R.E.N.A.L. 肾脏解剖评分在腹腔镜部分肾切除术的作用。
Role of R.E.N.A.L. Nephrometry Score in Laparoscopic Partial Nephrectomy.
机构信息
Department of Emergency Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China.
Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
出版信息
Chin Med J (Engl). 2017 Sep 20;130(18):2170-2175. doi: 10.4103/0366-6999.213973.
BACKGROUND
: Preoperative anatomical scoring system is conducive to comparison between treatment options and evaluation of postoperative outcomes in patients with small renal tumors. This study aimed to evaluate the clinical application efficacy of the R.E.N.A.L. nephrometry score (RNS) in predicting perioperative outcomes in patients with renal tumor who underwent laparoscopic partial nephrectomy (LPN).
METHODS
: The clinical data of 139 patients with renal tumors who underwent LPN between 2009 and 2015 were collected and analyzed. Patients were divided into three groups according to their RNS (low, moderate, and high). Clinical characteristics including perioperative variables, complications, and RNS were compared to evaluate the differences between the three groups. Multivariable logistic regression analysis was used to analyze the risk factors of postoperative complications.
RESULTS
: According to the RNS, there were 74, 50, and 15 patients in the low, moderate, and high RNS groups, respectively. There were significant differences in estimated blood loss (EBL; χ = 7.285, P = 0.026), warm ischemia time (WIT; χ = 13.718, P = 0.001), operation time (OT; χ = 6.882, P = 0.032), perioperative creatinine clearance change (PCCC; χ = 6.206, P = 0.045), and number of patients with complications (NPC; P = 0.002) among the three groups. The values for EBL, WIT, OT, PCCC, and NPC for patients in the high RNS group were higher than those for patients in the low RNS group. After adjustment for OT, WIT, and EBL, RNS was statistically significantly associated with the risk of postoperative complications in a multivariable logistic regression model (odds ratio = 1.541, 95% confidence interval: 1.059-2.242, P = 0.024).
CONCLUSIONS
: The RNS is a valuable tool for evaluating the complexity of renal tumor anatomy. It can aid surgeons in preoperative decision-making concerning management therapy. Future multicenter, large sample size studies are warranted for evaluating its predicting performance of perioperative outcomes.
背景
术前解剖评分系统有利于比较小肾肿瘤患者的治疗选择和术后结果。本研究旨在评估 R.E.N.A.L. 肾肿瘤测量评分（RNS）在预测行腹腔镜肾部分切除术（LPN）的肾肿瘤患者围手术期结局方面的临床应用效果。
方法
收集并分析了 2009 年至 2015 年间行 LPN 的 139 例肾肿瘤患者的临床资料。根据 RNS 将患者分为低、中、高 RNS 三组。比较三组间围手术期变量、并发症和 RNS 的差异。采用多变量 logistic 回归分析评估术后并发症的危险因素。
结果
根据 RNS，低、中、高 RNS 组患者分别为 74、50、15 例。三组间估计失血量（EBL；χ=7.285，P=0.026）、热缺血时间（WIT；χ=13.718，P=0.001）、手术时间（OT；χ=6.882，P=0.032）、围手术期肌酐清除率变化（PCCC；χ=6.206，P=0.045）、并发症患者人数（NPC；P=0.002）差异有统计学意义。高 RNS 组患者的 EBL、WIT、OT、PCCC 和 NPC 值均高于低 RNS 组。多变量 logistic 回归模型校正 OT、WIT 和 EBL 后，RNS 与术后并发症风险呈统计学显著相关（比值比=1.541，95%置信区间：1.059-2.242，P=0.024）。
结论
RNS 是评估肾肿瘤解剖复杂性的有用工具。它可以帮助外科医生在术前决策管理治疗方面。需要进行未来的多中心、大样本量研究，以评估其对围手术期结局的预测性能。
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