CT三维重建改良R.E.N.A.L.评分系统在50例腹腔镜肾部分切除术中的应用

目的 探讨基于CT三维重建技术改良R.E.N.A.L.评分系统在腹腔镜肾部分切除术中的应用价值。 方法 选取山东大学附属山东省立医院泌尿外科2018年9月至2019年11月间进行的T1期肾细胞癌腹腔镜肾部分切除术50例,所有纳入患者术前均行CT三维重建,并分别按照传统R.E.N.A.L.评分系统以及CT三维重建改良R.E.N.A.L评分系统进行术前评分,结果与手术实际难度进行比较,并利用 Spearman秩相关分析改良R.E.N.A.L.评分系统与患者手术时间、住院天数、术中热缺血时间(WIT)、术后血红蛋白下降、术后血肌酐及术后血尿素氮水平之间的相关性。 结果 CT三维重建改良R.E.N.A.L评分与患者的手术时间、WIT以及术后血红蛋白下降程度之间呈正相关(r_s分别为0.570、0.802、0.903,P<0.001),并且改良R.E.N.A.L评分系统的灵敏度、特异度以及约登指数均明显优于传统R.E.N.A.L.评分系统。 结论 CT三维重建改良R.E.N.A.L.评分系统对患者的手术难度的评估较传统R.E.N.A.L.评分系统更加准确,同时对患者围手术期指标有预测作用。

Application of CT three-dimensional reconstruction modified R.E.N.A.L. score in 50 cases of laparoscopic partial nephrectomy

Objective To explore the application value of the modified R.E.N.A.L.(radius, exophytic/endophytic, nearness, anterior/posterior, location)scoring system based on CT three-dimensional(3D)reconstruction technology in laparoscopic partial nephrectomy(LPN)for renal cell carcinoma(RCC). Methods A total of 50 patients undergoing LPN for stage T1 RCC in the Department of Urology of Shandong Provincial Hospital during Sep. 2018 and Nov. 2019 were enrolled. CT 3D reconstruction was performed in all patients before surgery, who were evaluated with the conventional R.E.N.A.L. score and modified R.E.N.A.L. score, respectively. The results were compared with the actual surgery. The correlation between the modified R.E.N.A.L. score and operation time, hospitalization days, intraoperative warm ischemia time(WIT), postoperative hemoglobin reduction, serum creatinine and blood urea nitrogen was analyzed with Spearman’s rank correlation analysis. Results There was a significant positive correlation between the modified R.E.N.A.L score and operation time, WIT, and hemoglobin reduction(r_s=0.570, 0.802, 0.903, P<0.001). The specificity, sensitivity and Yoden index of the modified R.E.N.A.L. score were significantly better than those of the conventional R.E.N.A.L. score. Conclusion The CT 3D reconstruction modified R.E.N.A.L. scoring system is more accurate than conventional R.E.N.A.L. scoring system in evaluating the surgical difficulty, and it can predict the perioperative indicators.