| Objective:Renal cancer is a high incidence malignant tumor of urinary system,and its mortality rate is the first.For T1 stage renal cancer patients,the effective development of modern medical precision treatment suggests that we should not only rely on the clinical experience and the "indications" in the existing literature guidelines,but also carry out partial nephrectomy or radical nephrectomy blindly or even expand resection according to the individual situation of patients In order to protect the renal function of patients to the maximum extent and to achieve renal tumor RO resection(tumor control),the existing r.e.n.a.l system evaluation system has limitations.Therefore,this paper mainly studies the application of the improved r.e.n.a.l.system in the evaluation of T1 stage renal cancer patients with partial nephrectomy.Materials and methods:1.Analysis of clinical data:retrospective cohort study was used to analyze renal cancer patients admitted to urology department of our hospital from 2017 to 2019.Finally,50 patients were included in the study.All 50 patients were diagnosed as renal tumor by imaging and confirmed as renal cancer by pathology.According to the TNM stage of AJCC 2010,the stage was T1.The information collected in this study includes:tumor diameter ratio,height,weight,age,number of renal arteries,operation time,renal artery blocking time,bleeding volume,difference between preoperative creatinine and postoperative creatinine in the first reexamination,postoperative hospital stay,complications,etc.follow up the patients according to the recommended follow-up content in the 2014 Chinese guidelines for diagnosis and treatment of urological diseases,and follow up the patients Spss22.0 was used to analyze the data.2.The patients were evaluated with the improved r.e.n.a.l.scoring system.We improved the traditional r.e.n.a.l.score mainly as follows:l.We introduced the concept of tumor diameter ratio to replace the traditional r.e.n.a.l.score by tumor size as the evaluation parameter.The ratio of the maximum tumor diameter to the maximum diameter of the patient’s kidney was made,in which,1 point was recorded for<1/3 of the patients’ kidneys,2 point was recorded for≥1/3 of the patients’ kidneys,<1/2 of the patients’ kidneys,3 point was recorded for≥1/2 of the patients’kidneys.2.Body mass index(BMI)was introduced into the improved r.e.n.a.l.system as a measurement parameter,in which BMI<24 was scored 1 point,BMI≥ 24～<27 was scored 2 points,BMI>27 was scored 3 points.3.Number of branches of renal artery:before operation,the number of branches of renal artery on the affected side of the patient was searched according to imaging.One,two and three branches of renal artery were scored as one,two and three respectively.All subjects were divided into three scoring groups:low(6-10 points),medium(11-14 points)and high(15-18 points).The high score group was high surgical difficulty risk group,the medium rating group was medium surgical difficulty risk group,and the low rating group was low surgical risk difficulty group.Result:Through strict implementation of the inclusion criteria and exclusion criteria,we finally selected 50 selected patients,including 32 males and 18 females.All patients were diagnosed as early renal cancer by imaging.According to the AJCC TNM staging standard 2010,all patients were in T1 stage,and there were 2 patients before operation Patients had mild hypertension and diabetes mellitus.The subjects had no serious basic diseases.The creatinine value was normal before and after operation.The mean age was 51.4±9.9 years old.The mean BMI was 26.9 ± 3.5 kg/m2.The mean maximum tumor diameter was 4.1±1.7 Cm,,the average time of hot ischemia was 20.6±5.0 min,the average time of operation was 131.0±48.8 min,The mean postoperative hemoglobin was 128.4±17.2g/l,hand the average length of stay was 7.5±2.3 days.Conclution:The choice of operation plan for renal tumor depends on the complexity of the tumor,and renal resection after renal artery occlusion is the most important speed limiting step of radical nephrectomy.Therefore,it is considered that the improved scoring system is less related to the perioperative situation of radical nephrectomy,and may be more related to partial nephrectomy.At present,the surgical treatment of renal cancer is mainly developed around the progress of laparoscopic technology,which is divided into two types:transabdominal and retroperitoneal.This paper mainly discusses the transabdominal partial nephrectomy.We further explored the relationship between the improved r.e.n.a.l.scoring system and the perioperative situation of 50 cases of laparoscopic partial nephrectomy.It was not difficult to find that there was a significant correlation between the operation time,warm ischemia time,intraoperative bleeding and the improved r.e.n.a.l.scoring system(P<0.05). |
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