摘要目的:探讨R. E. N. A. L. 评分系统对腹腔镜下保留肾单位手术难度及效果的影响。方法:回顾性分析2006年5月~2015年3月期间收集的38例行腹腔镜下肾部分切除术肾癌患者的病例资料,根据R. E. N. A. L. 评分系统将患者分为低难度组(＜7分),中难度组(7~9分),高难度组(≥10分),并比较分析各组间手术时间、出血量、热缺血时间及手术前后肌酐的变化情况。结果:38例患者中低难度组20例,中难度组15例,高难度组3例。其中低难度组及中难度组手术时间、出血量、热缺血时间、手术前后肌酐变化值分别为(119.30±47.21)∶(158.70±36.27)min(P=0.011)、(85.00±50.52)∶(178.00±163.06)ml(P=0.022)、(36.30±6.05)∶(42.1±4.75)min(P=0.005)、(18.10±8.65)∶30.20±14.91)μmol/L(P=0.005),均差异有统计学意义。高难度组中有2例中转肾癌根治术。结论:R. E. N. A. L. 评分是一种客观有效的手术难度评价系统,术前运用R. E. N. A. L. 评分评价保留肾单位手术难度有助于术者根据自身及患者的情况选择合适的患者行该手术。
Abstract：Objective: To evaluate the predictive value of R. E. N. A. L. nephrometry score on complexity and outcomes of laparoscopic partial nephrectomy. Methods: From May 2006 to March 2015, a consecutive series of 38 patients with renal cell carcinoma undergoing laparoscopic partial nephrectomywere retrospectively studied. According to the R. E. N. A. L. scoring system, the patients were divided into three groups including 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). The operation time (OT), estimate blood loss (EBL), warm ischemic time (WIT) and serum creatinine (SC) change among these groups were compared. Results: There were 20 cases in low risk group. 15 cases in median risk group, and 3 cases in high risk group. Importantly, the low risk group and median risk group showed significant difference in the OT [(119.3±47.21) vs. (158.7±36.27) min, P=0.011], EBL [(85.0±50.52) vs. (178.0±163.06) mL, P=0.022], WIT [(36.3±6.05) vs. (42.1±4.75) min, P=0.005] and SC [(18.1±8.65) vs. (30.2±14.91) μmol/L, P=0.005]. Two of three cases were converted to laparoscopic radical nephrectomy in high risk group because of complexity of laparoscopic partialnephrectomy. Conclusions: R. E. N. A. L. scoring system is effective to predict the complexity of laparoscopic partialne phrectomy, and helpful for selecting patients suitable for this kind of operation according to the conditions of the surgeons and patients.
李春生,夏海波,包国昌,高志明,任晓磊,门超,牧哈达. R. E. N. A. L. 评分系统在腹腔镜肾部分切除术中的应用(附38例报告)[J]. 微创泌尿外科杂志, 2015, 4(4): 218-220.
Li Chunsheng, Xia Haibo, Bao Guochang, Gao Zhiming, Ren Xiaolei, Men Chao, Mu Hada. Application of R. E. N. A. L. nephrometry score in laparoscopic partial nephrectomy: report of 38 cases. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2015, 4(4): 218-220.
[1] Rini BI, Campbell SC, Escudier B. Renal cell carcinoma. Lancet, 2009,373(9669): 1119-1132. [2]Herr HW. Surgical management of renal tumors: A historical perspective. Urol Clin North Am, 2008,35(4): 543-549; v. [3]谢永鹏,马鑫,李宏召,等.机器人辅助腹腔镜肾部分切除术（附20例报告）.微创泌尿外科杂志,2013,2(6):356-359. [4]刘哲,陈佳.后腹腔镜肾部分切除术和开放肾部分切除术治疗肾肿瘤的疗效比较.中国肿瘤临床与康复,2014,21(12):1482-1484. [5]储刚,温端改,浦金贤.后腹腔镜肾部分切除术治疗tla期肾肿瘤的临床价值.临床泌尿外科杂志,2011,26(3):189-190. [6]张中元,张晓春.Tlb期肾细胞癌:根治切除手术还是部分切除手术.现代泌尿外科杂志,2014,19(12):823-825. [7]Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: A comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol, 2009,182(3): 844-853. [8]Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical t1 renal mass. J Urol, 2009,182(4): 1271-1279. [9]Ljungberg B, Bensalah K, Canfield S, et al. Eau guidelines on renal cell carcinoma: 2014 update. Eur Urol, 2015,67(5): 913-924. [10] 黄毅,阴雷,黄海,等. R. E. N. A. L. 评分在后腹腔镜下肾部分切除术中预测肾脏热缺血时间的应用.微创泌尿外科杂志,2013,2(5): 324-327. [11] 李忠,牛远杰. R．E．N．A．L．评分系统在肾癌肾部分切除术中的应用.现代泌尿生殖肿瘤杂志, 2014,6(5): 315-318. [12] 何威,谢欣,芮文斌,等. R. E. N. A. L. 评分在机器人辅助肾部分切除术中的应用.临床泌尿外科杂志,2014,29(11): 954-956.
