Construction Of SIREN Renal Vascular Anatomy Scoring System And Its Clinical Significance In Nephron-sparing Surgery

Objective:To study the risk factors affecting nephron-sparing surgery and to explore the relationship between SIREN renal vascular anatomical scoring system and complications.Methods:The clinical data of 166 patients with renal cell carcinoma who underwent nephron sparing surgery(Nephron-sparing surgery,NSS)from January 2014 to June 2019 were analyzed retrospectively.according to the imaging data(CT data),the three-dimensional reconstruction images of renal cell carcinoma were obtained.The tumor anatomy and renal vascular anatomy were evaluated by R.E.N.A.L score and SIREN score,which were divided into three groups according to the score.To explore the relationship between score and postoperative complications,and logistic multivariate regression analysis was used to study the risk factors of postoperative complications in NSS.Results:In 135 cases of NSS166,the trunk of renal artery was temporarily clamped during NSS,the branches of renal artery were occluded in 31 cases of NSS,and the first branch of renal artery was temporarily clamped during operation,but the blood flow of renal artery was not completely blocked.According to the renal vascular anatomical SIREN score,the patients were divided into three layers: low,middle and high,which were 82,74,10 cases respectively.There were significant differences in operation time,warm ischemia time and blood loss among patients with different scores(?2 = 6.322,? 2 = 6.322,P < 0.042).According to the anatomy of the tumor,the R.E.N.A.L scores of low,middle and high were 74,80 and 12 cases,respectively.There were significant differences in operation time,ischemia time and blood loss among the patients(P < 0.05),but there was no significant difference among different operation methods(? 2 = 3.211).There were significant differences in the incidence of postoperative complications between the two groups with different scores of SIREN and R.E.N.A.L(P < 0.05).Univariate analysis showed that ischemia time,operation time,blood loss,SIREN score and R.E.N.A.L score were the risk factors of postoperative complications.),Logisitic multivariate regression analysis showed that SIREN score,R.E.N.A.L score and operation mode were the risk factors of postoperative complications.Conclusion:Three-dimensional reconstruction of the operation area structure of kidney cancer through image data before operation can visually display the tumor and vascular anatomy of the operation area.According to the SIREN and RENAL scoring system,the difficulty of surgery can be objectively evaluated.To a certain extent,the occurrence of postoperative complications can be judged.High SIREN The score and high RENAL score not only mean higher difficulty of operation,but also mean higher risk of complication,which plays an early warning role for the operator's preoperative decision and intraoperative operation.