摘要
目的分析腹腔镜肾脏手术难易度相关的血管解剖因素,探讨构建个体化肾血管解剖评分系统(SIREN)的可行性。方法回顾性分析2016年9月至2018年3月于山西医科大学第一医院行后腹腔镜根治性肾切除术(RLRN)的251例患者的临床资料。男154例,女97例;年龄26~84岁,平均58.7岁;体质指数22.5~30.7kg/m^2,平均25.8kg/m^2。肿瘤均为单发,最大径4.2~10.8cm,平均5.4cm;临床分期T1b^2bN0~1M0期。排除既往有术区手术及感染史者。根据术中操作难易情况,分为普通组(无血管相关性事件,无中转开放且腔镜下肾脏切除操作时间<60min)与困难组(有血管相关性事件或中转开放,或腔镜下肾脏切除操作时间≥60min)。所有患者术前均行泌尿系平扫+增强CT扫描,并行肾血管三维重建,记录待处理血管操作区内肾动、静脉相关空间解剖特征(包括待处理血管的支数、密集度、空间构型、侧别),以及R.E.N.A.L.评分和PADUA评分。先后应用χ^2检验及logistic多元回归,对与手术难度相关的血管解剖因素进行筛选和分析,根据其相关性并结合临床实际分别加权赋值,初步建立个体化肾血管解剖评分标准。将251例患者根据评分结果分为3个(低、中、高)难度组,分析不同难度组手术难易度的差异。结果本研究普通组160例,困难组91例。两组在性别、年龄、体质指数、瘤体最大径、R.E.N.A.L.评分和PADUA评分方面差异均无统计学意义(P>0.05),在待处理肾血管总支数、变异血管密集度、血管空间构型、侧别方面差异有统计学意义(χ^2值分别为125.700、102.014、97.090、12.603,均P<0.05)。logistic回归分析结果显示待处理肾血管总支数、变异血管密集度、血管空间构型与RLRN手术难易度密切相关(标准化回归系数分别为0.742、0.664、0.324,均P<0.05),侧别与手术难易度的相关性差异无统计学意义(P>0.05)。初步建立可供RLRN手术参考的SIREN。其中,待处理肾�
Objective To explore the clinical feasibility and effectiveness of novel preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy for retroperitoneoscopic radical nephrectomy (RLRN). Methods Two-hundred and fifty one consecutive patients who underwent RLRN for renal tumours from September 2016 to March 2018 were enrolled prospectively, including 154 males (61.4%) and 97 females (38.6%), aged 26 to 84 years with the mean age of 58.7 and mean BMI of 25.8 kg/m^2. The tumors were all isolated with the mean size of 5.4 cm. According to presence or absence of vascular correlation events (VCE) and nephrectomy times under endoscope (NTE), all the cases were divided into two groups: the common group (VCE, NTE <60 min) and the difficult group (no VCE, NTE ≥60 min). With the help of preoperative three-dimensional reconstruction, the specific and crucial arteriovenous anatomical features were recorded, which consist of side, count, spatial configuration and density of the vessel to be processed. After univariable analysis, multivariable analysis with logistic regression was performed for the selected risk factors. Individualized reno-vasculature evaluation for nephrectomy were established, when the value of risk factors were assigned separately according to its correlation and clinical practice. Results There was no statistical significance between common group and difficult group in the aspects of gender, age, BMI, maximum diameter of the tumor, R. E.N.A.L. score and PADUA score. There were statistical significance between common group and difficult group in the aspects of N (number of total vessels), D (vascular anomalies density), C (3D conformation), S (sides) of pending renal vessels (χ^2=125.700, 102.014, 97.090, 12.603, P<0.05). The correlation of N, D, C were closely related (standardized regression coefficient were 0.742, 0.664, 0.324, P<0.05), but S was not significant (P>0.05). SIREN was preliminarily established as a preoperative evaluating tool to achieve accurate
作者
王东文
张彬
原小斌
张旭辉
胡操阳
荆强
吴波
罗艳虹
Wang Dongwen;Zhang Bin;Yuan Xiaobin;Zhang Xuhui;Hu Caoyang;Jing Qiang;Wu Bo;Luo Yanhong(Department of Urology,First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Health Statistics,School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Department of Urology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Shenzhen 518116,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第10期726-731,共6页
Chinese Journal of Urology
关键词
腹腔镜
肾切除术
影响因素
肾血管
评分标准
Laparoscope
Nephrectomy
Influence factor
Renal vascular
Scoring standard
