肾上腺肿瘤评分系统的创立

The establishment of a score system for adrenal tumors

目的创建肾上腺肿瘤评分系统,评估肾上腺肿瘤手术的难度和复杂性。方法回顾单中心同一术者实施后腹腔镜肾上腺肿瘤手术的466例患者临床资料,对肿瘤的大小、与周围器官的边界、与腹腔大血管的边界、内分泌功能及体质量指数(BMI)进行量化,通过分析各因素与手术时间、术中出血量的相关性,筛选出具有相关性的指标创建肾上腺肿瘤评分(ATS)系统,并对该评分系统进行临床验证。结果肿瘤的大小、周围器官的边界、腹腔大血管的边界、内分泌功能、BMI与手术时间、术中出血量均有相关性(P<0.01)。ATS与手术时间、术中出血量均有相关性(P<0.01),高、中、低复杂性评分组间的手术时间、术中出血量差异均有显著统计学意义(P<0.05)。结论肾上腺肿瘤评分系统涵盖了影响肾上腺肿瘤手术的难度和复杂性的主要因素,对于术前评估具有重要的临床指导价值。

Objective To found a score system to estimate operation difficulty and surgical complexity of adrenal tumors. Methods A retrospective single-center analysis was made in 466 patierts with adrenal tumors who underwent retroperitoneal laparoscopic surgery by the same surgeon. The adrenal tumor score system（ATS） was based on the quantization of the following independent variables： size of the tumors, boundary with surrounding organs, boundary with abdominal great vessels, endocrine function and body mass index, which were associated with operation time and the amount of bleeding after screening, and a clinical validation was performed for the score system. Results By univariate and multivariate Logistic regression analysis in 466 cases of adrenal tumor, size of the tumors, boundary with surrounding organs, boundary with abdominal great vessels, endocrine function and body mass index were all associated with operation time and the amount of bleeding（P〈0.01）. A correlation existed between ATS and operation time, blood loss during operation（P〈0.01）. And there were significant differences among high, moderate and low complexity groups. Conclusion ATS system covering all the major factors that influence operation difficulty and surgical complexity of adrenal tumors, has important clinical value of surgical treatment.