基于CT的R.E.N.A.L评分联合MAP评分对后腹腔镜肾部分切除术中热缺血时间的影响分析

Effect Analysis of CT-Based R.E.N.A.L Score Combined with MAP Score on Warm Ischemia Time in Retroperitoneal Laparoscopic Partial Nephrectomy

摘要: 目的：探讨基于CT的R.E.N.A.L评分联合MAP评分对后腹腔镜肾部分切除术中热缺血时间的影响分析。方法：选择我院2018年至2020年度86例腹腔镜下肾部分切除的肾脏占位患者进行病例回顾分析，收集患者临床及影像资料，通过CT患者术前肾周脂肪及相关因素(位置、大小、外生/内生、腹侧/背侧、距肾门距离)进行统计测量，然后分析，并对患者术后肿块的病理类型(WHO分级)进行统计，分析不同类型肾脏占位肾周脂肪情况及肿块情况，查找其结果与患者一般情况、手术方式、手术时间及肾脏缺血时间等结果的相关性。结果：不同等级的R.E.N.A.L评分间的手术时间和热缺血时间存在显著性差异(F (2, 83) = 4.249, p = 0.018 < 0.05, F (2, 83) = 14.960, p = 0.000 < 0.001)。不同等级的MAP评分间的手术时间和热缺血时间存在显著性差异(F (2,83) = 3.897, p = 0.024 < 0.05, F (2,83) = 6.157, p = 0.003 < 0.001)。结论：通过术前分析肾周脂肪黏度及其相关影响因素(如：位置、大小、外生/内生、腹侧/背侧、距肾门距离)等，能够指导临床对于临床不同类型肾脏占位制定合理的手术方案，预测手术时间及热缺血时间，并对术后肾功能的恢复有一定的指导意义。

Abstract: Objective: To investigate the effect of CT-based R.E.N.A.L score combined with MAP score on warm ischemia time in retroperitoneal laparoscopic partial nephrectomy. Methods: 86 cases of renal space occupying patients undergoing laparoscopic partial nephrectomy in our hospital from 2018 to 2020 were selected for case retrospective analysis. The clinical and imaging data of the patients were collected. The preoperative perirenal fat and related factors (location, size, exoge-nous/endogenous, ventral/dorsal, distance from the hilum) of CT patients were statistically meas-ured, and then analyzed, and the pathological types (WHO classification) of postoperative masses were statistically analyzed, the perirenal fat and mass of different types of renal space occupying were analyzed to find out the correlation between the results and the general situation of patients, operation mode, operation time and renal ischemia time. Results: There were significant differ-ences in operation time and warm ischemia time between different grades of R.E.N.A.L scores (F (2, 83) = 4.249, p = 0.018 < 0.05, F (2, 83) = 14.960, p = 0.000 < 0.001). There were significant differ-ences in operation time and warm ischemia time between different grades of MAP scores (F (2, 83) = 3.897, p = 0.024 < 0.05, F (2, 83) = 6.157, p = 0.003 < 0.001). Conclusion: Preoperative analysis of perirenal fat viscosity and its related influencing factors (such as location, size, exoge-nous/endogenous, ventral/dorsal, distance from hilum) can guide clinical practice, formulate rea-sonable operation plans for different types of renal space occupying, predict operation time and warm ischemia time, and have certain guiding significance for the recovery of postoperative renal function.