区域NePhRO评分系统在腹腔镜下肾部分切除术治疗T1期肾癌中的应用

目的探讨区域NePhRO评分系统在腹腔镜下肾部分切除术(LPN)治疗T1期肾癌中的临床意义及应用价值。方法2016年5月至2019年12月郑州大学第一附属医院泌尿外科行LPN治疗且术后病理证实为肾癌的T1期肾癌患者98例。根据术前影像资料对患者行区域NePhRO评分,将患者分为低风险组(4~6分)、中风险组(7~9分)、高风险组(10~12分),分析各组间手术时间、热缺血时间、出血量、术后第1天较术前血肌酐变化、围手术并发症等的关系。结果共98例患者纳入研究,低、中、高风险组患者分别为51、34、13例,98例患者均顺利完成手术且切缘均为阴性,术后并发症4例,低风险组2例(1例术后出血经保守治疗好转,1例肺部感染);中等风险组1例(尿漏经积极引流后好转),高风险组1例(术后出血经超选择性介入栓塞治疗)。术后病理:92例为透明细胞癌,4例为乳头状癌,2例嫌色细胞癌。各组在性别(χ²=4.154,P>0.05)、年龄(50.14±12.04)岁比(53.44±15.59)岁比(52.46±12.05)岁,F=0.653,P>0.05]、BMI(26.14±2.38)kg/m²比(25.02±2.62)kg/m²比(25.87±2.66)kg/m²,F=2.079,P>0.05]、出血量(68.04±47.16)ml比(84.71±59.61)ml比(103.08±80.04)ml,F=2.293,P>0.05]、术后住院天数(7.29±1.10)d比(7.76±1.37)d比(7.92±1.70)d,F=2.021,P>0.05)]差异无统计学意义,在手术时间(101.57±22.09)min比(107.53±20.34)min比(141.85±33.48)min,F=15.593,P<0.05]、热缺血时间(18.78±4.97)min比(20.74±5.38)min比(22.46±5.47)min,F=3.208,P<0.05]、血肌酐变化(6.19±7.96)比(15.21±9.92)比(17.69±9.60),F=14.892,P<0.05]差异有统计学意义。结论不同分级的肾肿瘤在手术时间、热缺血时间、血肌酐变化等重要的手术和功能参数有明显差异。

Application of Zonal NePhRO scoring system in laparoscopic partial nephrectomy for T1 stage renal cell carcinoma

Objective To explore the clinical significance and applied value of Zonal NePhRO scoring system in laparoscopic partial nephrectomy(LPN)in the treatment of T1 renal cell cancer(RCC).Methods An analysis of the clinical data of 98 patients with stage T1 RCC who received LPN treatment at the First Affiliated Hospital of Zhengzhou University from May 2016 to December 2019 and pathologically confirmed after the operation was done.According to the preoperative imaging data,the patients were scored by Zonal NePhRO,and the patients were divided into low-risk group(4-6 points),medium-risk group(7-9 points),and high-risk group(10-12 points).The operation time,warm ischemia time,blood loss,changes in blood creatinine,and perioperative complications were compared among the groups.Results A total of 98 patients were included in the study.There were 51,34,and 13 patients in the low-,medium-,and high-risk groups,respectively.All 98 patients successfully completed the operation with negative margins.The postoperative complications occurred in 4 cases,including 2 cases in the low-risk group(one case of postoperative bleeding improved by conservative treatment,and one case of pulmonary infection);one case in the medium-risk group(urinary leakage improved after active drainage),and one case in the high-risk group(postoperative bleeding treated by superselective interventional embolization).Postoperativelly pathological examination confirmed there were 92 cases of clear cell carcinoma,4 cases of papillary carcinoma,and 2 cases of chromophobe cell carcinoma.There was no significant difference in gender(χ²=4.154,P>0.05),age(50.14±12.04)years vs.(53.44±15.59)years vs.(52.46±12.05)years,F=0.653,P>0.05],BMI(26.14±2.38)kg/m² vs.(25.02±2.62)kg/m² vs.(25.87±2.66)kg/m²,F=2.079,P>0.05],blood loss(68.04±47.16)ml vs.(84.71±59.61)ml vs.(103.08±80.04)ml,F=2.293,P>0.05],and postoperative hospital stay(7.29±1.10)d vs.(7.76±1.37)d vs.(7.92±1.70)d,F=2.021,P>0.05]among groups(P>0.05).There were significant differences in operation time(101.57±22.09)min vs.(107.53±20.34)min vs.(141.85±33.48)min,F=15.593,P<0.05],warm ischemia time(18.78±4.97)min vs.(20.74±5.38)min vs.(22.46±5.47)min,F=3.208,P<0.05],and blood creatinine changes(6.19±7.96)vs.(15.21±9.92)vs.(17.69±9.60),F=14.892,P<0.05]among groups.Conclusion Kidney tumors of different grades have significant differences in important surgical and functional parameters such as operation time,warm ischemia time,and blood creatinine changes.