R.E.N.A.L.,PADUA和C-index三种评分系统在肾部分切除术中的应用价值研究

doi:10.3969/j.issn.1009-976X.2021.01.021

摘要/Abstract

摘要： 目的探讨R.E.N.A.L.,PADUA和C-index三种评分系统在肾部分切除术中的应用价值。方法对本院2013年1月至2020年6月收治的134例行PN的单侧肾肿瘤患者临床资料进行回顾性分析,阅读134例单侧肾肿瘤患者术前影像学资料,应用R.E.N.AL.,PADUA和C-index三种评分系统对肾肿瘤解剖特征进行评分并分组,分析三个评分系统评分之间的相关性,分析三种评分系统不同组别间热缺血时间、估计出血量、手术时间、手术前后血肌酐升高值及住院天数的相关性。结果 61例和73例患者分别接受了开放式和腹腔镜下肾部分切除术。三种评分系统两两相关,R.E.N.A.L.和PADUA之间的相关性最强（相关系数：0.749,P<0.001）,其次是C-index和PADUA（相关系数：-0.266,P=0.002）,最后是C-index和R.E.N.A.L.（相关系数：-0.191,P=0.027）。R.E.N.A.L.、PADUA评分分组与热缺血时间、估计出血量存在正相关,而与手术时间、肌酐升高值及住院时间无明显相关。C-index评分分组不仅与热缺血时间和估计出血量相关,还与手术时间存在显著正相关,且相关系数均高于其他两个评分系统,C-index评分分组与肌酐升高值及住院时间无明显相关。结论三个评分系统均可对手术复杂程度及相关风险进行评估,C-index评分系统优于R.E.N.A.L.和PADUA。

关键词: 肾部分切除术, 评分系统, R.E.N.A.L., PADUA, C-index

Abstract: Objective To investigate the application value of R.E.N.A.L., PADUA and C-index nephrometry systems in partial nephrectomy. Methods The clinical data of 134 patients underwent PN between January 2013 and June 2020 were analyzed retrospectively. Abdominopelvic computerized tomography or magnetic resonance imaging was used to obtain R.E.N.A.L., PAUDA and C-index. The correlations between nephrometries and perioperative parameters （warm ischemia time, estimated blood loss, operating time, elevated serum creatinine values and length of hospital stay） were evaluated. Results Sixty-one and seventy-three patients underwent open and laparoscopic partial nephrectomy, respectively. Spearman correlation analysis showed that three nephrometries were correlated with each other. The strongest correlations were between R.E.N.A.L. and PADUA （correlation coefficient： 0.749, P<0.001）, followed by C-Index and PADUA （correlation coefficient：-0.266, P=0.002）. R.E.N.A.L. and PADUA groups were significantly correlated with hot ischemia time and estimated blood loss, but not with operation time, creatinine elevation and length of hospital stay. The C-index score grouping was not only correlated with hot ischemia time and estimated blood loss, but also had significant positive correlation with operation time, and the correlation coefficient was higher than other two nephrometry systems. The C-index score was not also significantly correlated with creatinine elevation and length of hospital stay. Conclusion All the three nephrometry systems can evaluate the complexity of surgery and related risks. C-index system is superior to R.E.N.A.L. and PADUA.

Key words: partial nephrectomy, nephrometry system, R.E.N.A.L., PADUA, C-index

中图分类号:

R699.2

李法江, 陈帅, 黄红星, 郑轶群, 黎卫, 石映江, 连文清. R.E.N.A.L.,PADUA和C-index三种评分系统在肾部分切除术中的应用价值研究[J]. 岭南现代临床外科, 2021, 21(01): 112-116.

LI Fa-jiang, CHEN Shuai, HUANG Hong-xing, ZHENG Yi-qun, LI Wei, SHI Ying-jiang, LIAN Wen-qing. Clinical study on the application value of R.E.N.A.L., PADUA and C-index nephrometry scores in partial nephrectomy[J]. Lingnan Modern Clinics In Surgery, 2021, 21(01): 112-116.

参考文献

[1] 那彦群,叶章群,孙光,主编. 中国泌尿外科疾病诊断治疗指南[M]. 北京:人民卫生出版社, 2014:3-19.
[2] Capitanio U, Terrone C, Antonelli A, et al.Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function[J]. Eur Urol, 2015, 67(4):683-689.
[3] Tan HJ, Norton EC, Ye Z, et al.Long-term survival following partial vs radical nephrectomy among older patients with early stage kidney cancer[J]. JAMA, 2012, 307(15): 1629-1635.
[4] Veccia A, Antonelli A, Uzzo RG, et al.Predictive Value of Nephrometry Scores in Nephron-sparing Surgery: A Systematic Review and Meta-analysis[J]. Eur Urol Focus, 2020, 6(3): 490-504.
[5] Kara L W, Ghosh P, Stein S, et al.Value of Nephrometry Score Constituents on Perioperative Outcomes and Split Renal Function in Patients Minimally Invasive Partial Nephrectomy[J]. Urology, 2017,99:112-117.
[6] 田焕书,苏泽轩,叶木石,等. R.E.N.A.L.评分系统在肾部分切除术中的应用[J]. 中华实验外科杂志, 2017, 34(6): 1054-1057.
[7] 王苏贵, 马松, 阳东荣, 等. 术前解剖特征分类评分系统在后腹腔镜肾部分切除术中的应用[J]. 中华临床医师杂志(电子版), 2016, 10(12): 1691-1694.
[8] 王仪春,徐昳文,俞兆儿,等. R.E.N.A.L联合C-index评分系统对T1期肾肿瘤术式选择的价值研究[J].中国肿瘤外科杂志, 2017, 9(5): 286-291.
[9] Chang X, Liu T, Zhang F, et al.The Comparison of R.E.N.A.L., PADUA and Centrality Index Score in Predicting Perioperative Outcomes and Complications after Laparoscopic Radio Frequency Ablation of Renal Tumors[J]. J Urol, 2015, 194(4): 897-902.
[10] Wang YD, Huang CP, Chang CH, et al.The role of RENAL, PADUA, C-index, CSA nephrometry systems in predicting ipsilateral renal function after partial nephrectomy[J]. BMC Urol, 2019, 19(1): 72.
[11] Okhunov Z, Rais-Bahrami S, George AK, et al.The comparison of three renal tumor scoring systems: C-Index, PADUA, and R.E.N.A.L. nephrometry scores[J]. J Endourol, 2011, 25(12): 1921-1924.
[12] Alma E, Ercil H, Eken A, et al.The role of RENAL, PADUA and C-index scoring systems in predicting the results of partial nephrectomy without ischemia[J]. Asian J Surg, 2019, 42(1): 326-331.
[13] Choi JD, Park JW, Choi JY, et a1.Rena1 damage caused by warm ischaemia during laparoscopic and robt-assisted partial nephrectomy: an assessment using Tc99m-DTPA glomeruler filtration rate[J]. Eur Uro1, 2010, 58(6): 900-905.
[14] Ficarra V, Rossanese M, Giannarini G, et al.The use of nephrometry scoring systems can help urologists predict the risk of conversion to radical nephrectomy in patients scheduled for partial nephrectomy[J]. Ann Transl Med, 2019, 7(Suppl 6):S213.