| ObjectiveTo explore the clinical significance and application value of Zonal NePhRO scoring system in laparoscopic partial nephrectomy(LPN)in the treatment of T1 renal cancer.MethodsAfter screening by the inclusion criteria and exclusion criteria,a total of 98 patients who underwent laparoscopic partial nephrectomy(LPN)treatment and surgery in the Department of Urology,the First Affiliated Hospital of Zhengzhou University from May 2016 to December 2019 were statistically analyzed.Clinical data of patients with T1 stage renal cancer who were confirmed to be renal cancer by pathology.According to the preoperative imaging data,the patients were scored by Zonal NePhRO,and the patients were divided into low-risk group(4-6 points),medium-risk group(7-9 points),and high-risk group(10-12 points).Analyze the relationship between operation time,warm ischemia time,blood loss,changes in blood creatinine,and perioperative complications among the groups.Before the operation,two urologists(resident and attending physician)with different levels of experience scored independently on the CT image data.Finally,a chief physician reviewed and unified the data,independent of three urologists of different seniority.The scoring results are paired for consistency test.ResultsAmong the 98 patients included in the study,the number of patients in the lowrisk group was 51,the number of patients in the medium-risk group was 34,and the number of patients in the high-risk group was 13.All patients successfully completed the operation and the margins were negative.There were four cases of postoperative complications,two cases of Clavien-Dindo grade Ⅰ complication in the low-risk group(one case of postoperative bleeding improved by conservative treatment,one case of lung infection);one case of Clavien-Dindo grade Ⅰ complication in the medium-risk group(urine Leakage menstruation improved after active drainage),and one case of high-risk group with Clavien-Dindo grade Ⅲ complication(postoperative bleeding was treated by super-selective interventional embolization)..Postoperative pathology:92 cases were clear cell carcinoma,four cases were papillary carcinoma,and two cases were chromophobe cell carcinoma.There were no significant difference in gender(χ2=4.154,p=0.125),age[(50.14±12.04)years vs(53.44±15.59)years vs(52.46±12.05)years 岁,P=0.523],BMI[(26.14±2.38)kg·m-2vs(25.02±2.62)kg·m2 vs(25.87±2.66)kg·m-2,P=0.131],blood loss[(68.04±47.16)ml vs(84.71±59.61)ml vs(103.08±80.04)ml,P=0.106],and postoperative hospital stay[(7.294±1.10)d vs(7.764±1.37)d vs(7.923±1.70)d,P=0.138]in each group(P>0.05).There were significant difference in operation time[(101.57±22.09)min vs(107.53±20.34)min vs(141.85±33.48)min,P<0.001],warm ischemia time[(18.78±4.97)min vs(20.74±5.38)min vs(22.46±5.47)min,P=0.045],and blood creatinine changes[(6.19±7.96)vs(15.21±9.92)vs(17.69±9.60),P<0.001](P<0.05).The scoring results of three urologists of different ages were tested for consistency.The Kappa value between the chief physician and the resident physician was 0.512,and the number of cases with the same score was 61(62.24%).The chief physician and the attending physician were one of them.The Kappa value between the two groups was 0.706,the number of cases with the same score was 77(78.57%),the Kappa value between the attending phy sician and the resident was 0.665,and the number of cases with the same score was 74(75.51%).The difference was statistically significant(P<0.01).The results show that among urologists of different ages,the regional NePhRO scoring system has a medium-to-high consistency,indicating that it has good repeatability.ConclusionOur research has shown that different grades of kidney tumors have significant differences in important surgical and functional parameters such as operation time,warm ischemia time,and blood creatinine changes,and the scores have high consistency among urologists at different levels of experience.Therefore,the Zonal NePhRO score is a good tool to objectify the complexity of the tumor and provide a reference for the development of surgical plans and guidance for intraoperative operations. |
PDF Full Text Request