| Objective: To investigate the clinical value of modified-R.E.N.A.L. nephrometry score in renal neoplasm operation.Methods: To improve the deficiency of R.N.E.A.L. nephrometry score, a modified nephrometry score was carried out. Then clinical data of 122 patients with renal tumor had been analyzed from Oct. 2010 to Dec. 2014, retrospectively. Two urologists scored the CT of renal tumor based on the modified-R.E.N.A.L nephrometry score, and one of them repeated after two weeks. After that, the feasibility of the modified-R.E.N.A.L. nephrometry score was analyzed, including stability and the association with the choice of surgery pattern. Subsequently the value of modified and original nephrometry score system was compared on the operative difficulty in nephron sparing surgery. Finally, the effect of modified-R.E.N.A.L. nephrometry score were analyzed to predict prei-operative conditions on laparoscopic nephron sparing surgery.Results: 1. The Kappa of radius, exophytic / endophytic, nearness to sinus and collecting system, location in relation to polar lines, anterior/posterior, renal artery, relation with renal artery/vein and the sum of components in the same person were 0.876, 0.541, 0.633, 0.680, 0.812, 0.560, 0.757, 0.827, 0.772, respectively; the Kendall in different ones are 0.886, 0.537, 0.430, 0.449, 0.772, 0.202, 0.440, 0.731, 0.681, respectively. 2. The patients who underwent laparoscopic radical nephrectomy, open radical nephrectomy, laparoscopic partial nephrectomy, and open partial nephrectomy were 51, 28, 39 and 4, respectively. Average score of modified-R.E.N.A.L. nephrometry in the four operation types were 13.57±1.574, 13.04±1.743, 12.75±1.258, 11.49±2.246, respectively. And R.E.N.A.L nephrometry score were 9.61±1.257, 9.10±1.513, 9.00±0.816, 7.87±1.542 respectively. The modified R.E.N.A.L nephrometry score was significantly associated with surgery patterns(p<0.05). 3. The coincidence rate of the modified system in assessing the difficulty of nephron sparing surgery in mild, moderate, and high degree is 72%, 60%, 70%, respectively; the sensitivity were 33%, 77%, 17%, respectively; the specificity were 82%, 43%, 90%, respectively. On the same way, the following data of the original system: the coincidence rate : 79%, 60%, 62%, respectively; the sensitivity: 33%?82%?8%, respectively; specificity: 91%, 38%, 84%, respectively. From the data, the modified system is better than the original one in assessing high difficult of nephron sparing surgery. 4. The association between the modified nephrometry score and postoperative complication was significantly(P<0.039), so does the categories of radius(P=0.011),nearness to sinus(P=0.008) and collecting system(P=0.008) and relation with renal artery/vein(P=0.022). The categories of radius can also significantly influence operation time(P=0.006) and bleeding volume(P=0.043).Conclusion: The modified R.E.N.A.L nephrometry can help to chose optional surgery pattern, with high stability. It is more accurate to assess the high difficulty of nephron sparing surgery, which also has relation with the postoperative complication of laparoscopic nephron sparing surgery. |
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