The Application Of CT Three-dimensional Reconstruction Combined With R.E.N.A.L. Score In Retroperitoneoscopic Nephron Sparing Surgery Of Renal Tumor

Objective:To investigate the clinical application value of CT three-dimensional reconstruction combined with R.E.N.A.L.score in retroperitoneoscopic renal nephron nephrectomy and analyze the predictive significance of three-dimensional reconstruction of CT in surgical planning and perioperative outcomes.Methods:To collect and analyze 64 patients with clinical stage T1(cT1)renal tumors from June 2015 to March 2018,including 50 male patients(78%)and 14 female patients(22%),aged 36-68 years old,mean(52 ± 9)years old,31 cases(48%)on the left side,33 cases(52%)on the right side,Sixty-four patients were divided into two groups.32 cases were preoperatively classified as 3D groups by 3D reconstruction of CT images,and 32 cases were 2D groups of multi-slice CT examinations before surgery.All patients received preoperative R.E.N.A.L.scores,and partial nephrectomy under laparoscopy.The differences in clinical parameters such as general clinical data and surgical parameters before surgery were compared between the two groups.Results:The three-dimensional CT reconstruction of the tumor images acquired by multi-slice CT showed that the images of renal tumors in 32 patients were more clear and the anatomical structure was more obvious.Sixty-four patients underwent successful retroperitoneal nephrolithotomy under a retroperitoneal approach.No deaths occurred and surgery was required during open surgery.Urinary leakage occurred in 3 cases in the 2D group,and no urinary leakage occurred in the 3D group.Pathological results 39 cases of clear cell carcinoma(61%),papillary carcinoma in 14 cases(22%),chromophobe in 4 cases(6%),eosinophil adenoma in 2 cases(3%),vascular smooth muscle tumor 5 Example(8%).Intraoperative blood loss,postoperative complications,postoperative renal function changes,operation time and ischemic time were not statistically significant.However,further analysis was performed on patients with RENAL ≥ 7 complicated tumors.The operative time of the 3D and 2D groups were mean ± SD(130.7 ± 34.4 min/158.8 ± 32.7 min,P <0.05)and the number of patients with postoperative urinary leakage(0 and 3,0% and 9.4%,respectively).Significant reduction in the 3D group.Conclusion:Three-dimensional CT reconstruction provides accurate information on the anatomy of the tumor before surgery and is reliable for guiding surgical planning and surgical design.The results of this study show that three-dimensional CT reconstruction has clear,stereoscopic,and intuitive anatomical images,which is conducive to accurately guide the surgeon to completely remove the tumor in LPN,and has guiding significance for the operation of complex renal tumors.