中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2014年
10期
734-738
,共5页
刘勇%姜德田%毛昕%钟修龙%王洪%纪建磊%宋树欣
劉勇%薑德田%毛昕%鐘脩龍%王洪%紀建磊%宋樹訢
류용%강덕전%모흔%종수룡%왕홍%기건뢰%송수흔
肾肿瘤%术前解剖特征分类评分系统%保留肾单位手术
腎腫瘤%術前解剖特徵分類評分繫統%保留腎單位手術
신종류%술전해부특정분류평분계통%보류신단위수술
Kidney neoplasms%Preoperative aspects and dimensions used for an anatomical%Nephron-sparing surgery
目的 探讨术前解剖特征分类(preoperative aspects and dimensions used for an anatomical,PADUA)评分系统在T1期肾肿瘤术式选择中的应用价值. 方法 回顾性分析2010年1月至2012年12月122例行手术治疗的T1期肾肿瘤患者的临床资料.男84例,女38例.年龄21～81岁,平均51岁.体质指数(22.8±3.9) kg/m2.肿瘤位于左肾63例,右肾59例;直径为(3.6±1.3)cm.T1a期78例,T1b期44例.行保留肾单位手术77例,根治性肾切除术45例.T1a期患者中行保留肾单位手术56例,根治性肾切除术22例;T1b期行保留肾单位手术21例,根治性肾切除术23例.将患者术前CT检查的肾解剖学特征行PADUA系统评分,分析其与术式的关系. 结果 本组122例的PADUA评分低、中、高度复杂肿瘤分别为24、62、36例.在PADUA评分低、中、高复杂程度中根治性肾切除术例数分别为2例(8.3％)、19例(30.6％)、24例(66.7％),保留肾单位手术例数分别为22例(91.7％)、43例(69.4％)、12例(33.3％).77例保留肾单位手术中,PADUA评分低、中、高复杂程度的腹腔镜下手术分别为18、25、2例,开放手术分别为4、18、10例.不同PADUA评分程度下的保留肾单位手术和根治行肾切除术例数(x2 =23.16,P＜0.01)及开放式和腹腔镜下保留肾单位手术例数(x2=13.57,P＜0.01)比较差异均有统计学意义.PADUA评分中的肿瘤直径(HR=2.79;95％ CI,1.29 ～6.02;P＜0.01)、外凸率(HR=3.82;95％CI,1.77～8.09;P＜0.01)、沿纵轴位置(HR=4.00; 95％ CI,1.83～8.72;P＜0.01)、与集合系统关系(HR=15.11;95％ CI,5.95 ～ 38.35;P＜0.01)、与肾窦关系(HR=103.13;95％ CI,21.85 ～486.81;P＜0.01)、内外侧(HR=3.50;95％CI,1.61～7.59;P＜0.01)均与术式有相关性,其中肿瘤与肾窦关系的相关系数最高(r-0.70). 结论 PADUA评分系统对指导T1期肾肿瘤手术方式的选择有重要意义,低度复杂肿瘤首选保留肾单位手术,中度复杂肿瘤应尽可能行保留肾单位手术,但要结合单项解剖学特征进行个体化选择,高度复杂肿瘤应选择根治性肾切除术.
目的 探討術前解剖特徵分類(preoperative aspects and dimensions used for an anatomical,PADUA)評分繫統在T1期腎腫瘤術式選擇中的應用價值. 方法 迴顧性分析2010年1月至2012年12月122例行手術治療的T1期腎腫瘤患者的臨床資料.男84例,女38例.年齡21～81歲,平均51歲.體質指數(22.8±3.9) kg/m2.腫瘤位于左腎63例,右腎59例;直徑為(3.6±1.3)cm.T1a期78例,T1b期44例.行保留腎單位手術77例,根治性腎切除術45例.T1a期患者中行保留腎單位手術56例,根治性腎切除術22例;T1b期行保留腎單位手術21例,根治性腎切除術23例.將患者術前CT檢查的腎解剖學特徵行PADUA繫統評分,分析其與術式的關繫. 結果 本組122例的PADUA評分低、中、高度複雜腫瘤分彆為24、62、36例.在PADUA評分低、中、高複雜程度中根治性腎切除術例數分彆為2例(8.3％)、19例(30.6％)、24例(66.7％),保留腎單位手術例數分彆為22例(91.7％)、43例(69.4％)、12例(33.3％).77例保留腎單位手術中,PADUA評分低、中、高複雜程度的腹腔鏡下手術分彆為18、25、2例,開放手術分彆為4、18、10例.不同PADUA評分程度下的保留腎單位手術和根治行腎切除術例數(x2 =23.16,P＜0.01)及開放式和腹腔鏡下保留腎單位手術例數(x2=13.57,P＜0.01)比較差異均有統計學意義.PADUA評分中的腫瘤直徑(HR=2.79;95％ CI,1.29 ～6.02;P＜0.01)、外凸率(HR=3.82;95％CI,1.77～8.09;P＜0.01)、沿縱軸位置(HR=4.00; 95％ CI,1.83～8.72;P＜0.01)、與集閤繫統關繫(HR=15.11;95％ CI,5.95 ～ 38.35;P＜0.01)、與腎竇關繫(HR=103.13;95％ CI,21.85 ～486.81;P＜0.01)、內外側(HR=3.50;95％CI,1.61～7.59;P＜0.01)均與術式有相關性,其中腫瘤與腎竇關繫的相關繫數最高(r-0.70). 結論 PADUA評分繫統對指導T1期腎腫瘤手術方式的選擇有重要意義,低度複雜腫瘤首選保留腎單位手術,中度複雜腫瘤應儘可能行保留腎單位手術,但要結閤單項解剖學特徵進行箇體化選擇,高度複雜腫瘤應選擇根治性腎切除術.
