R.E.N.A.L.肾肿瘤评分联合MAP肾周脂肪评分用于肾部分切除手术的临床意义

Clinical significance of R.E.N.A.L.renal tumor score combined with MAP perirenal fat score in partial nephrectomy

目的:探讨联合应用R.E.N.A.L.评分系统与肾周脂肪评分系统(mayo adhesive probability,MAP)对保留肾单位肾部分切除术(partial nephrectomy,PN)的临床意义。方法:回顾性分析宁夏医科大学总医院2011年1月—2017年12月140例行PN肾肿瘤患者的临床资料,其中男85例,女55例;行开放肾部分切除术(open partial nephrectomy,OPN)68例,行腹腔镜肾部分切除术(laparoscopic partial nephrectomy,LPN)72例。所有患者依据术前腹部CT结果进行R.E.N.A.L.评分与MAP评分,并根据评分结果分为R.E.N.A.L.低、中、高度组和MAP低、中、高度组。分析不同R.E.N.A.L.、MAP分度下患者手术方式及围手术期临床指标的差异。结果:R.E.N.A.L.低度组中,随MAP分度逐渐增高,行OPN患者的例数增多(P<0.05);MAP低度组中,随R.E.N.A.L.分度的变化也有类似趋势(P<0.05)。但在R.E.N.A.L.或MAP中、高度组中,随MAP或R.E.N.A.L.分度变化,行LPN和OPN患者的例数无明显差异(P>0.05)。R.E.N.A.L.低度组行LPN者术中出血量较少,R.E.N.A.L.高度组行LPN者肾缺血时间较长。在R.E.N.A.L.低度组中,行LPN的MAP高度组患者术中出血量、手术时间均多于MAP低度组患者;R.E.N.A.L.中分度患者行LPN时,随MAP分度增加术中出血量增多。结论:R.E.N.A.L.评分系统联合MAP评分系统更能全面的评估PN手术的难度并指导PN手术术式的选择;尤其在R.E.N.A.L.低度组患者中,随着MAP评分增高,应更加积极进行术前准备或倾向于选择OPN术式。

Objective:To explore the clinical significance of R.E.N.A.L.scoring system combined with Mayo adhesive probability in partial nephrectomy.Methods:A retrospective analysis of 140cases of renal tumors treated with PN from January 2011to December 2017in General Hospital of Ningxia Medical University was performed.Among them,85were male and 55were female.Sixty-eight underwent open surgery,while 72underwent laparoscopic surgery.All patients were scored by R.E.N.A.L.and MAP according to preoperative abdominal CT results.According to the scoring results,they were divided into R.E.N.A.L.low,middle and high groups and MAP low,middle and high groups.The difference of surgical methods and clinical indicators in patients with different R.E.N.A.L.and MAP scores was analyzed.Results:The patients with low R.E.N.A.L.grade and high MAP grade had more cases of OPN(P<0.05).The number of OPN patients increased in the R.E.N.A.L.low grade group with the gradual increase of MAP scores(P<0.05).There was a similar trend with the change of R.E.N.A.L.score in MAP low group(P<0.05).However,there was no significant difference in the number of patients with LPN and OPN in the R.E.N.A.L.or MAP medium and high group with the change of MAP or R.E.N.A.L.scores(P>0.05).The amount of blood loss was less with LPN in the R.E.N.A.L.low group,while in the R.E.N.A.L.high group,the renal ischemia time was longer.In R.E.N.A.L.low group,the blood loss and operation time in MAP high group were more than those in MAP low group.The blood loss increased with the increase of MAP scroes in R.E.N.A.L.moderate group with LPN.Conclusion:R.E.N.A.L.scoring system combined with MAP scoring system can more comprehensively evaluate the difficulty of PN and guide the choice of PN mode.Preoperative preparation should be more active or OPN should be preferred with the increase of MAP scroes in the R.E.N.A.L.low group.