ABC评分系统在肾部分切除术中的临床应用研究

Study on application of ABC scoring system for partial nephrectomy

目的：探讨ABC肾肿瘤评分系统对肾部分切除术的临床应用价值。方法：通过筛选研究我院2013年1月~2015年5月施行腹腔镜下肾部分切除术的135位患者的临床资料,包括患者一般状况、围术期并发症情况及肾功能随访数据。根据患者术前CT/MR进行ABC系统评分,将患者分为低危组和高危组,分析ABC评分与肾脏热缺血时间（WIT）、术中出血量（EBL）、围手术期并发症、术后急性肾功能变化等相互关系。结果：ABC评分与WIT（P=0.002）、术中出血量（P〈0.001）和围术期并发症（P=0.02）均有明显关系,亦与术后肾功能变化率（P=0.03）有明显相关性,但与术后3个月（P=0.06）、6个月（P=0.17）及12个月（P=0.34）的肾功能变化率也无明显相关性;术后3个月肾图也说明患侧分肾功能下降水平在ABC低危组及高危组的差异无明显统计学意义。结论：ABC评分系统是基于肾肿瘤和血管密切关系的一种简便评估方法,具有良好的临床应用性,能够帮助泌尿外科医生在术前进行围术期并发症及急性期肾功能损伤（AKI）的预测;但其评估远期肾功能的价值仍需进一步探究。

Objective：To investigate the clinical significance of Arterial Based Complexity（ABC）scoring system for partial nephrectomy.Method：We retrospectively analyzed 135 patients with renal cell carcinoma（RCC）undergoing laparoscopic partial nephrectomy in Renji hospital from January 2013 to May 2015.The baseline characteristic information,perioperative data and follow-up results were collected.Using newly developed ABC system based on the CT/MRI images,these patients were divided into low and high complexity groups.The association between perioperative data and ABC scoring system was studied.Result：ABC scoring system was significantly associated with warm ischemia time（WIT）（P=0.002）,estimated blood loss（EBL）（P〈0.001）and perioperative complications（P=0.02）.Meanwhile,the association between ABC scoring system and acute renal function decline（P=0.03）was found.However,no association was found in 3-month（P=0.06）,6-month（P=0.17）and12-month（P=0.34）renal function decline.The spilt affected renal function evaluated by GFR performed in postoperative three months also showed the same result.Conclusion：ABC scoring system is a simple and effective method to evaluate the complexity of partial nephrectomy.It can help surgeons to predict perioperative complications and acute kidney injury（AKI）after surgery,but further researches are required to predict the long-term outcomes.