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目的探讨R.E.N.A.L.肾脏肿瘤评分系统在肾脏肿瘤手术治疗中的应用价值。方法回顾性分析2007年1月～2012年8月194例保留肾单位手术(nephron-sparing surgery,NSS)的临床资料。根据CT/MRI对每例患者进行R.E.N.A.L.评分,按评分高低将肿瘤解剖复杂程度分为低度、中度、高度,了解评分与围手术期并发症的关系,采用logistic多因素回归分析NSS术后并发症的危险因素。结果 NSS 194例,其中147例行腹腔镜手术,47例行开放手术。低、中、高度评分肿瘤分别为89、98、7例,按评分高低进行分层分析,不同评分患者在手术时间、肾脏热缺血时间、术中出血量有统计学差异(P<0.05),在手术方式上存在明显差异(χ2=25.526,P=0.000)。对NSS术后并发症的有关因素进行单因素分析显示,手术时间、术中出血量、肾脏热缺血时间、手术方式和R.E.N.A.L.评分是并发症发生的影响因素(P<0.05),logistic多因素回归分析显示,R.E.N.A.L.评分高低和手术方式是预测并发症发生的危险因素(β=1.687,OR=1.05,95%CI=1.010～1.090,P=0.025;β=2.325,OR=1.56,95%CI=1.170～2.050,P=0.002)。结论 R.E.N.A.L.评分系统能客观评判肾脏肿瘤的解剖复杂程度,对NSS术后并发症有判断作用,有利于手术方式的制定。
Objective To investigate the value of R.E.N.A.L. renal tumor scoring system in surgical treatment of renal tumors. Methods The clinical data of 194 nephron-sparing surgery (NSS) patients from January 2007 to August 2012 were retrospectively analyzed. According to CT / MRI, RENAL score of each patient was divided into three groups: low, moderate and high, according to the score, the relationship between the score and perioperative complications was analyzed. Logistic regression analysis was used to analyze NSS Risk factors for complications. Results 194 cases of NSS, of which 147 cases of laparoscopic surgery, 47 cases underwent open surgery. The scores of low, medium and high grade tumors were 89, 98, and 7, respectively. According to the scores, stratified analysis was performed. There were significant differences in the operation time, renal warm ischemia time and intraoperative blood loss in different score patients (P <0.05) , There is a significant difference in the surgical approach (χ2 = 25.526, P = 0.000). Univariate analysis of the related factors of NSS postoperative complications showed that operation time, intraoperative blood loss, renal warm ischemia time, surgical approach and RENAL score were the influencing factors of complication (P <0.05), logistic multifactor Regression analysis showed that the RENAL score and surgical method were risk factors for predicting the complication (β = 1.687, OR = 1.05, 95% CI = 1.010-1.090, P = 0.025; β = 2.325, OR = 1.56, 95% CI = 1.170 ~ 2.050, P = 0.002). Conclusion The R.E.N.A.L. scoring system can objectively evaluate the anatomic complexity of renal tumors and determine the postoperative complications of NSS, which is conducive to the development of surgical methods.