R．E．N．A．L．评分系统对T1期肾肿瘤手术方式选择的意义

Significance of the R. E. N. A.L. nephrometry scoring system in renal tumour of T1 stage

目的探讨R．E．N．A．L．（最大径、外凸率、最近距离、侧别、纵向位置）肾肿瘤评分系统在T1期肾肿瘤手术方式选择的应用价值。方法2010年1月至2012年12月，回顾分析122例施行手术的T1期肾肿瘤患者，其中男性76例，女性46例，年龄（51±16）岁（29-82岁），体重指数（22．84-3．9）kg／m2。收集患者影像资料、手术方式及预后等数据，将术前cT资料按R．E．N．A．L．肾肿瘤评分系统进行评分，分析R．E．N．A．L．系统评分与手术方式选择及保留肾单位手术（NSS）方法的关系。结果122例患者均完成手术，根治性肾切除术（RN）45例；NSS术77例，其中腹腔镜下NSS（LNSS）45例，开放NSS（ONSS）32例。R．E．N．A．L．肾肿瘤评分系统与手术方式的选择有显著相关性（）（2=27．89，P〈0．05），与NSS方法亦有相关性（）（。=12．87，P〈0．05）。R．E．N．A．L．评分〈7分时，主要行NSS（92．9％），分值〉9分时，主要RN（69．4％）。单个因素均与手术方式选择存在相关性（X2=7．00～14．57，尸〈0．05）；因素R、E、N、L与NSS方法选择有关（X。=4．92～15．07，P〈0．05）。结论R．E．N．A．L．肾肿瘤评分系统是一个简单、实用、量化T1期肾肿瘤复杂程度的综合性评估系统，可为手术提供有效指导。

Objective To evaluate the application value of R. E. N. A. L. nephrometry score for surgery type decisions of T1 stage renal tumor, Methods Clinical data including image data, surgery type and prognosis etc were collected retrospectively for 122 cases from January 2010 to December 2012. There were 76 male and 46 female patients and they were 29-82 years （mean 51 years）. The body mass index was （ 22. 8 ± 3.9） kg/m2. The patients were undergoing surgical excision with renal tumor of T1 stage. The R. E. N. A. L. nephrometry score was analyzed to evaluate their relationships to surgery type （RN or NSS ） and the approach of NSS （ONSS or LNSS） using chi-square tests, Fisher＇s exact tests, and logistic regressions analysis. Results All surgery had been completed. The surgery included RN of 45 patients, LNSS of 45 patients and ONSS of 32 patients. The R. E. N. A.L. nephrometry score was significantly associated with the type of surgery （ （X2 = 27.89, P 〈 0. 05 ） , and the NSS approach （ X2 = 12. 87, P 〈 0. 05）. When the scores less than 7 points, it is majorly treated by nephron sparing surgery （92. 9% ）, and when the scores more than 9 points, it is majorly treated by radical nephrectomy （ 69.4% ）. Individual component scores were analyzed to evaluate that they were all related to surgery type （ X2 = 7.00-14. 57, P 〈 3. 05）, and the individual component N associated the surgery type mostly. Furthermore, individual component R,E,N and L were statistically significant predictors of the NSS approach （X2 = 4. 92-15.07, P 〈 0. 05）. Conclusion The R. E. N. A. L. nephrometry scoring system provides a simple, useful, and stable system to character the salient renal anatomy of T1 stage, and can provide the best surgery approach.