基于CT三维重组技术的R.E.N.A.L.评分在腹腔镜肾部分切除术中的应用研究

Application Research of R.E.N.A.L. Score Based on CT Three-Dimensional Reconstruction Technology in Laparoscopic Partial Nephrectomy

摘要: 目的：探讨基于CT三维重组技术的R.E.N.A.L.评分系统在腹腔镜肾部分切除术中的临床应用价值。方法：搜集我院2020年6月至2024年1月经手术治疗的79例肾肿瘤患者的临床及术前影像资料，根据术前肾脏CT三维重组结果，分析血管变异与肾脏热缺血时间、手术总时间、术中出血量及术后并发症之间的关系，并进行R.E.N.A.L.评分。采用Logistic回归筛选出肾热缺血时间大于20 min的独立危险因素。结果：有无血管变异在肾脏热缺血时间、手术总时间、术中出血量及术后并发症之间无明显差异(P > 0.05)。R.E.N.A.L.总评分是肾热缺血时间大于20 min的独立危险因素(P < 0.05)，R.E.N.A.L.总评分分组每升高一级，肾脏热缺血时间大于20 min的可能性提高约21.7倍。R.E.N.A.L.评分系统具有很好的稳定性(P < 0.05)。结论：CT三维重组能在术前清晰地了解到肾脏、肿瘤及血管的解剖位置，从而可以减少围手术期并发症的发生。

Abstract: Objective: To explore the clinical application value of R.E.N.A.L. scoring system based on CT three-dimensional reconstruction technology in laparoscopic partial nephrectomy. Methods: The clinical and preoperative imaging data of 79 patients with renal tumors who underwent surgical treatment in our hospital from June 2020 to January 2024 were collected. According to the results of preoperative renal CT three-dimensional reconstruction, the relationship between vascular variation and renal warm ischemia time, total operation time, intraoperative bleeding and postoperative complications was analyzed, and R.E.N.A.L. score was performed. Logistic regression was used to screen out independent risk factors for renal warm ischemia time greater than 20 min. Results: There was no significant difference in renal warm ischemia time, total operation time, intraoperative blood loss and postoperative complications between the presence or absence of vascular variation (P > 0.05). The total R.E.N.A.L. score was an independent risk factor for renal warm ischemia time greater than 20 min (P < 0.05). The possibility of renal warm ischemia time greater than 20 min increased by about 21.7 times with each increase in the total R.E.N.A.L. score. The R.E.N.A.L. scoring system has good stability (P < 0.05). Conclusion: CT three-dimensional reconstruction can clearly understand the anatomical location of the kidney, tumor and blood vessels before surgery, thereby reducing the occurrence of perioperative complications.