DAP肾肿瘤评分系统在保留肾单位手术中的临床价值及其可信度和可重复性研究

发布时间：2018-05-01 21:44

本文选题：肾肿瘤 + DAP评分系统　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:探讨DAP肾肿瘤评分系统对行保留肾单位手术患者的临床应用价值。同时,对该评分系统的可信度和可重复性进行研究,评估该评分系统的评分稳定性。方法:收集2013年10月至2015年8月安徽医科大学第一附属医院泌尿外科收治的110例行开放、腹腔镜及机器人辅助腹腔镜肾部分切除手术患者的临床及影像学资料。术前应用DAP评分系统进行评分,并根据肿瘤的复杂程度将其分为高分、中分及低分组,分析该评分与手术方式及手术时间、热缺血时间和估计失血量等围手术期结局之间的相关性。另由5名泌尿外科医师(2名主治医师和3名住院医师)采用DAP系统独立进行评分,其中,两名住院医师间隔3个月后再次进行评分。分别利用Kappa和Kendall tau-b分析法评估同一评分者和两名评分者间DAP各参数及总分的一致性。利用ICC检验分析不同资历医师之间评分结果的一致性。结果:本研究中开放、腹腔镜及机器人辅助腹腔镜保留肾单位手术分别为18例、62例、30例。其中,男性患者54例、女性患者56例。患者的平均年龄为(50.9±12.2)岁,体质指数为(23.4±3.3)kg/m2,ASA麻醉评分为(1.4±0.5)分。在所有患者中,左侧肾肿瘤55例,右侧肿瘤55例,所有肿瘤均为单发。DAP评分与手术方式、手术时间、热缺血时间和估计失血量显著相关(P0.05),而与术后住院天数和围手术期肾小球率过滤的的变化率之间无明显相关性(P0.05)。同一评分者DAP各参数及总分的Kappa值分别为0.889、0.817、0.787和0.693;0.897、0.834、0.830和0.708。两名评分者之间DAP各参数及总分的Kendall tau-b值分别为0.896、0.832、0.847、0.832。在Bland-Altman图中,D、A、P三个参数均有超过90%的位点在95%的置信区间的参考线内。高年资医师间的评分一致性较低年资医师高。结论:DAP肾肿瘤评分系统对相关围手术期结局具有较好的临床预测价值,有助于指导手术方式的合理选择。同时,DAP肾肿瘤评分系统在同一评分者及不同评分者间的一致性好,具有良好的可信度和可重复性。
[Abstract]:Objective: to evaluate the clinical value of DAP renal tumor scoring system in patients undergoing nephron-sparing surgery. At the same time, the reliability and repeatability of the scoring system were studied to evaluate the stability of the scoring system. Methods: from October 2013 to August 2015, 110 patients with open, laparoscopic and robot-assisted laparoscopic partial nephrectomy were collected from the first affiliated Hospital of Anhui Medical University. DAP scoring system was used to score the tumor before operation. According to the complexity of the tumor, the tumor was divided into three groups: high score, middle score and low score. Correlation between warm ischemic time and perioperative outcomes such as estimated blood loss. In addition, 5 urologists and 2 attending physicians and 3 resident physicians were assessed independently by DAP system, in which the two resident physicians were graded again after 3 months' interval. Kappa and Kendall tau-b analysis were used to evaluate the consistency of DAP parameters and total scores between the same score and two raters. ICC test was used to analyze the consistency of scoring results among doctors with different qualifications. Results: in this study, the open, laparoscopic and robotic assisted laparoscopic nephron sparing surgery were 18 cases (62 cases) and 30 cases (30 cases), respectively. Among them, 54 cases were male and 56 cases were female. The average age of the patients was 50.9 卤12.2 years, and the body mass index (BMI) was 23.4 卤3.3 kg / m ~ 2 ASA score of 1.4 卤0.5). Among all the patients, 55 cases were left renal tumor, 55 cases were right tumor, all tumors were single .DAP score, operation method, operation time. There was a significant correlation between the time of hot ischemia and the estimated amount of blood loss (P0.05), but there was no significant correlation between the duration of hospitalization and the change rate of perioperative glomerular filtration. The Kappa values of each parameter and total score of DAP in the same score were 0.88170.87 and 0.6930.8970.834 / 0.830 and 0.708 respectively. The Kendall tau-b values of DAP parameters and total scores between the two scores were 0.896 卤0.832 and 0.847 卤0.832, respectively. In the Bland-Altman diagram, more than 90% of the three parameters are in the reference line of 95% confidence interval. The consistency of scores among senior physicians was higher than that among junior physicians. Conclusion the renal tumor score system with the weight DAP has a good clinical value in predicting the perioperative outcome and is helpful to guide the rational selection of surgical methods. At the same time, DAP renal tumor scoring system has good consistency and good reliability and repeatability.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.11

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