改良R.E.N.A.L.评分系统在后腹腔镜下T1期肾癌肾部分切除术中的临床应用及评价

发布时间：2018-06-09 04:15

本文选题：肾癌 + 后腹腔镜　；参考：《石河子大学》2014年硕士论文

【摘要】：目的：评价改良R.E.N.A.L.评分系统在后腹腔镜下T1期肾癌肾部分切除术中的临床应用及价值。方法：回顾性分析2007年1月至2012年6月石河子大学医学院第一附属医院泌尿外科收住的39例T1期肾肿瘤患者，并由同一组主刀医生和助手完成后腹腔镜下肾单位保留术患者的相关病历及影像学资料，根据热缺血时间和或手术时间将研究对象的手术难度分为低度、中度、高度三个等级，然后根据相关资料使用改良设计的R.E.N.A.L.评分系统和R.E.N.A.L.评分系统进行评分，根据各自评分结果及评判标准将手术难度分级，最后分析改良R.E.N.A.L.评分系统与围手术期结局的关系并比较两评分系统对手术难度评估的灵敏度、特异度、约登指数。结果：最终确定入选患者39例其中男性17例，女性22例，平均年龄54.3±12.0岁，BMI平均值25.8±3.8kg/m2，肿瘤平均最大直径3.7±1.5cm，肿瘤边缘离集合系统平均最近距离5.7±2.3mm，平均热缺血时间18.6±5.7min，平均手术时间：100.0±21.1min，平均术中失血量：118.5±41.2ml，平均住院天数6.4±1.2d，术前有2例患者患有轻度高血压，糖尿病，研究对象均无严重基础疾病，术前、术后肌酐值均正常，1例患者术后伤口漏尿，，留置导尿管及输尿管导管加强引流1周后症状消失，无其他严重并发症，根据热缺血时间和或手术时间划分手术难度，其中17例手术难度为低度、17例为中度、5例为高度；通过使用R.E.N.A.L.评分系统回顾性对39例患者进行拟术前评分，其中24例手术难度为低度、13例为中度、2例为高度，而改良R.E.N.A.L.评分系统回顾性对39例患者进行拟术前评分的结果是其中15例手术难度为低度、17例为中度、7例为高度。改良R.E.N.A.L.评分系统与手术时间，热缺血时间，术中出血量之间存在显著关系（P＜0.05），根据两套评分系统对手术难度评估的灵敏度、特异度、约登指数可知改良设计的R.E.N.A.L.评分系统指导意义更好。结论：改良R.E.N.A.L.评分系统较为准确的评价了后腹腔镜下T1期肾癌肾部分切除术的手术难度，可作为术前T1期肾癌患者后腹腔镜下肾部分切除术手术难度分级标准，但需要做进一步的前瞻性研究。
[Abstract]:Objective: to evaluate the modified R.E.N.A.L. Clinical application and value of retroperitoneal laparoscopic partial nephrectomy for T1 stage renal carcinoma methods: a retrospective analysis of 39 cases of urology received in the first affiliated Hospital of Shihezi University Medical College from January 2007 to June 2012 T1 stage renal neoplasms, The medical records and imaging data of patients with retroperitoneal laparoscopic renal unit retention were completed by the same group of surgeon and assistant. According to the time of hot ischemia and operation, the difficulty of operation was divided into three grades: low degree, moderate degree and high level. Then, based on the relevant information, the modified R.E.N.A.L. The scoring system and R.E.N.A.L. The grading system was used to grade the operation difficulty according to the results and criteria. Finally, the modified R.E.N.A.L. The relationship between the scoring system and the perioperative outcome was compared. The sensitivity, specificity, and Yorden index of the two scoring systems for the evaluation of surgical difficulty were compared. Results: 39 patients were selected, including 17 males and 22 females. The mean age was 54.3 卤12.0 years old, the mean BMI was 25.8 卤3.8 kg 路m ~ (-2), the mean maximum diameter of tumor was 3.7 卤1.5 cm, the average distance from the margin to the collecting system was 5.7 卤2.3 mm, the mean time of hot ischemia was 18.6 卤5.7 min, the mean operative time was 10 0 卤21.1min, the average intraoperative blood loss was 118.5 卤41.2 ml, the average hospitalization was 6.4 卤1.2 days, the preoperative mean time was 2. Patients with mild hypertension, Patients with diabetes mellitus had no serious underlying diseases. Before and after operation, the creatinine values were normal in 1 patient with postoperative wound leakage. The symptoms disappeared after one week of indwelling ureteral catheter and ureteral catheter drainage, and there were no other serious complications. The difficulty of operation was divided according to the time of hot ischemia and operation, of which 17 cases had low degree of operation and 17 cases had moderate degree of surgery, 5 cases were high. The evaluation system was used retrospectively to evaluate 39 patients before operation. Among them, 24 cases had low degree of difficulty and 13 cases had moderate grade and 2 cases were high, while modified R.E.N.A.L. The results showed that 15 cases had low degree of operation and 17 cases had moderate grade and 7 cases were high. Improved R.E.N.A.L. There was a significant correlation between the scoring system and operative time, hot ischemia time, and intraoperative bleeding volume (P < 0.05). According to the sensitivity and specificity of the two scoring systems to the evaluation of surgical difficulty, the improved R.E.N.A.L. Conclusion: modified R.E.N.A.L. The scoring system was used to evaluate the surgical difficulty of partial nephrectomy under retroperitoneal laparoscopy for T1 stage renal cell carcinoma, and it could be used as the standard for the classification of surgical difficulty of partial nephrectomy in patients with preoperative T1 stage renal cell carcinoma. But further forward-looking research is needed.
【学位授予单位】：石河子大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

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