基于动脉复杂性肾肿瘤评分系统对LPN复杂程度的预测价值

目的:分析基于动脉复杂性的肾肿瘤评分系统对腹腔镜下肾部分切除术（aroscopic panial nephrectomy，LPN）复杂程度的预测价值。方法:对本院2010年1月至2017年12月收治的128例行LPN的单侧肾肿瘤患者行回顾性分析。由本院1名主任医师、1名主治医师和2名住院医师分别对96例单侧肾肿瘤患者术前腹部增强CT进行重新阅片，采用基于动脉复杂性的肾肿瘤评分系统进行等级评分（包括1、2、3S、3H 4个等级），其中以主任医师的读片结果作为评价标准，其他医师的评级一致性采用Kappa值进行评估，同时算出每2名评分者评分完全匹配的百分比。采用Logistics多元回归分析评估该肾肿瘤评分系统与手术时间、术中出血量、术中热缺血时间的关系。结果:4名医师两两配对平均Kappa值=0.50，表示其评分等级分布具有较高的一致性。根据Logistics多元回归分析结果分析，基于动脉复杂性的肾肿瘤评分系统与手术时间无明显相关性（P＞0.05），而与术中出血量、术中热缺血时间均具有明显相关性（均P＜0.05）。结论:基于动脉复杂性的肾肿瘤评分系统与术中出血量、术中热缺血时间关系密切，对LPN复杂程度具有重要的预测价值。

Predictive value of renal tumor scoring system on arterial based complexity in the complexity of LPN

Objective:To analyze the predictive value of renal tumor scoring system on arterial based complexity in the complexity of LPN.Methods:A retrospective analysis was performed on 128 patients with unilateral renal tumor undergoing laparoscopic partial nephrectomy (LPN) from January 2010 to December 2017.1 chief physician,1 attending doctor and 2 residents were selected in our hospital to re-read the preoperation abdominal enhanced CT of 96 cases of unilateral renal tumor.The renal tumor scoring system on arterial based complexity was used (including the 1,2,3S,3H grades),and the reading results of chief physicians as the evaluation criteria,the rating consistency of other doctors using Kappa value for assessment,and worked out every 2 raters score completely.Logistics multivariate regression analysis was used to evaluate the correlation between renal tumor scoring system on arterial based complexity and operative time,intraoperative blood loss,warm ischemia time.Results:4 physicians in paired average Kappa=0.50,showed the score consistent with high grade distribution.According to multivariate Logistics regression analysis,it was showed that there was no significant correlation between renal tumor scoring system on arterial based complexity and operation time,but it showed significant correlation with the intraoperative bleeding loss and warm ischemia time (both P＜0.05).Conclusion:The renal tumor scoring system on arterial based complexity is closely related to intraoperative bleeding loss and warm ischemia time,so it is of great value in predicting the complexity of LPN.