R.E.N.A.L评分在机器人辅助肾部分切除术中的应用

目的:探讨肾脏肿瘤测量评分系统(R.E.N.A.L评分)在机器人辅助腹腔镜肾部分切除术(RALPN)中评估手术成功率和手术结果的价值。方法:2010年3月~2014年5月,回顾性分析我科施行的45例RALPN的手术数据,并进行R.E.N.A.L评分。其中低危组(R.E.N.A.L评分7分)20例,中危组(R.E.N.A.L评分7~9分)15例,高危组(R.E.N.A.L评分≥10分)10例。将三组患者手术成功率、手术数据进行比较。结果:低危组均顺利完成RALPN;中危组13例完成RALPN,2例因行RALPN困难而行机器人辅助腹腔镜根治性肾切除术(RALRN);高危组7例完成RALPN,3例行RALRN。所有手术均在机器人辅助腹腔镜下完成,无中转开放手术。低危组平均手术时间(OT)、热缺血时间(WIT)、失血量(EBL)分别为(65.0±1.4)min、(14.0±0.9)min和(35.0±4.7)ml。中危组平均OT、WIT和EBL分别为(95.0±2.7)min、(22.0±1.6)min和(110.0±7.1)ml。高危组平均OT、WIT和EBL分别为(150.0±4.9)min、(30.0±2.1)min和(320.0±15.6)ml。三组间OT、WIT和EBL的差异有统计学意义(P0.05)。三组患者术后均无并发症出现。结论:对于RALPN,术前R.E.N.A.L评分同样与手术成功率、手术时间、失血量和热缺血时间有关。R.E.N.A.L评分≥10分不应该成为RALPN的禁忌证。

Association of R.E.N.A.L nephrometry score with outcomes of robot-assisted laparoscopic partial nephrectomy

Objective：To evaluate the predictive value of R.E.N.A.L（radius,exophytic/endophytic,nearness to collecting system,anterior/posterior,and location）nephrometry scoring system and to investigate its influence on perioperative outcomes of robot-assisted laparoscopic partial nephrectomy（RALPN）.Method：From March 2010 to May 2014,45 RALPNs were divided into low risk group（R.E.N.A.L nephrometry score〈7）,median risk group（R.E.N.A.L nephrometry score 7-9）and high risk group（R.E.N.A.L nephrometry score≥10）.We retrospectively analyzed their perioperative data.Result：All the procedures were fulfilled successfully except that two cases in median risk group and three cases in high risk group converted to robot-assisted laparoscopic radical nephrectomy（RALRN）.The operating time（OT）,warm ischemic time（WIT）and estimated blood loss（EBL）in low risk group was（65.0±1.4）minutes,（14.0±0.9）minutes and（35.0±4.7）ml,and（95.0±2.7）minutes,（22.0±1.6）minutes and（110.0±7.1）ml in median risk group,and（150.0±4.9）minutes,（30.0±2.1）minutes and（320.0±15.6）ml in high risk group（P〈0.05）.The recovery was uneventful and no complication was identified.Conclusion：R.E.N.A.L nephrometry score is considered as a predictive tool for success rate and perioperative outcomes of RALPN,and R.E.N.A.L nephrometry score≥10should not be a contraindication of RALPN.