应用CT肾周脂肪粘连评分预测后腹腔镜肾部分切除术的手术难度

Application of the CT-adherent perinephric fat score in predicting surgical difficulty of retroperitoneal laparoscopic partial nephrectomy

目的评估术前应用CT肾周脂肪粘连评分对后腹腔镜肾部分切除术手术难度的预测价值。方法对行后腹腔镜肾部分切除术的232例患者的临床资料进行分析。术前均怀疑肾脏恶性肿瘤,根据术前增强CT图像对肾周脂肪粘连程度进行梅奥粘连概率(MAP)评分,并将患者分为MAP低分组、MAP中分组、MAP高分组。对不同MAP评分组患者的一般资料、合并症、肿瘤情况和术后并发症、围术期临床指标进行比较。结果3组患者的年龄、性别比例、肿瘤左/右比例、体质量指数、高血压患者比例、糖尿病患者比例、肿瘤最大直径、美国麻醉师协会评分、RENAL评分和术后3个月并发症发生率的差异均无统计学意义(均P>0.05)。MAP低分组和MAP中高分组比较,术中肾脏热缺血时间和术后住院时间无统计学差异(均P>0.05),手术时间、术中出血量和分离脂肪时间有统计学差异(均P<0.05)。结论术前CT的MAP评分对后腹腔镜肾部分切除术的手术难度有一定的预测价值,MAP中高分的患者手术时间、术中出血量和分离脂肪时间增加,但对术中肾脏热缺血时间、术后住院时间及短期并发症无明显影响。

Objective To assess the predictive value of the preoperative application of the computed tomography(CT)-adherent perinephric fat score for the prediction of the surgical difficulty of retroperitoneal laparoscopic partial nephrectomy(RLPN).Methods The clinical data of 232 patients who underwent RLPN were analyzed.All patients were suspected of renal malignancy.The Mayo adhesive probability(MAP)score was obtained based on the degree of perirenal fat adhesion according to preoperative enhanced CT images.The patients were divided into the low,middle,and high MAP score groups.The general data,comorbidities,tumor conditions,postoperative complications,and perioperative clinical parameters in different MAP score groups were compared.Results No significant differences in age,gender ratio,tumor(left/right)ratio,body mass index,hypertension,diabetes mellitus,maximum tumor diameter,American Society of Anesthesiologists score,RENAL score,and postoperative complications at 3 months were found among the 3 groups(all P>0.05).Intraoperative renal warm ischemia time and postoperative hospital stay were not significantly different between the low and middle to high MAP score groups(all P>0.05);however,operation time,estimated blood loss,and fat separation time were statistically different between the groups(all P<0.05).Conclusion The MAP score of preoperative CT has a predictive value for the surgical difficulty of RLPN.The operation time,estimated blood loss,and fat separation time increased in the middle and high MAP score groups,although there was no significant effect on intraoperative renal warm ischemia time,postoperative hospitalization stay,and short-term complications.