| Objective: To explore the clinical application value of modified R.E.N.A.L.nephrometry score—a comprehensive evaluation of renal tumor anatomy by preoperative CT enhanced scan images—in nephron sparing surgery for renal neoplasms,which can guide the doctors choose the appropriate clinical managements.Methods: A retrospective analysis was conducted of clinical and imaging materials of 106 patients with renal tumor(diameter<7cm)who underwent nephron sparing surgery from september 2013 to september2016 in our hospital.All patients underwent CT enhancement scan 10 days before operation.Two radiologists who experienced strict training scored the renal tumor anatomy features using the R.E.N.A.L.scoring system via the preoperative enhanced CT scan images.According to the R.E.N.A.L.score we divided the operation difficulty into three levels:low-score(group A),middle-score(group B),and high-score(group C).Then we modified the R.E.N.A.L.scoring system properly by down-regulating the boundary value of the diameter,adding the thickness of perirenal fat and the renal artery count.All patients were divided into three groups according to the results of modified scoring system: low-score(group D),middle-score(group E),and high-score(group F).The tumors assigned the suffix h(hilar)which abutted the main renal artery or vein were classified into high-score group directly.Analyzed the correlation between the modified R.E.N.A.L.score and the surgery approach,the operation time,the warm ischemia time,postoperative hospitalization time,and the postoperative complications.And then compared the clinical significance of two scoring systems.Results: A total of 106 patients,there are 42 group A,53 group B,11 group C of R.E.N.A.L.nephrometry score,and 31 group D,60 group E,15 group F of the modified R.E.N.A.L.nephrometry score.There were no statistical significances between the two scoring systems and age,sex,side,preoperative serum creatinine concentration and the preoperative glomerular filtration rate(P>0.05).There was statistical significance between the two scoring systems and the choice of surgical approach,P<0.05.The total scores both of two scoring systems of the patients with open partial nephrectomy are higher than laparoscopic partial nephrectomy.Analyzed the correlation between the two scoring systems and the perioperative factors,there were significant statistical differences between the total R.E.N.A.L.score and the operation time,the warm ischemia time.But there was no statistical significance of the operation time between group A and group B(P>0.05);there was also no significant statistical difference of the warm ischemia time between group B and group C.While there were significant statistical differences between the group D,E and F in the operation time and the warm ischemia time according to the modified scoreing system(P = 0.000,0.001).In addition,the operation time and the warm ischemia time that between the group D and E,group D and F,group E and F had statistical difference(P<0.05).And there was no significant correlation between the two scoring systems and postoperative hospitalization time(P>0.05).Using the Fisher exact test to analyze the relationship between the two scoring systems and postoperative complications,it showed that there were no statistical significances between the R.E.N.A.L.score groups and the incidence of postoperative complications(P>0.05).While there were significant statistical differences between the modified score groups and the incidence of postoperative complications(P<0.05).Then the ROC curve was used to analyze the predictive effectiveness of two scoring systems for postoperative complications.The results demonstrated that the AUC value(0.670)of the modified scoring system was higher than that of the R.E.N.A.L.scoring system(0.629).Conclusions: Preoperative evaluation results about the difficulty of partial nephrectomy according to the modified R.E.N.A.L.scoring system of which based on CT images were significantly related with the surgery approach,the operation time,the warm ischemia time,and postoperative complications.The modified R.E.N.A.L.scoring system could objectively and quantitatively evaluate the difficulty of partial nephrectomy preoperatively.The modified R.E.N.A.L.scoring system was more suitable for renal neoplasms with partial nephrectomy.Its preoperative evaluation of surgical difficulty and the prediction of postoperative complications were more effective,which guided the choice of appropriate clinical managements,thus reduced the operation risk and improved the prognosis. |
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