R．E．N．A．L.评分系统在肾部分切除术中的应用

Significance of the R. E. N. A. L. measurement scoring system for partial nephrectomy

目的探讨肾脏肿瘤测量评分系统（R．E．N．A．L．评分系统）在肾部分切除术中的临床应用价值，并分析影响肾部分切除术危险因素。方法分析83例行肾部分切除术患者的临床资料，采用R．E．N．A．L．评分系统将肾癌患者分为低难度组、中难度组、高难度组，比较分析各组间手术时间、术中出血量、热缺血时间、术后住院时间、术后血肌酐、术后并发症等围手术期指标差异，并分析R．E．N．A．L.评分与术后并发症的关系，同时运用Logistic回归分析影响肾部分切除术效果的可能危险因素。结果83例患者中低难度组29例（34．94％），中难度组43例（51．81％），高难度组11例（13．25％）；在手术时间、术中出血量、热缺血时间、术后并发症方面R．E．N．A．L．评分低的患者低于R．E．N．A．L。评分高的患者（F／X2=17．300、28．980、7．160、12．860、P=0．000、0．000、0．001、0．073）；随着R．E．N．A．L．评分升高，肾部分切除术患者术后并发症的Clavien分级发生率呈上升趋势，但差异均无统计学意义（P=0．788、0．081、0．368、0．133）；Logistic回归分析显示术前低蛋白血症、手术时间、肿瘤大小和住院时间是影响肾部分切除术手术效果的危险因素。结论R．E．N．A．L．评分系统是一种肾肿瘤手术难度评价的有效方法，术前采用R．E．N．A．L．评分系统区分肿瘤复杂程度有助于术者选择合适的手术方式。影响肾部分切除术效果的因素主要有术前低蛋白血症、手术时间、肿瘤大小、住院时间等。

Objective To explore the clinical value of kidney tumor measurement scoring system （ R. E. N. A. L. ） for partial nephrectomy and to analyze the influencing factors of partial nephrectomy. Methods The clinical data of 83 cases of partial nephrectomy from January 2009 to June 2016 were re- viewed. According to the R. E. N. A. L. scoreing system, the patients were divided into three groups inclu- ding low risk group, median risk group and high risk group. The operating time, peri - operative bleeding, warm ischemic time, postoperative hospital stay, serum creatinine change as well as postoperative complications among these groups were compared. The correlation between postoperative complications and R. E. N. A.L. scoreing system was analyzed. Logistic regression analysis was applied to define possible predictors of the partial nephrectomy. Results There were 29 cases in low risk group, 43 cases in median risk group, and 11 cases in high risk group. The preoperative hypoproteinemia occurrence was lower, operating time and hospital stays were shorter, and tumor size was less among patients of low score of R. E. N. A. L. than high score of R. E. N. A.L. （F/x2 = 17. 300, 28. 980, 7. 160, 12. 860,P =0. 000, 0. 000, 0. 001, 0. 073）. With increases in R. E. N. A. L. scores, the incidence of Clavien complications in postoperative patients was on the rise （ P = 0. 788, 0. 081,0. 368, 0. 133 ）. Logistic regression analysis showed that pre- operative hypoproteinemia, operative time, tumor size and hospital stays were the influencing factors for surgical effects in patients with partial nephrectomy. Conclusion R.E.N.A.L. scoreing system is a vali- dated method that can be successfully used to evaluate operation difficulty during R. E. N. A. L. tumor. Preoperative application of R. E. N. A. L. scoreing system to identify tumor complexity will contribute to guide the operator selecting the suitable operations for partial nephrectomy. The main influencing factors of surgical effects for partial nephrectomy include preoperative hypoproteinemia, operative time, tumor size,hospital stays, etc.