Division of Urology/Department of Surgery, University of California San Diego School of Medicine, La Jolla, CA, USA.
Urology. 2013 Apr;81(4):775-80. doi: 10.1016/j.urology.2012.11.037. Epub 2013 Feb 20.
To analyze outcomes and complications of percutaneous (PRC) and laparoscopic renal cryoablation (LRC) using the radius, endophytic, nearness to collecting system, anterior/posterior, and location (RENAL) nephrometry system.
Retrospective multicenter analysis of 154 consecutive patients who underwent either ultrasound-guided LRC (n = 88) or computed tomography (CT)-guided PRC (n = 66) from March 2003 to December 2011. RENAL score and demographics were compared to postoperative complications (Clavien). Multivariable analysis was carried out for factors associated with development of postprocedure complications.
Mean age was 68 years (94 men/60 women). Median follow-up was 34 months (range 23.6-45.6 months). Mean tumor size was 2.6 ± 1 cm. Mean RENAL score was 5.2 ± 1.4. Differences in (A)nterior/posterior component and (H)ilar domain of the RENAL scores were noted, with PRC favoring posterior tumors and hilar lesions compared to LRC (P < .001 and P = .044, respectively). There were 14.9% complications, all of which were low-grade (Clavien 1,2). There were no differences in complications between LRC and PRC (15.9% vs 13.6%, P = .82). Most common complication type was hemorrhagic in 9 of 154 patients (5.8%); significant increase in the hemorrhagic complication rate was noted for patients with "N" ("nearness") component score of 2 or 3 (5/36, or 13.9%), compared to patients with "N" score of 1 (4/115 or 3.5%, P = .033). multivariable analysis demonstrated that increasing RENAL score was associated with postprocedure complications (odds ratio [OR] = 1.37, P = .025). When separated into individual domains, multivariable analysis revealed that "N" score 3 was significantly associated with postoperative complications (OR 16.15, P = .027).
Increasing RENAL score was associated development of postprocedure complications after renal cryotherapy. Further investigation is requisite to elucidate the role of RENAL nephrometry score in risk stratification prior to renal cryotherapy.
分析应用半径、内生性、靠近集合系统、前后位和位置（RENAL）肾分测系统行经皮（PRC）和腹腔镜肾冷冻消融（LRC）的治疗结果和并发症。
对 2003 年 3 月至 2011 年 12 月间行超声引导下 LRC（n=88）或 CT 引导下 PRC（n=66）的 154 例连续患者进行回顾性多中心分析。比较 RENAL 评分和人口统计学资料与术后并发症（Clavien 分级）。对与术后并发症发生相关的因素进行多变量分析。
患者平均年龄 68 岁（94 名男性/60 名女性）。中位随访时间为 34 个月（23.6-45.6 个月）。肿瘤平均大小为 2.6±1cm。平均 RENAL 评分为 5.2±1.4。RENAL 评分的前后位和肾门域成分存在差异，PRC 有利于后位肿瘤和肾门病变（P<.001 和 P=.044）。并发症发生率为 14.9%，均为低级别（Clavien 1、2 级）。LRC 和 PRC 之间的并发症无差异（15.9%比 13.6%，P=.82）。最常见的并发症类型是 154 例患者中的 9 例（5.8%）出血；与“N”评分 1 分（4/115 或 3.5%，P=.033）的患者相比，“N”评分 2 或 3 分（5/36 或 13.9%）的患者出血并发症发生率显著增加。多变量分析表明，RENAL 评分增加与术后并发症相关（比值比[OR] 1.37，P=.025）。当按单独域分开时，多变量分析显示“N”评分 3 与术后并发症显著相关（OR 16.15，P=.027）。
RENAL 评分增加与肾冷冻治疗后并发症的发生有关。需要进一步研究以阐明 RENAL 肾分测评分在肾冷冻治疗前风险分层中的作用。
