R.E.N.A.L.评分系统在局限性肾肿瘤手术治疗中的应用研究

发布时间：2018-03-14 13:23

  本文选题：R.E.N.A.L.评分　切入点：肾肿瘤　出处：《广西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨R. E. N. A. L.评分系统在局限性肾肿瘤手术治疗中的作用,比较不同复杂程度的肿瘤在手术方式、临床指标方面的区别。材料与方法：本研究回顾性分析了我院2008年9月至2014年12月期间,同一术者手术治疗152例局限性肾肿瘤患者的临床资料。使用R. E. N. A. L.评分系统(R. E. N. A. L. nephrometry score, RNS)对每个肾肿瘤进行量化评分,根据R. E. N. A. L.,总分(total nephrometry score, TNS)将肿瘤分为低度复杂、中度复杂和高度复杂三组；统计学运用非参数检验、ROC曲线等方法进行组间的分析与比较。结果：152例患者中,低度复杂25例(16.4%),中度复杂65例(42.8%),高度复杂62例(40.8%),中位TNS为9分(范围4-12),中位肿瘤大小5.7 cm(范围1.5,10.3)；行保留肾单位手术54例(35.5%),开放和腹腔镜分别为22例和32例；行根治性肾切除术98例(64.5%),开放和腹腔镜分别为55例和43例。低、中、高度复杂组间的首诊症状、估计出血量和手术方式均有显著差异(P0.001)。肿瘤复杂程度越低,无症状肾肿瘤越多,术中估计出血量越少。TNS与不同手术方式的选择密切相关(P0.001),从ROC曲线的结果可知,TNS能有效预测手术方式(P≤0.007),当TNS9分(敏感度85.7%,特异度85.1%)时,可考虑行根治性肾切除术；另外,在行保留肾单位手术的患者中,当TNS8分(敏感度36.4%,特异度100%)时,可考虑行腹腔镜保留肾单位手术。结论：RNS可以比较全面地描述肾肿瘤空间上的解剖学特征,评估肿瘤复杂程度,指导制定手术方案：TNS≤8分推荐行腹腔镜保留肾单位手术；TNS≥9分推荐行根治性肾切除术。该结论可能只适用于本研究中的术者,尚需在不同中心或不同术者中比较证实。
[Abstract]:Objective: to investigate the role of R.E.N.A.L. scoring system in the surgical treatment of localized renal tumors, and to compare the surgical methods of tumors with different degrees of complexity. Materials and methods: this study retrospectively analyzed the period from September 2008 to December 2014 in our hospital. Clinical data of 152 patients with localized renal neoplasms treated by the same operation. Each renal tumor was quantified by using the R.E.N.A.A.L. nephrometry score system. According to R. E. N. A. L., total nephrometry score (TNSs), the tumors were divided into three groups: low degree complex group, moderate complex group and high complex group. There were 25 cases with low complexity, 65 cases with moderate complexity with 42.8%, 62 cases with high complexity with 40.8m, with median TNS of 9 points (range 4-12, median tumor size 5.7 cm (range 1.510. 3), 54 cases with nephron-sparing surgery, 22 cases with open surgery and 32 cases with laparoscopy, respectively. 98 cases underwent radical nephrectomy, 55 cases with open nephrectomy and 43 cases with laparoscopy. There were significant differences in the first diagnosis symptoms, estimated bleeding volume and surgical methods among the low, middle and high complex groups. The lower the tumor complexity, the more asymptomatic renal tumors. The less blood loss estimated during the operation, the more closely related to the choice of different surgical methods. From the results of the ROC curve, it can be seen that TNS can effectively predict the surgical procedure P 鈮，

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