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目的:探讨影像学评分对于肾癌肾部分切除术(PN)术后肾功能下降的预测作用。方法:选择本科室2005年9月~2014年7月因单一肾肿瘤行PN且诊断为肾癌的165例患者为研究对象,收集手术前后肾小球滤过率估计值(eGFR)等临床信息,根据术前影像学资料行DAP评分及R.E.N.A.L.评分。通过Spearman检验、ROC曲线、Logistic回归分析等统计学方法,分析两种评分对术后急性肾功能下降的评价价值,并进行比较。结果:DAP评分和R.E.N.A.L.评分与缺血时间等围术期参数均有相关性(P<0.05)。两者可用于缺血时间≥30min、%ΔeGFR(术前-术后1天)≥30%、术后急性肾功能损伤(AKI)发生的预测(P<0.05),对术后急性肾功能下降的预测效能R.E.N.A.L.评分优于DAP评分。相对来说R.E.N.A.L.评分中E指标和N指标更为重要,R.E.N.A.L.评分≥7分(中危)即可增加AKI的发生风险。结论:DAP评分及R.E.N.A.L.评分能较为客观的反映肿瘤的复杂性,对术后肾功能的下降有良好的预测作用,预测效能R.E.N.A.L.评分优于DAP评分,术前评价有助于指导术中术后保肾措施的提前干预。
Objective: To investigate the predictive value of imaging score for renal function decline after partial nephrectomy (PN) of renal cell carcinoma. Methods: From September 2005 to July 2014, 165 patients with PN diagnosed as renal cancer by single renal tumor were enrolled in this study. Clinical data such as estimated glomerular filtration rate (eGFR) before and after surgery were collected. , According to preoperative imaging data line DAP score and RENAL score. The Spearman test, ROC curve and Logistic regression analysis were used to analyze the value of the two scores in the evaluation of postoperative acute renal failure, and compared. Results: The DAP score and R.E.N.A.L. scores were correlated with perioperative parameters such as ischemic time (P <0.05). Both of them can be used to predict the occurrence of acute renal injury (AKI) after ischemic time≥30min,% ΔeGFR (preoperative-postoperative one day) ≥30%, postoperative acute renal function decline The predicted performance RENAL score was better than the DAP score. Relatively the R.E.N.A.L. score in the E and N indicators is more important, R.E.N.A.L. score ≥ 7 points (in danger) can increase the risk of AKI. Conclusion: The DAP score and RENAL score can objectively reflect the complexity of the tumor and predict the decline of postoperative renal function. The predicted RENAL score is better than the DAP score. Preoperative evaluation is helpful to guide the postoperative Kidney intervention measures in advance.