近似肿瘤实质接触面积与肾部分切除术围手术期参数的相关性分析

李鹏; 杨庆; 陈俊明; 肖成武; 徐斌; 刘冰; 叶华茂; 王林辉; 孙颖浩

doi:10.13201/j.issn.1001-1420.2015.03.007

近似肿瘤实质接触面积与肾部分切除术围手术期参数的相关性分析

- 1第二军医大学长海医院泌尿外科(上海, 200433)

详细信息

通讯作者: 王林辉,E-mail:wlhui@medmail.com.cn

中图分类号: R737.11

收稿日期: 2014-11-20

Correlation between estimated tumor contact surface area and perioperative parameters in partial nephrectomy

- 1 Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China;

More Information

Corresponding author: WANG Linhui, E-mail: wlhui@medmail.com.cn

Received Date: 20 November 2014

摘要

摘要: 目的:探讨近似肿瘤实质接触面积与肾部分切除术围手术期参数的相关性。方法:选择第二军医大学附属长海医院泌尿外科2014年1~7月因肾肿瘤入院并接受肾部分切除术治疗的94例患者为研究对象,根据术前CT或MRI图像,并参照球冠面积公式计算肾肿瘤与肾实质接触面积的近似值(estimated tumor contact surface area, eCSA),以eCSA中位数13 cm²将患者分成≥13 cm²组(n=47)和＜13 cm²组(n=47),比较两组间手术时间、肾缺血时间、术中出血量和术后肾功能等围手术期参数的差异,分析eCSA与肿瘤解剖学R.E.N.A.L.评分、PADUA评分以及上述围手术期参数的相关性。结果:94例患者均顺利完成手术,eCSA≥13 cm²组肿瘤复杂性更高,其肿瘤大小、内生比例、R.E.N.A.L.评分和PADUA评分均高于＜13 cm²组(P＜0.01)。eCSA≥13 cm²组开放手术的比例更高(P＜0.05),其肾缺血时间及术中出血量分别长于、多于＜13 cm²组(P＜0.01),但两组间手术用时、术后并发症发生率无明显差别(P＞0.05),相关分析提示eCSA与肿瘤大小、肿瘤内生程度、R.E.N.A.L.评分、PADUA评分、肾脏缺血时间、术中出血量以及术后肾功能下降幅度均显著相关(P＜0.01)。结论:以近似肿瘤实质接触面积作为参数能够客观地评价肾肿瘤的复杂性。该指标与肾部分切除术的缺血时间、手术出血量以及术后肾功能下降幅度均密切相关,可作为上述围手术期参数的预测因素,其临床应用价值有待进一步研究验证。
- 前列腺肿瘤 /
- 胃肠道外间质瘤
Abstract: Objective:To explore the impact of estimated tumor contact area (eCSA) on the clinical parameters in nephron-sparing surgery.Method:The relationship between the perioperative parameters and eCSA, which is calculated by the spherical cap's surface area formula, were retrospectively analyzed by reviewing the clinical data of 94 patients. All cases underwent partial nephrectomy for renal tumors from January 2014 to July 2014 at the department of urology of Changhai Hospital. The operation time, renal ischemic time, estimated blood loss and postoperative renal function were compared between one group whose eCSA≥13 cm² and the other group whose eCSA＜13 cm². The correlations between eCSA and perioperative parameters, R.E.N.A.L. score and PADUA score were tested by statistical method. Result:All of the partial nephrectomies were successfully conducted in the 94 patients. The tumors were more complex in one group whose eCSA≥13 cm² (n=47) with larger tumor size, more endophytic ratio, and higher R.E.N.A.L. score or PADUA score compared with the other group whose eCSA ＜13 cm² (n=47, P＜0.01). More open surgery (P＜0.05), renal ischemia time (P＜0.01) and estimated blood loss (P＜0.01) were observed in one group whose eCSA≥13 cm² than those in the other group whose eCSA ＜13 cm², while there were no significant differences in operative time and complication incidence between the two groups (P＞0.05). And Spearman correlation analysis showed eCSA was closely related to tumor size, endophytic character, R.E.N.A.L. score, PADUA score, ischemia time, estimated blood loss and postoperative renal function decline (P＜0.01).Conclusion:The eCSA, which could be an objective index for describing the complexity character of the renal tumor, is correlated with ischemia time, estimated blood loss and postoperative renal function decline in partial nephrectomy. And its clinical value as a predictor of those perioperative parameters should be verified in future studies.
- renal tumor /
- partial nephrectomy

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