向心性指数评分系统在肾癌后腹腔镜肾部分切除术中的应用价值研究

Application values of the centrality index nephrometry score system in retroperitoneal laparoscopic partial nephrectomy of kidney neoplasms

目的 探讨向心性指数（CI）评分系统在肾癌后腹腔镜下肾部分切除术（RLPN）中的临床应用价值.方法 回顾性分析2011年1月-2015年12月在徐州医科大学附属淮安医院及苏州大学附属第二医院收治的行RLPN的116例肾癌患者的临床资料.其中男70例,女46例;年龄40~88岁,平均（51.8±4.8）岁.应用CI评分系统对肿瘤进行评分,依据评分分为低度复杂组（CI〉2.5）38例、中度复杂组（1.6〈CI≤2.5）57例、高度复杂组（CI≤1.6）21例,分析比较3组间手术时间、术中热缺血时间、术中出血量、术后住院时间、术后血肌酐变化、术后并发症等情况.结果 116例患者成功完成RLPN.不同CI评分组间,随着CI评分复杂度的增加,手术时间、术中热缺血时间、术中出血量、术后血肌酐及术后并发症发生率逐渐增加,差异均有统计学意义（F=29.730、9.506、56.712、3.498,χ^2=10.306,P值均〈0.05）,而术后住院时间无明显变化,差异均无统计学意义（F=0.423,P值均〉0.05）.不同CI评分组间并发症Clavien分级比较,差异无统计学意义（Z=4.348,P〉0.05）.结论 CI评分系统可较全面地评价肾脏肿瘤解剖特点,对RLPN的风险及手术难度有一定预测作用,但其临床应用价值仍然需进一步深入研究.

Objective To evaluate the efficacy of the C-index nephrometry score system in retroperitoneal laparoscopic partial nephrectomy （RLPN） of kidney neoplasms.Methods Clinical data of 116 patients treated with RLPN in Huai＇an Hospital Affiliated of Xuzhou Medical University and the Second Affiliated Hospital of Soochow University from January 2011 to December 2015 were retrospectively analyzedo, including 70 males and 46 females;aged 40 to 88 years, mean （51.8 ± 4.8） years.Among the 116 patients, 38, 57, 21 were rated as low（CI〉2.5）, moderate（1.6〈CI≤2.5） and high （CI≤1.6） in complications.The correlation between perioperative such as operation time, warm ischemia time, blood loss, postoperative hospital stay, serum creatinine level as well as postoperative complications and centrality index nephrometry score system was analyzed.Results RLPN was successfully performed in 116 patients.There were significant differences between patients of different centrality index nephrometry score system categories in operation time, warm ischemia time, blood loss, serum creatinie level and postoperative complications（F=29.730, 9.506, 56.712, 3.498, χ^2=10.306, all P values〈0.05）.There was no difference in postoperative hospital stay（F=0.423, all P values〉0.05）.In different centrality index nephrometry score group, there was no significant difference in the incidence of Clavien （Z=4.348, P〉0.05）.Conclusions The centrality index nephrometry score system is a useful tool which can delineate anatomy characteristics of renal tumors comprehensively.Centrality index nephrometry score system can estimate the surgical outcomes of RLPN.However, further research is required to evaluate its clinical significance more accurately.