R.E.N.A.L.肾脏肿瘤评分系统在肾脏肿瘤手术治疗中的临床应用价值分析

目的 探讨R.E.N.A.L.肾脏肿瘤评分系统在肾脏肿瘤手术治疗中的应用价值.方法 回顾性分析2007年1月～ 2012年8月194例保留肾单位手术(nephron-sparing surgery,NSS)的临床资料.根据CT/MRI对每例患者进行R.E.N.A.L.评分,按评分高低将肿瘤解剖复杂程度分为低度、中度、高度,了解评分与围手术期并发症的关系,采用logistic多因素回归分析NSS术后并发症的危险因素.结果 NSS 194例,其中147例行腹腔镜手术,47例行开放手术.低、中、高度评分肿瘤分别为89、98、7例,按评分高低进行分层分析,不同评分患者在手术时间、肾脏热缺血时间、术中出血量有统计学差异(P＜0.05),在手术方式上存在明显差异(x2=25.526,P=0.000).对NSS术后并发症的有关因素进行单因素分析显示,手术时间、术中出血量、肾脏热缺血时间、手术方式和R.E.N.A.L.评分是并发症发生的影响因素(P＜0.05),logistic多因素回归分析显示,R.E.N.A.L.评分高低和手术方式是预测并发症发生的危险因素(β=1.687,OR=1.05,95％ CI=1.010～1.090,P=0.025;β=2.325,0R=1.56,95％ CI=1.170～2.050,P=0.002).结论 R.E.N.A.L.评分系统能客观评判肾脏肿瘤的解剖复杂程度,对NSS术后并发症有判断作用,有利于手术方式的制定.

The Value of Clinical Application of R.E.N.A.L. Nephrometry Score in Renal Tumor Surgery

Objective To evaluate the application value of R.E.N.A.L.nephrometry score（RNS） in renal tumor surgery.Methods Between January 2007 and August 2012,the clinical data of 194 cases undergoing nephron-sparing surgery（NSS） were analyzed retrospectively.RNS was evaluated according to CT or MRI imaging.RNS was categorized as low,moderate or high,reflecting tumor complexity.Perioperative outcomes were analyzed by RNS category.Logistic regression analysis was used to find the factors impacting the complications of NSS.Results Among the 194 cases of NSS,147 cases（75.8%） were managed by LPN（laparoscopy partial nephroectomy） and 47（24.2%） by OPN（open partial nephroectomy）.89,98 and 7 cases were rated as low,moderate and high in complexity,respectively.Stratified by RNS,there were significant differences between patients of different RNS categories in the warm ischemia time（WIT）,operation time,intraoperative blood loss（P〈0.05） and surgical procedure（χ^2=25.526,P=0.000）.The postoperative complications were associated with the operation time,intraoperative blood loss,surgical procedure and RNS（P〈0.05）.Logistic regression analysis showed that RNS and surgical procedure were associated with postoperative complications（β=1.687,OR=1.05,95% CI=1.010-1.090,P=0.025;β=2.325,OR=1.56,95% CI=1.170-2.050,P=0.002）.Conclusions RNS can objectively reflect the complexity of the renal tumor.It is associated with postoperative complications of NSS,which is helpful for making surgical decisions.