梅奥粘连概率评分对T1期肾癌患者外科治疗的指导效果研究

Effect of Mayo adhesive probability score on surgical treatment of patients with stage T1 renal carcinoma

摘要:

目的 探讨肾周脂肪梅奥粘连概率（MAP）评分对T₁期肾癌患者外科治疗的指导效果。方法 回顾性分析2014年1月－2018年12月该院收治的200例T₁期肾癌患者的临床资料，依据肿瘤切除术式进行分组。其中，A组行经腹腔开腹部分肾切除术（OPN）（n = 49）、B组行腹腔镜部分肾切除术（LPN）（n = 67）、C组行开放性肾癌根治术（ORN）（n = 33）、D组行腹腔镜根治性肾切除术（LRN）（n = 51）。按照MAP评分标准将各组进行亚分组：MAP低度组（0～1分）、MAP中度组（2～3分）和MAP高度组（4～5分）。分析MAP评分系统与肾切除术式的关系，并评估围术期不同术式组MAP评分与手术时间、术中出血量、术后并发症的相关性。结果 A组和C组患者中，MAP低度组、中度组、重度组的手术时间、术中出血量比较，差异无统计学意义（P > 0.05）；MAP低度组的术后并发症发生率低于中度组和高度组，中度组低于高度组，差异有统计学意义（P < 0.05）；B组和D组患者中，MAP低度组手术时间短于中度组和重度组、术中出血量少于中度组和重度组、术后并发症发生率低于中度组和重度组，且中度组低于重度组，差异有统计学意义（P < 0.05）。B组和D组影像学MAP评分与手术时间、术中出血量、术后并发症呈正相关（P < 0.05）。结论 MAP评分可有效指导T₁期肾癌切除术式的选择，MAP评分低度和中度患者可选择腹腔镜手术，MAP评分高度患者可选择开放性手术，且MAP评分可用于评估LPN及LRN的围手术期相关临床指标。

Abstract:

Objective To analyze the effect of perirenal fat Mayo adhesive probability (MAP) score on surgical treatment of patients with T₁ renal carcinoma.Methods The clinical data of 200 patients with T₁ renal carcinoma from January 2014 to December 2018 were retrospectively analyzed. 200 patients were divided according to tumor resection. Group A (open partial nephrectomy, n = 49), group B (laparoscopic partial nephrectomy, n = 67), group C (open radical nephrectomy, n = 33) and group D (laparoscopic radical nephrectomy, n = 51). Each group was divided into subgroups according to MAP scoring criteria: MAP mild group (0~1 points), MAP moderate group (2~3 points) and MAP severe group (4~5 points). To analyze the relationship between MAP scoring system and nephrectomy, and evaluate whether there is any correlation between MAP scores of different surgical groups and operation time, intraoperative blood loss and postoperative complications.Results There were no significant differences of operative time and intraoperative blood loss between group A and group C in the MAP score mild, moderate, and severe group (P > 0.05). In group A and group C, the incidence of postoperative complications in mild group was lower than that in moderate group and severe group, and the mild group was lower than that in moderate group, the difference were statistically significant (P < 0.05). In group B and group D, the operative time in MAP mild group was shorter than that in moderate group and severe group, intraoperative blood loss less than that in moderate group and severe group, and postoperative complication rate lower than that in moderate group and severe group, and the moderate group were lower than those in severe group, the difference were statistically significant (P < 0.05). The imaging MAP scores of group B and group D were positively correlated with operative time, intraoperative blood loss, and postoperative complications (P < 0.05).Conclusion MAP score can effectively guide the choice of surgical methods for nephrectomy. Laparoscopic surgery can be selected for patients with low and moderate MAP score, open surgery can be selected for patients with high MAP score, and MAP score can be used to evaluate the clinical indicators of LPN and LRN.