목적 탐토술전해부특정분류(preoperative aspects and dimensions used for an anatomical,PADUA)평분계통재T1기신종류술식선택중적응용개치. 방법 회고성분석2010년1월지2012년12월122례행수술치료적T1기신종류환자적림상자료.남84례,녀38례.년령21～81세,평균51세.체질지수(22.8±3.9) kg/m2.종류위우좌신63례,우신59례;직경위(3.6±1.3)cm.T1a기78례,T1b기44례.행보류신단위수술77례,근치성신절제술45례.T1a기환자중행보류신단위수술56례,근치성신절제술22례;T1b기행보류신단위수술21례,근치성신절제술23례.장환자술전CT검사적신해부학특정행PADUA계통평분,분석기여술식적관계. 결과 본조122례적PADUA평분저、중、고도복잡종류분별위24、62、36례.재PADUA평분저、중、고복잡정도중근치성신절제술례수분별위2례(8.3％)、19례(30.6％)、24례(66.7％),보류신단위수술례수분별위22례(91.7％)、43례(69.4％)、12례(33.3％).77례보류신단위수술중,PADUA평분저、중、고복잡정도적복강경하수술분별위18、25、2례,개방수술분별위4、18、10례.불동PADUA평분정도하적보류신단위수술화근치행신절제술례수(x2 =23.16,P＜0.01)급개방식화복강경하보류신단위수술례수(x2=13.57,P＜0.01)비교차이균유통계학의의.PADUA평분중적종류직경(HR=2.79;95％ CI,1.29 ～6.02;P＜0.01)、외철솔(HR=3.82;95％CI,1.77～8.09;P＜0.01)、연종축위치(HR=4.00; 95％ CI,1.83～8.72;P＜0.01)、여집합계통관계(HR=15.11;95％ CI,5.95 ～ 38.35;P＜0.01)、여신두관계(HR=103.13;95％ CI,21.85 ～486.81;P＜0.01)、내외측(HR=3.50;95％CI,1.61～7.59;P＜0.01)균여술식유상관성,기중종류여신두관계적상관계수최고(r-0.70). 결론 PADUA평분계통대지도T1기신종류수술방식적선택유중요의의,저도복잡종류수선보류신단위수술,중도복잡종류응진가능행보류신단위수술,단요결합단항해부학특정진행개체화선택,고도복잡종류응선택근치성신절제술.
Objective To evaluate the efficacy of preoperative aspects and dimensions used for an anatomical (PADUA) scores in determining the surgical approach for T1 stage renal masses.Methods From Jan 2010 to Dec 2012,clinical data of 122 cases (76 males and 46 females),who underwent surgery for T1 stage renal masses,were collected retrospectively.The mean age was 51 years(range 21-81) and mean body mass index was (22.8±3.9) kg/m2.Sixty-three tumors were found in left kidney and 59 in right kidney.Among them,78 patients were diagnosed as T1a stage and 44 patients were T1b stage.In patients with T1a stage,56 received nephron sparing surgery (NSS) and 22 received radical nephrectomy (RN).In patients with T1b stage,21 received NSS and 23 received RN.The PADUA nephrometry score was analyzed to evaluate their relationships to surgical type and the approach of NSS.Results According to the PADUA nephrometry score,the number of low risk,middle risk and high risk patients were 24,62,26,respectively.Inlow risk group,middle risk group and high risk group,the proportion of RN and NSS was 8.3％/ 91.7％,30.6％/69.4％,66.7％/33.3％.In 77 patients received NSS,the unmber of laparoscopic NSS and open NSS was 18 ∶ 4,25 ∶ 18,2 ∶ 10,respectively.The PADUA nephrometry score was significantly associated with the type of surgery (x2 =23.16,P＜0.01),and the NSS approach (x2 =13.57,P＜0.01).Tumor size (HR =2.79 ; 95％ CI,1.29-6.02 ; P＜ 0.01),percentage of tumor deepening into the kidney (HR =3.82; 95％CI,1.77-8.09; P＜0.01),longitudinal (HR=4.00;95％CI,1.83-8.72; P＜0.01),tumor relationships with renal sinus(HR=103.13; 95％CI,21.85-486.81 ; P＜0.01),tumor relationships with urinary collecting system (HR =15.11 ; 95％ CI,5.95-38.35 ; P＜ 0.01),rim tumor location (HR =3.50 ; 95％ CI,1.61-7.59; P＜0.01) were closely related with surgery approach.The correlation coefficients of relationship with renal sinus was highest (r=0.70).Conclusions The PADUA nephrometry score provides a simple,useful and stable system to character the salient renal anatomy and guide the surgery.Low risk group should consider the NSS as the first line therapy.NSS could also be chosen in the middle risk group.However,the renal anatomy in those patients should be referred.RN should be chosen in high risk group.
