四种肾肿瘤评分系统预测后腹腔镜下肾部分切除术临床结局的比较

Comparison of four nephrometry scoring systems in predicting perioperative outcomes after retroperitoneal laparoscopic partial nephrectomy

目的:比较R.E.N.A.L.、PADUA、C-index、DAP评分系统预测经后腹膜腹腔镜下肾部分切除术围手术期结局的效能。方法:回顾性分析我院131例接受后腹腔镜下肾部分切除术患者的临床资料,分别评估4种评分系统对术后达成MIC(即手术切缘阴性、热缺血时间<20 min、未出现Clavien-Dindo 3~4级的重大并发症)的预测效能。并进一步分析4种评分系统评分与其他围手术期结局的相关性。结果:4种评分系统均能够预测术后能否达成MIC,其中R.E.N.A.L.评分、DAP评分的预测效能最佳(P<0.001)。R.E.N.A.L.、DAP、C-index评分为低复杂的肿瘤患者更容易术后达成MIC(P<0.05)。4种评分系统评分均与手术时间及热缺血时间相关(P<0.05);C-index、DAP评分还与预计失血量相关(P<0.05)。结论:R.E.N.A.L.评分、DAP评分对肾肿瘤复杂程度评估及能否达到MIC结局预测效果最佳;4种评分与其他围手术期结局均具有不同程度的相关性。

Objective:To evaluate the efficacy of nephrometry scores R.E.N.A.L.,PADUA,C-index and DAP in predicting perioperative outcome of retroperitoneal laparoscopic partial nephrectomy.Methods:The clinical data of 131 patients undergoing retroperitoneal laparoscopic partial nephrectomy in our hospital were retrospectively evaluated to determine the predictive value of each nephrometry score for MIC achievement.The MIC achievement was reached when surgical margins were negative,warm ischemia time was<20 min and no major complications(grade 3-4,according to Clavien-Dindo classification)occurred.Moreover,correlation was determined between the four nephrometry scoring systems scores and other quantitative perioperative outcomes.Results:All the four nephrometry scores were predictive for MIC achievement.Among them,the R.E.N.A.L.and DAP score had the best predictive value(P<0.001).MIC achievement rate was higher in tumors with low complexity compared to that with high complexity using nephrometry scores R.E.N.A.L.,DAP and C-index(P<0.05).All the four nephrometry scores correlated with operative time and warm ischemia time(P<0.05).In addition,C-Index and DAP score also correlated with estimated blood loss(P<0.05).Conclusion:The R.E.N.A.L.and DAP scores correlate best with the complexity evaluation of renal tumors and MIC achievement.And all the four nephrometry scoring systems have varying degrees of correlation with other perioperative outcomes.