肾细胞癌R.E.N.A.L得分与术中热缺血时间及围手术期并发症的关系

发布时间：2018-12-08 10:45

【摘要】：目的：回顾性分析腹腔镜下保留肾单位手术的肾细胞癌患者的肿瘤R.E.N.A.L评分、术中热缺血时间与围手术期并发症发生情况之间的关系。 方法：本研究调查了2012年3月至2014年4月期间在中南大学湘雅二医院接受腹腔镜下保留肾单位手术的116名肾细胞癌患者的病历资料,从中提取每位患者的年龄、性别、术前肿瘤评估资料、术中热缺血时间与围手术期并发症发生情况等信息,同时调取了每位患者相应的原始影像学资料,并对每位患者的肿瘤形态学特点(如大小、部位等)进行了量化评估,根据R.E.N.A.L评分方法为每位患者的肿瘤予以评分。根据患者的肿瘤评估得分,将其分为低(4-5分)、中(6-7分)、高(8-9分)三个复杂度组；研究者从患者的围手术期病程记录与术后医嘱资料中对每位患者围手术期的恢复情况进行了解,并根据Accordion并发症分级标准将每位患者的围手术期并发症进行分级。 结果：低、中、高度复杂组分别入组患者30人、56人、30人,三组患者在平均年龄与性别构成上均无显著性差异,低度复杂组患者与中、高度复杂组患者之间在体重指数上存在显著差异,中、高度复杂组之间的差异无统计学意义；低、中、高度复杂组的平均热缺血时间分别为24.4分钟、20.0分钟与27.8分钟,各组两两之间的差异均具有统计学意义。所有患者围手术期并发症等级最高为Ⅲ级,Ⅱ级并发症与Ⅲ级并发症的发生率在三组之间没有显著差异。 结论：肾细胞癌患者R.E.N.A.L得分越高,术中热缺血时间越长；R.E.N.A.L得分9分以内的患者,其得分与并发症的发生率无明确关系,且围手术期并发症均可通过保守处理获得良好控制。
[Abstract]:Objective: to retrospectively analyze the relationship between tumor R.E.N.A.L score, intraoperative hot ischemia time and perioperative complications in patients with renal cell carcinoma undergoing laparoscopic nephron-sparing surgery. Methods: from March 2012 to April 2014, 116 patients with renal cell carcinoma underwent laparoscopic nephron-sparing surgery in Xiangya second Hospital of Central South University were investigated, and the age and sex of each patient were extracted. Preoperative tumor evaluation data, intraoperative hot ischemia time and perioperative complications were obtained. Corresponding original imaging data of each patient were obtained, and morphologic features of each patient (such as size, etc.) A quantitative assessment was performed and each patient's tumor was graded according to the R.E.N.A.L scoring method. According to the patients' tumor evaluation scores, they were divided into three groups: low (4-5), middle (6-7) and high (8-9) complexity groups. The recovery of each patient during perioperative period was investigated from the patient's perioperative course record and doctor's advice, and each patient's perioperative complications were graded according to the Accordion complication classification standard. Results: there were 30 patients, 56 patients and 30 patients in the low, middle and high complex groups, respectively. There was no significant difference in average age and gender composition among the three groups, but there was no significant difference between the patients in the low complex group and in the middle group. There was significant difference in body mass index between the patients in the highly complex group, but there was no significant difference between the middle and the highly complex groups. The mean time of hot ischemia was 24.4 minutes, 20.0 minutes and 27.8 minutes in the low, middle and high complex groups, respectively. The difference between the two groups was statistically significant. The grade of perioperative complications was the highest in all patients, and there was no significant difference between the two groups in the incidence of grade 鈪，

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