Qiu Min, Zong You Long, Wang Bin Shuai, Yang Bin, Xu Chu Xiao, Sun Zheng Hui, Lu Min, Zhao Lei, Lu Jian, Liu Cheng, Tian Xiao Jun, Ma Lu Lin
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Department of Urology, Yan'an Hospital of Traditional Chinese Medicine/Yan'an Branch of Peking University Third Hospital, Yan'an 716000, Shaanxi, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2023 Oct 18;55(5):833-837. doi: 10.19723/j.issn.1671-167X.2023.05.009.
To investigate the treatment outcome of laparoscopic partial nephrectomy in the patients with renal tumors of moderate to high complexity (R.E.N.A.L. score 7-10).
In the study, 186 patients with a renal score of 7-10 renal tumors who underwent laparoscopic partial nephrectomy in Peking University Third Hospital from February 2016 to April 2021 were selected. Laparoscopic partial nephrectomy was performed after examination. The patients were followed-up, and their postoperative hemoglobin, creatinine, complications, and length of hospital stay recorded. The data were represented by mean±standard deviation or median (range).
There were 128 males and 58 females in this group, aged (54.6±12.8) years, with body mass index of (25.4 ± 3.4) kg/m; The tumors were located in 95 cases on the left and 91 cases on the right, with maximum diameter of (3.1±1.2) cm. The patient's preoperative hemoglobin was (142.9±15.8) g/L, and blood creatinine was 78 μmol/L (47-149 μmol/L). According to preoperative CT images, the R.E.N.A.L. score was 7 points for 43 cases, 8 points for 67 cases, 9 points for 53 cases, and 10 points for 23 cases. All the ope-rations were successfully completed, with 12 cases converted to open surgery. The operation time was 150 minutes (69-403 minutes), the warm ischemic time was 25 minutes (3-60 minutes), and the blood loss was 30 mL (5-1 500 mL). There were 9 cases of blood transfusions, with a transfusion volume of 800 mL (200-1 200 mL). Postoperative hemoglobin was (126.2±17.0) g/L. The preoperative crea-tinine was 78 μmol/L (47-149 μmol/L), the postoperative creatinine was 83.5 μmol/L (35-236 μmol/L), the hospital stay was 6 days (3-26 days), and surgical results achieved "the trifecta" in 87 cases (46.8%). In the study, 167 cases were followed up for 12 months (1-62 months), including 1 case with recurrence and metastasis, 4 cases with metastasis, and 2 cases with other tumors (1 case died).
Laparoscopic partial nephrectomy is safe and effective in the treatment of renal tumors with R.E.N.A.L. score of 7-10. Based on the complexity of the tumor, with the increase of difficulty, the warm ischemia time and operation time tend to increase gradually, while "the trifecta" rate gradually decreases. The complications of this operation are less, and the purpose of preserving renal function to the greatest extent is achieved.
探讨腹腔镜下部分肾切除术治疗中高复杂性肾肿瘤（R.E.N.A.L.评分7 - 10分）患者的治疗效果。
本研究选取2016年2月至2021年4月在北京大学第三医院接受腹腔镜下部分肾切除术的186例R.E.N.A.L.评分为7 - 10分的肾肿瘤患者。检查后行腹腔镜下部分肾切除术。对患者进行随访，记录其术后血红蛋白、肌酐、并发症及住院时间。数据以均数±标准差或中位数（范围）表示。
该组患者中男性128例，女性58例，年龄（54.6±12.8）岁，体重指数为（25.4±3.4）kg/m²；肿瘤位于左侧95例，右侧91例，最大直径为（3.1±1.2）cm。患者术前血红蛋白为（142.9±15.8）g/L，血肌酐为78 μmol/L（47 - 149 μmol/L）。根据术前CT图像，R.E.N.A.L.评分为7分的有43例，8分的有67例，9分的有53例，10分的有23例。所有手术均成功完成，其中12例中转开放手术。手术时间为150分钟（69 - 403分钟），热缺血时间为25分钟（3 - 60分钟），出血量为30 mL（5 - 1500 mL）。有9例输血，输血量为800 mL（200 - 1200 mL）。术后血红蛋白为（126.2±17.0）g/L。术前肌酐为78 μmol/L（47 - 149 μmol/L），术后肌酐为83.5 μmol/L（35 - 236 μmol/L），住院时间为6天（3 - 26天），87例（46.8%）手术结果达到“三连胜”。本研究中，167例患者随访12个月（1 - 62个月），其中1例复发转移，4例转移，2例患其他肿瘤（1例死亡）。
腹腔镜下部分肾切除术治疗R.E.N.A.L.评分为7 - 10分的肾肿瘤安全有效。基于肿瘤的复杂性，随着难度增加，热缺血时间和手术时间往往逐渐增加，而“三连胜”率逐渐降低。该手术并发症较少，最大程度实现了保留肾功能的目的。
