R.E.N.A.L.肾脏测量评分系统在保留肾单位手术中的应用

Application of R.E.N.A.L.nephrometry score in renal tumors treated by nephron-sparing surgery

目的探讨R.E.N.A.L.肾脏测量评分系统在施行保留肾单位手术的肾肿瘤患者中的临床应用价值。方法回顾2007年6月至2012年6月就诊于四川省人民医院施行肾部分切除手术的肾脏肿瘤患者63例,收集患者一般情况、影像学检查、手术情况及术后并发症等资料,并应用R.E.N.A.L.肾脏测量评分系统对肿瘤进行评分,分析R.E.N.A.L.评分与手术方式、手术时间、热缺血时间、估计出血量及手术前后血肌酐变化等围手术期结局的相关性。结果 R.E.N.A.L.肾脏测量评分与手术方式显著相关(P<0.001),并与手术时间(P=0.007)、术中热缺血时间(P<0.001)、术中出血量(P=0.008)均显著相关,而与围手术期并发症、术后住院时间和手术前后血肌酐变化等无明显关系。结论 R.E.N.A.L.肾脏测量评分能较全面评价肾脏肿瘤的解剖特点,可协助指导手术方式的选择,并对围手术期结局有一定的预测作用,但仍需进一步研究评价其临床应用价值。

Objective To investigate the clinical significance of R. E. N. A. L. nephrometry score for renal tumors in patients who underwent nephron-sparing surgery. Methods The clinical data of 63 patients with renal tumors who underwent nephron-sparing surgery in the People＇s Hospital of Sichuan from June 2007 to June 2012 were reviewed retrospectively, including clinical characteristics, image examination, surgery outcomes and postoperative complications. The correlation between surgical approach, perioperative outcomes such as operation time, warm ischemia time, percentage change of the serum creati- nine level as well as estimated blood loss and R. E. N. A. L. nephrometry score was analyzed. Results The R. E. N. A. L. nephrometry score was significantly associated with the surgical approach （P〈0. 001）, operation time （P = 0. 007）, warm ischemia time （P〈0. 001） and estimated blood loss （P〈0. 008）, while there was no significant association between the score system and the perioperative complications, postoperative hospital stay or percentage change of the serum creatinine level. Conclusions The R. E. N. A. L. nephrometry score is a useful tool which delineate anatomy characteristics of renal tumors comprehensively. It helps surgeons to decide on surgical approach and predict perioperative outcomes. However, further research is required to evaluate its clinical significance more accurately.