术前CT密度值评估对经后腹腔镜肾部分切除术患者合并肾周脂肪粘连的预测作用  

Predictive effect of preoperative CT density evaluation on perirenal fatty adhesion in patients undergoing retroperitoneal laparoscopic partial nephrectomy

作　　者：翟铭 韩起鹏 ZHAI Ming;HAN Qipeng(Department of Urology,Northern Theater General Hospital,Shenyang,Liaoning 110000,China)

机构地区：[1]北部战区总医院泌尿外科,辽宁沈阳110000

出　　处：《中国医学工程》2022年第12期40-46,共7页China Medical Engineering

摘　　要：目的肾周脂肪粘连(APF)会显著增加腹腔镜肾部分切除手术难度,对其进行术前评估对于改善手术质量极为关键。本研究旨在分析术前CT密度值评估与后腹腔镜肾部分切除术患者合并APF的相关性和预测作用。方法回顾性纳入了北部战区总医院2019年6月至2021年12月期间连续性收治行腹腔镜肾部分切除术的肾透明细胞癌患者的临床资料。根据术中所见是否合并APF将研究对象分为两组,即粘连组和无粘连组。分析比较两组患者的基线特征、肿瘤特征、术前三项CT肾周脂肪密度值(三个水平面上测得)、梅奥粘连概率(MAP)评分、手术时间和术中出血量等临床资料,并通过多因素Logistic回归分析APF的独立危险因素。为了更好地量化CT值对APF的影响,引入CT密度值评分将三个平面CT肾周脂肪密度值合并。结果粘连组和无粘连组相比,年龄、性别和肿瘤最大直径差异无统计学意义(P>0.05)。粘连组患者吸烟、患糖尿病和高血压比例高于非粘连组,粘连组的MAP评分和术前CT密度值评分也高于非粘连组(P<0.05)。从手术难度上看,粘连组患者手术时间和术中出血量明显高于非粘连组(P<0.05)。为了评估肾周脂肪粘连的独立危险因素,将单因素分析中P<0.1的相关变量纳入到多因素Logistic回归分析,最后得出高血压(OR=6.134,P<0.05)、糖尿病(OR=9.803,P<0.05)、MAP评分(OR=8.213,P<0.05)和CT密度值评分(P<0.05)是APF的独立危险因素。结论APF会显著增加经后腹腔镜肾部分切除术的手术时间,而通过多因素分析得出CT密度值评分能作为术前独立危险因素提示APF风险,从而能在术前有效评估手术难度,有利于术者制定个体化的手术方案,提高手术质量和改善患者的整体预后。【Objective】Adherent perirenal fat(APF)will significantly increase the difficulty of laparoscopic partial nephrectomy,and preoperative evaluation of APF is very important to improve the operation quality.The purpose of this study is to analyze the correlation and predictive function between preoperative CT density evaluation and APF in patients with retroperitoneal laparoscopic partial nephrectomy.【Methods】The clinical data of patients with renal clear cell carcinoma who underwent laparoscopic partial nephrectomy from June 2019 to December 2021 in the Northern Theater General Hospital were retrospectively included.The subjects were divided into two groups according to whether they were combined with APF during operation,that is,adhesion group and non-adhesion group.The baseline characteristics,tumor characteristics,preoperative three CT perirenal fat density values(measured on three levels),MAP score,operation time and intraoperative blood loss were compared between the two groups,and the independent risk factors of APF were analyzed by multivariate logistic regression.In order to quantify the influence of CT values on APF better,the CT density score was introduced to combine the perirenal fat density values of three plane CT.【Results】Compared with non-adhesion group,there was no significant difference in age,gender and maximum tumor diameter(P>0.05).The proportion of smoking,diabetes and hypertension in adhesion group was higher than that in non-adhesion group.At the same time,the MAP score and preoperative CT density score in adhesion group were significantly higher than that in non-adhesion group(P<0.05).From the point of view of operation difficulty,the operation time and blood loss in the adhesion group were significantly higher than those in the non-adhesion group(P<0.05).In order to evaluate the independent risk factors of perirenal fat adhesion,the related variables of P<0.1 in univariate analysis were included in multivariate logistic regression analysis,and finally hypertension(OR=6.134,P<0.0

关 键 词：肾周脂肪粘连 早期肾癌 后腹腔镜肾部分切除 影响因素 危险因素 

分 类 号：R692[医药卫生—泌尿科学]