改良R.E.N.A.L.评分在后腹腔镜肾部分切除术中的应用

The applications of modified-R.E.N.A.L.score in retroperitoneal laparoscopic partial nephrectomy

目的探讨改良R.E.N.A.L.评分系统在后腹腔镜肾部分切除术(retroperitoneal laparoscopic partial nephrectomy,RLPN)中的应用。方法回顾性分析2007年1月至2014年6月79例行RLPN患者的临床资料,其中男51例,女28例,左侧42例,右侧37例,平均年龄(54.3±12.0)岁,平均BMI值(25.8±3.8)kg/m2,平均肿瘤直径(3.7±1.5)cm。应用改良R.E.N.A.L.评分系统对RLPN进行评分。结果 79例患者,未改良评分系统中低分组42例,中分组28例,高分组9例;改良评分系统中各组例数分别为31、32和16例。改良R.E.N.A.L.评分系统对手术难度的评判结果与手术时间、热缺血时间、术中出血量之间存在显著关系(P<0.05),而术后住院时间及并发症发生率差异无统计学意义(P<0.05)。将两套评分系统对手术难度评估的灵敏度、特异度、约登指数等加以比较后发现改良评分系统临床效果更好。结论改良R.E.N.A.L.评分更加符合后腹腔镜手术环境,且可更客观量化评估RLPN风险及手术难度,但仍需要多中心、大样本研究进一步支持。

Objective To investigate the application of modified R.E.N.A.L.scoring system in retropeitoneal laparoscopic partial nephrectomy. Methods Retrospectively analyzed the clinical data of 79 patients with RLPN from January 2007 to June 2014.There were 51 males and 28 females in total,42 cases had left side tumor,37 cases had right side tumor.The mean age was （54.3±12.0）years. The mean BMI was （25.8±3.8）kg/m2 .The average tumor diameter was （3.7±1.5）cm.We evalutated all of the patients with modified R.E.N.A.L.scoring system. Results A total of 79 patients,there were 42 cases with low score,28 cases with middle score and 9 cases with high score according origi-nal scoring system,while there were 31,32 and 1 6 cases according modified scoring system,respec-tively.Modified R.E.N.A.L.scoring system showed a significant relationship （P〈0.05）with op-erating time,warm ischemia time and blood loss for evaluating the difficulty of surgery,while there were no significant difference with postoperative hospital stay and incidence of complications （P〈0.05）.The modified scoring system was better after comparing the two sets of scoring system for assessing the sensitivity,specificity,Youden and so on. Conclusions Modified R.E.N.A.L.was more suitable for retropeitoneal surgery,and could be more objective and quantitative to assess the risks and difficulty of RLPN.A multi-center,large scale studies should be needed for strong evi-dence.