| Objective:To explore the clinical significance of patients who exerted nephron sparing surgery with an comprehensive evaluation of patients with renal tumor anatomy by preoperative CT enhanced scan images, which can guide the clinical doctors choose nephron sparing surgery properly.Materials and Methods:According to the case inclusion criteria, we collected clinical and imaging materials of51patients with local renal tumors who had nephron sparing surgery between september2011to march2013in our hospital, all patients were informed consent. Two radiologists scored the renal tumor anatomy features using the R.E.N.A.L. score system via the preoperative enhanced CT data. by double-blind, three measurements were made for each anatomy and take the average value as a result of the score finally. The post-reconstruction were done on the CT workstation and the R.E.N.A.L. score were made at the same time. Analyzing the condition of the perioperation, the postoperative complications were evaluated by Clavien classification. Analyzing the correlation between the total R.E.N.A.L. score and the single score and the age, the body mass index, the operation time, the warm ischemia time, the length of hospital stay, the operation method, the tumor pathological subtype, the TNM staging, the total complications after surgery and the postoperative urinary leakage. Analyzing the consistency among the total score and the single score by using Kappa value.Results:(1)The Kappa value of the total R.E.N.A.L.score and the single score were greater than0.75, a good consistency. The consistency of the score of the exophytic (E) was the best, the variability of the nearness(N) of the tumor deepest portion to the collecting system or sinus was the strongest. The consistency of the total R.E.N.A.L. score was the best among all the scores.(2)There was no statistical significance between the total R.E.N. A.L. score and age, the body mass index, the operation time, the tumor pathological subtype, the TNM stage, the total complications after surgery and the postoperative urinary leakage (P>0.05). There was statistical significance between the total R.E.N.A.L. score and the warm ischemia time (P<0.05), of which the low group and moderate group, the moderate group and the high group had statistical difference (P<0.05), but there was no statistical significance between the low group and the moderate group(P>0.05). There was statistical significance between the total R.E.N.A.L. score and the length of hospital stay (P<0.05), of which the low group and high group, the moderate group and the high group had statistical difference (P<0.05), but there was no statistical significance between the low group and the moderate group(P>0.05). There was statistical significance between the total R.E.N.A.L.score and the choice of surgical approach.(3)There was no statistical significance between the tumor size and the operation time, the renal ischemia time heat, the hospitalization time, the choice of the surgical approach, tumor pathological subtype, the postoperative complications and the postoperative urinary leakage(P>0.05). There was statistical significance between the tumor size and the TNM stage (P <0.05).(4)There was no statistical significance between the exophytic (E) and the operation time, the renal ischemia time heat, the hospitalization time, the choice of the surgical approach, the TNM stage, the postoperative total complications (P>0.05). There was statistical significance between the exophytic (E) and the pathological subtype and the postoperative urinary leakage (P<0.05).(5)There was statistical significance between the nearness of tumor deepest portion to the collecting system or sinus and the operation time (P<0.05), of which the low group and the moderate group, the moderate group and the high group had statistical significance (P<0.05), but the low and the high group had no statistical difference (P>0.05). There was statistical significance between the nearness of tumor deepest portion to the collecting system or sinus and the tumor pathological subtype, the postoperative complications and the total urinary leakage(P<0.05). There was no statistical significance between the nearness of tumor deepest portion to the collecting system or sinus and the kidney warm ischemia time, the length of hospital stay, the operation method choice and the TNM stage (P>0.05).(6)There was no statistical significance between the the (A)nterior(a)/posterior(p) descriptor and the operation time, the kidney warm ischemia time and the length hospital stay (P>0.05).(7)There was statistical significance between the location relative to the polar line and the operation time (P<0.05), of which the low group and the moderate group, the low group and the high group had statistical significance(P<0.05), but there was no statistical significance between the low group and the high group (P>0.05). There was no statistical significance between the location relative to the polar line and the operation time and the warm ischemia time, the length of hospital stay, the operation method choice, the tumor pathological subtype, the TNM stage, the total complications after surgery and the postoperative urinary leakage (P>0.05).Conclusion:The R.E.N.A.L. scoring system was a simple tool, which has a strong repeatability. The total score of the R.E.N.A.L.can predict the renal ischemia time,and it is associated with the choice of operation method.The tumor size can predict the degree of tumor differentiation; the exophytic and the nearness of the tumor deepest portion to the collecting system or sinus can predict the pathological subtype. The tumor exophytic and the nearness of the tumor deepest portion to the collecting system or sinus require careful operation as far as possible avoid postoperative urinary leakage. |
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