Liu Zhuo, Zhao Xun, Zhang Hong-Xian, Ma Run-Zhuo, Li Li-Wei, Tang Shi-Ying, Wang Guo-Liang, Zhang Shu-Dong, Wang Shu-Min, Tian Xiao-Jun, Ma Lu-Lin
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Health Science Center, Peking University, Beijing 100191, China.
Chin Med J (Engl). 2020 May 20;133(10):1166-1174. doi: 10.1097/CM9.0000000000000799.
Radical nephrectomy and thrombectomy is the standard surgical procedure for the treatment of renal cell carcinoma (RCC) with tumor thrombus (TT). But the estimation of intra-operative blood loss is only based on the surgeon's experience. Therefore, our study aimed to develop Peking University Third Hospital score (PKUTH score) for the prediction of intra-operative blood loss volume in radical nephrectomy and thrombectomy.
The clinical data of 153 cases of renal mass with renal vein (RV) or inferior vena cava tumor thrombus admitted to Department of Urology, Peking University Third Hospital from January 2015 to May 2018 were retrospectively analyzed. The total amount of blood loss during operation is equal to the amount of blood sucked out by the aspirator plus the amount of blood in the blood-soaked gauze. Univariate linear analysis was used to analyze risk factors for intra-operative blood loss, then significant factors were included in subsequent multivariable linear regression analysis.
The final multivariable model included the following three factors: open operative approach (P < 0.001), Neves classification IV (P < 0.001), inferior vena cava resection (P = 0.001). The PKUTH score (0-3) was calculated according to the number of aforementioned risk factors. A significant increase of blood loss was noticed along with higher risk score. The estimated median blood loss from PKUTH score 0 to 3 was 280 mL (interquartile range [IQR] 100-600 mL), 1250 mL (IQR 575-2700 mL), 2000 mL (IQR 1250-2900 mL), and 5000 mL (IQR 4250-8000 mL), respectively. Meanwhile, the higher PKUTH score was, the more chance of post-operative complications (P = 0.004) occurred. A tendency but not significant overall survival difference was found between PKUTH risk score 0 vs. 1 to 3 (P = 0.098).
We present a structured and quantitative scoring system, PKUTH score, to predict intra-operative blood loss volume in radical nephrectomy and thrombectomy.
根治性肾切除术联合血栓切除术是治疗伴有肿瘤血栓（TT）的肾细胞癌（RCC）的标准外科手术。但术中失血量的估计仅基于外科医生的经验。因此，我们的研究旨在开发北京大学第三医院评分（PKUTH评分），以预测根治性肾切除术联合血栓切除术中的术中失血量。
回顾性分析2015年1月至2018年5月北京大学第三医院泌尿外科收治的153例伴有肾静脉（RV）或下腔静脉肿瘤血栓的肾肿物患者的临床资料。术中失血总量等于吸引器吸出的血量加上血浸纱布中的血量。采用单因素线性分析分析术中失血的危险因素，然后将显著因素纳入后续多变量线性回归分析。
最终的多变量模型包括以下三个因素：开放手术方式（P＜0.001）、Neves分类IV级（P＜0.001）、下腔静脉切除（P = 0.001）。根据上述危险因素的数量计算PKUTH评分（0 - 3分）。随着风险评分升高，失血量显著增加。PKUTH评分0至3分的估计中位失血量分别为280毫升（四分位间距[IQR] 100 - 600毫升）、1250毫升（IQR 575 - 2700毫升）、2000毫升（IQR 1250 - 2900毫升）和5000毫升（IQR 4250 - 8600毫升）。同时，PKUTH评分越高，术后并发症发生的几率越高（P = 0.004）。PKUTH风险评分0与1至3之间总体生存差异有趋势但不显著（P = 0.098）。
我们提出了一种结构化的定量评分系统，即PKUTH评分，以预测根治性肾切除术联合血栓切除术中的术中失血量。
