| 摘要: |
| 目的 探讨肾周脂肪梅奥粘连概率（MAP）评分在机器人辅助腹腔镜肾部分切除术（RAPN）术前评估中的临床意义。方法 回顾性分析2016年10月至2018年10月海军军医大学（第二军医大学）长征医院由同一术者行RAPN的229例T1aN0M0期肾肿瘤患者资料。患者年龄为（53.14±11.84）岁；男145例，女84例；左侧肾肿瘤122例，右侧肾肿瘤107例；术前估算的肾小球滤过率（eGFR）为（100.24±24.35）mL/（min·1.73 m2）。根据MAP评分将患者分为MAP低分（≤ 3分）组175例和MAP高分（>3分）组54例，比较两组之间临床资料的差异。结果 229例患者RAPN手术均顺利完成，无术中转为根治性肾切除术或开放手术者。手术时间为（140.57±41.05）min，术中出血量为（98.56±65.38）mL，总输血率为7.9%（18/229），术后住院时间为（6.41±2.39）d。4例患者未阻断肾动脉，13例患者为选择性分支动脉阻断，其余患者均为肾动脉主干阻断，肾脏热缺血时间为（17.73±7.91）min。13例Clavien-Dindo分级Ⅱ级的患者围手术期进行输血治疗，4例患者因术后出血行数字减影血管造影栓塞止血，1例因出血而再次急诊手术行根治性肾切除术，所有患者经治疗后均平稳出院。术后随访1年，均未见肿瘤复发或转移。末次随访时eGFR为（94.40±22.63）mL/（min·1.73 m2），与术前相比差异有统计学意义（P=0.001）。与MAP低分组患者比较，MAP高分组患者手术时间较长[（152.51±39.53）min vs（136.91±41.15）min，P=0.015]，术中出血量较多[（123.11±93.15）mL vs（94.75±59.89）mL，P=0.029]，并发症Clavien-Dindo分级较高[Ⅰ级45例（83.3%）、Ⅱ级8例（14.8%）、Ⅲ级1例（1.9%）vs Ⅰ级165例（94.3%）、Ⅱ级7例（4.0%）、Ⅲ级3例（1.7%），P=0.019]，术后住院时间较长[（7.04±3.32）d vs（6.21±2.01）d，P=0.027]。结论 MAP评分能提前评估RAPN术中肾脏和肿瘤游离时间延长、出血量增加的风险，指导临床医师术前做好手术规划。 |
| 关键词: 肾肿瘤 梅奥粘连概率评分 机器人手术 腹腔镜技术 肾部分切除术 |
| DOI：10.16781/j.0258-879x.2020.07.0709 |
| 投稿时间：2019-11-20修订日期：2020-02-13 |
| 基金项目: |
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| Application of Mayo adhesive probability score in robot-assisted laparoscopic partial nephrectomy |
| WANG Jian-chao1△,LI Ming-min2△,WU Zhen-jie1,ZHANG Zong-qin1,BAO Yi1,LIU Bing1,WANG Lin-hui1* |
(1. Department of Urology, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Department of Radiology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the clinical value of Mayo adhesive probability (MAP) score in the preoperative evaluation of robot-assisted laparoscopic partial nephrectomy (RAPN). Methods The clinical data of 229 patients with T1aN0M0 renal tumor who received RAPN by the same surgeon in Changzheng Hospital of Naval Medical University (Second Military Medical University) from Oct. 2016 to Oct. 2018 were retrospectively analyzed. There were 145 males and 84 females, with an average age of (53.14±11.84) years, including 122 cases of left renal tumor and 107 cases of right renal tumor. The preoperative estimated glomerular filtration rate (eGFR) was (100.24±24.35) mL/(min·1.73 m2). The patients were divided into two groups according to the MAP score:low-MAP group (MAP score ≤ 3, n=175) and high-MAP group (MAP score>3, n=54). The clinical data were compared between the two groups. Results The RAPN was successfully performed in all the 229 patients, with no intraoperative conversion to radical nephrectomy or open surgery. The operation time was (140.57±41.05) min, the intraoperative blood loss was (98.56±65.38) mL, the total transfusion rate was 7.9% (18/229), and the postoperative hospital stay was (6.41±2.39) days. Four patients had no renal artery blocking, 13 patients had selective branch artery blocking, and the rest patients had main renal artery blocking. The warm ischemia time of kidney was (17.73±7.91) min. Thirteen patients with Clavien-Dindo classification grade Ⅱ received perioperative blood transfusion therapy, four patients received digital subtraction angiography embolization for hemostasis due to postoperative hemorrhage, and one patient underwent emergency radical nephrectomy due to hemorrhage. All patients were discharged uneventfully after treatment. During a 1-year follow-up, no tumor recurrence or metastasis was found. The eGFR at the latest follow-up was (94.40±22.63) mL/(min·1.73 m2), significantly different from preoperation (P=0.001). Compared with the low-MAP group, the high-MAP group had significantly longer operation time ([152.51±39.53] min vs [136.91±41.15] min, P=0.015), more intraoperative blood loss ([123.11±93.15] mL vs [94.75±59.89] mL, P=0.029), higher Clavien-Dindo classification (45 cases [83.3%] in grade Ⅰ, eight [14.8%] in grade Ⅱ and one [1.9%] in grade Ⅲ vs 165 [94.3%] in grade Ⅰ, seven [4.0%] in grade Ⅱ and three [1.7%] in grade Ⅲ, P=0.019), and longer postoperative hospital stay ([7.04±3.32) d vs [6.21±2.01] d, P=0.027). Conclusion MAP score can be used to evaluate the risk of prolonged kidney and tumor dissociation time and increased bleeding in RAPN in advance, guiding clinicians to make better preoperative surgical plan. |
| Key words: kidney neoplasms Mayo adhesive probability score robotic surgical procedures laparoscopy partial nephrectomy |
