Ito Hiroki, Makiyama Kazuhide, Kawahara Takashi, Osaka Kimito, Izumi Koji, Yokomizo Yumiko, Nakaigawa Noboru, Yao Masahiro
Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Can Urol Assoc J. 2017 May;11(5):E215-E221. doi: 10.5489/cuaj.4192. Epub 2017 May 9.
We aimed to develop a scoring system to quantify the distance between the renal hilum and renal tumour, termed the modified C index (m-CI), and to predict renal functional loss (RFL) following laparoscopic partial nephrectomy (LPN).
The m-CI was measured by using computed tomography in 113 patients who underwent LPN between May 2003 and June 2014. The RFL following LPN was calculated by examining the estimated glomerular filtration rate (eGFR) and radioisotope renography one year postoperatively. The Pythagorean theorem was used to calculate the distance from the tumour centre to the renal hilum. The distance was divided by the tumour radius to obtain the m-CI. The correlation between the m-CI and the postoperative RFL were evaluated using Pearson's coefficient values. Multivariate logistic regression models were used to assess the potential predictive factors of RFL following LPN. The correlation between the m-CI and the operative time, ischemia time, and blood loss during LPN were also evaluated by the unpaired t-test.
Pearson's coefficient values between the postoperative RFL and the m-CI and C index were 0.294 and 0.173, respectively. In the multivariate analysis, the resected volume (p=0.031) and m-CI (p=0.036) significantly correlated with the postoperative RFL following LPN. The operative time (p<0.001), ischemia time (p=0.028), and blood loss (p=0.047) during LPN was significantly longer and larger, respectively, in the group with shorter m-CI (≤4.5) than in the group with the longer m-CI (>4.5).
The present study demonstrates that the m-CI can predict RFL following LPN, as well as the surgical difficulty.
我们旨在开发一种评分系统，用于量化肾门与肾肿瘤之间的距离，称为改良C指数（m-CI），并预测腹腔镜肾部分切除术（LPN）后肾功能丧失（RFL）情况。
在2003年5月至2014年6月期间接受LPN的113例患者中，使用计算机断层扫描测量m-CI。通过术后一年检查估计肾小球滤过率（eGFR）和放射性核素肾图来计算LPN后的RFL。使用勾股定理计算肿瘤中心到肾门的距离。将该距离除以肿瘤半径以获得m-CI。使用Pearson系数值评估m-CI与术后RFL之间的相关性。使用多变量逻辑回归模型评估LPN后RFL的潜在预测因素。还通过不成对t检验评估m-CI与LPN期间手术时间、缺血时间和失血量之间的相关性。
术后RFL与m-CI和C指数之间的Pearson系数值分别为0.294和0.173。在多变量分析中，切除体积（p = 0.031）和m-CI（p = 0.036）与LPN术后的RFL显著相关。m-CI较短（≤4.5）组的LPN手术时间（p < 0.001）、缺血时间（p = 0.028）和失血量（p = 0.047）分别明显长于和多于m-CI较长（> 4.5）组。
本研究表明，m-CI可以预测LPN后的RFL以及手术难度。
