Effect Of CT Based R.E.N.A.L Score Combined With MAP Score On Warm Ischemia Time In Retroperitoneal Laparoscopic Partial Nephrectomy

Objective: To investigate the effect of CT based renal score combined with map score on warm ischemia time in retroperitoneal laparoscopic partial nephrectomy.Methods:143 cases of renal occupying patients undergoing laparoscopic partial nephrectomy in our hospital from 2018 to 2020 were selected for case retrospective analysis.The detail clinical and imaging data of 143 patients were collected.The preoperative perirenal fat and related factors(location,size,exogenous / endogenous,ventral / dorsal,distance from the hilum)of CT patients were statistically measured,and then analyzed,and the pathological types(WHO classification)of postoperative masses were statistically analyzed,the R.E.N.A.L score was used to evaluate the operation method and degree of difficulty,whether to perform radical nephrectomy or partial nephrectomy,whether to perform open or laparoscopic surgery.To analyze the perirenal fat and mass in different types of renal space occupying lesions,and to find out the correlation between the results and the general conditions of patients,operation methods,operation time and renal ischemia time.Results: There were significant differences in operation time and warm ischemia time between different grades of R.E.N.A.L scores(f(2,83)=4.249,p=0.018<0.05,f(2,83)=14.960,p=0.000<0.001).There was no significant difference between the operation time of R.E.N.A.L score grade 1 and R.E.N.A.L score grade 2(p=0.607>0.05).There was a significant difference between the operation time of R.E.N.A.L score grade 1 and R.E.N.A.L score grade 3(p=0.014<0.05),that is,the operation time of R.E.N.A.L score grade 1 was significantly shorter than that of R.E.N.A.L score grade 3;There was a significant difference between the operation time of R.E.N.A.L score grade 2 and R.E.N.A.L score grade 3(p=0.048<0.05),that is,the operation time of R.E.N.A.L score grade 2 was significantly shorter than that of R.E.N.A.L score grade 3.In terms of warm ischemia time,there was a significant difference(p>0.05)between the warm ischemia time of R.E.N.A.L score grade 1,R.E.N.A.L score grade 2(p=0.000<0.001)and R.E.N.A.L score grade 3(p=0.000<0.001),that is,the warm ischemia time of R.E.N.A.L score grade 1 was significantly shorter than that of R.E.N.A.L score grade 2and R.E.N.A.L score grade 2;R.There was no significant difference between the warm ischemia time of R.E.N.A.L score grade 2 and R.E.N.A.L score grade 3(p=0.846>0.05).In addition,the operation time of laparoscopic partial resection was significantly correlated with the warm ischemia time(p<0.01),and the operation time was positively correlated with the warm ischemia time(the correlation coefficient was 0.334).Finally,there were significant differences in the operation time and warm ischemia time between different grades of map scores(f(2,83)=3.897,p=0.024<0.05,f(2,83)=6.157,p=0.003<0.001).There was a significant difference between the operation time of map score grade 2 and that of map score grade 3(p=0.006<0.01),that is,the operation time of map score grade 2 was significantly shorter than that of map score grade 3.Conclusion: preoperative analysis of perirenal fat viscosity and its related influencing factors(such as location,size,exogenous / endogenous,ventral / dorsal,distance from hilum)can guide clinical practice,formulate reasonable operation plans for different types of renal space occupying,predict operation time and warm ischemia time,and have certain guiding significance for the recovery of postoperative renal function.