【摘要】：目的:討論R.E.N.A.L評分系統(tǒng)和保留腎單位手術(shù)(NSS)的相關問題之間的關系。方法:采用回顧性分析的方法,納入130例行NSS的腎腫瘤(Kindney Neoplasm,KD)患者的臨床資料,行該類評分,討論手術(shù)方式、熱缺血時間、出血量、手術(shù)時間、手術(shù)并發(fā)癥與該類評分之間的關系,并行統(tǒng)計學的分析。結(jié)果:按該類評分系統(tǒng),低、中、高度復雜組分別有62(47.7%)、58(44.6%)、10(7.7%)例,行腹腔鏡腎部分切除術(shù)的例數(shù)分別為:59例(95.1%)、26例(44.8%)、2例(20%),不同評分患者在手術(shù)方式上存在顯著差異(P0.05)。按評分高低進行分層分析,行腹腔鏡輔助下腎部分切除術(shù)的低、中度復雜腫瘤的熱缺血時間平均為(18.6±5.8)min、(23.0±5.9)min,出血量的中位數(shù)分別為20m L、50m L,熱缺血時間及出血量均隨評分增加而增加,有統(tǒng)計學的差異(P0.05)。在開放腎部分切除術(shù)組中,不同評分類型的患者的熱缺血時間、手術(shù)時間、術(shù)中出血量上的差異有統(tǒng)計學意義(P0.05)。兩個手術(shù)組發(fā)生并發(fā)癥的例術(shù)上與該類評分的高低并沒有統(tǒng)計學上的差異(P0.05)。單因素分析NSS圍手術(shù)期并發(fā)癥的影響因素的結(jié)果提示:R.E.N.A.L評分越高、采用開放性保留腎單位手術(shù)、熱缺血時間及手術(shù)時間越長以及術(shù)中出血量越多都會使并發(fā)癥發(fā)生的幾率增加(P0.05)。結(jié)論:R.E.N.A.l評分系統(tǒng)能客觀地、有效地評估腎腫瘤的解剖學復雜程度,在一定程度上預估手術(shù)的難度和風險,從而對腎腫瘤治療策略的選擇起到指導作用。
[Abstract]:Objective: to discuss the relationship between R.E.N.A.L scoring system and (NSS) in nephron sparing surgery. Methods: the clinical data of 130 patients with Kindney NeoplasmKD (Kindney NeoplasmKD) who were treated with NSS were retrospectively analyzed, and the clinical data were evaluated. The operative methods, the time of hot ischemia, the amount of bleeding and the time of operation were discussed. The relationship between surgical complications and the score was analyzed statistically. Results: according to this kind of scoring system, there were 62 cases (47.7%), 58 cases (44.6%) and 10 cases (7.7%) in the low, middle and high complex group respectively, and the number of cases of laparoscopic partial nephrectomy were 59 cases (95.1%), 26 cases (44.8%) and 2 cases (20%), respectively. There were significant differences in the operation methods among the patients with different scores (P0.05). According to the grading, the mean warm ischemic time of laparoscopic assisted partial nephrectomy was (18.6 鹵5.8) min, () 23.0 鹵5.9 min, the median of bleeding was 20ml / L (50 mL), the time of hot ischemia and the amount of bleeding increased with the increase of score. There was statistical difference (P0.05). In the open partial nephrectomy group, there were significant differences in warm ischemia time, operation time and intraoperative bleeding volume among patients with different scoring types (P0.05). There was no statistical difference between the complications of the two groups and the score (P0.05). Univariate analysis showed that the higher the score of NSS perioperative complications was, the higher the score was, the longer the warm ischemia time, the longer the operation time and the more blood loss, the higher the probability of complications (P0.05). Conclusion the system can objectively and effectively evaluate the anatomical complexity of renal tumors and predict the difficulty and risk of surgery to a certain extent, and thus play a guiding role in the choice of treatment strategies for renal tumors.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.11

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