was no significant difference in serum creatinine between preoperative and postoperative 3 months in all groups(P>0.05). Also, there was no significant difference in gender, age, BMI, tumor diameter, operative time, conversion to open surgery rate or complications between the low group and the middle group(P>0.05). However, the warm ischemia time, blood loss, postoperative hospital stay of low group was significantly lower than those of middle group, and the difference was statistically significant(P<0.05). Conclusion: RNS is an important method to evaluate the anatomical complexity of renal tumors, and it can effectively evaluate the difficulty and effect of LPN in T1renal cell carcinoma, provide reference for determining the surgical plan and guide the intraoperative operation.

关 键 词：肾肿瘤 R.E.N.A.L.评分系统 腹腔镜保留肾单位手术 T1期 

分 类 号：R737.11[医药卫生—肿瘤]