目的 探讨改良R.E.N.A.L.肾肿瘤评分系统的临床应用价值.方法 回顾性分析2009年10月至2014年12月海南省人民医院泌尿外科收治的122例肾肿瘤患者的影像学资料和手术方案.依据术前CT,由二位泌尿外科医师按改良系统标准独立评分,其中1例在两周后再次评分.验证系统在同一观察者及不同观察者中的稳定性,并分析改良系统与手术方案选择的关系.结果 同一观察者对直径、外凸率、与肾窦距离、与集合系统距离、纵向位置、侧别、肾动脉数、侵犯肾蒂血管与否、改良系统复杂度一致性的Kappa值分别为0.876、0.541、0.633、0.680、0.812、0.560、0.757、0.827、0.772.不同观察者一致性的Kendall值分别为0.886、0.537、0.430、0.449、0.772、0.202、0.440、0.731、0.681.122例肾肿瘤患者中28例行开放性肾切除术、51例腹腔镜肾切除术、4例行开放性部分切除术、39例行腹腔镜部分切除术,改良系统与术式选择显著相关(P<0.05).结论 改良R.E.N.A.L.评分系统具有较好的稳定性,并能指导肾肿瘤手术方式的选择.%Objective To investigate the clinical application value of the modified R.E.N.A.L. nephrometry scoring system. Methods The clinical data (imaging data and operation plan) of 122 patients of renal tumor in Depart-ment of Urology, People's Hospital of Hainan Province from Oct. 2009 to Dec. 2014 were retrospectively analyzed. Ac-cording to preoperative CT, the patients were scored by two urologists independently according to the modified system, and one of the patients was scored again after two weeks. The stability of the system was verified in the same urologist and different urologists, and the relationship between the modified system and selection of surgical treatment was ana-lyzed. Results In the same urologist, the kappa values for diameter, outer convex rate, distance with the renal sinus, dis-tance with collection system, longitudinal position, side, number of renal arteries, whether violate renal pedicle vessels or not, consistency of complex degree of modified system were 0.876, 0.541, 0.633, 0.680, 0.812, 0.560, 0.757, 0.827, 0.772, respectively. In different urologists, the Kendall values were 0.886, 0.537, 0.430, 0.449, 0.772, 0.202, 0.440, 0.731, 0.681, respectively. Among the 122 patients, there were 28 cases of open-nephrectomy, 51 cases of laparoscopic nephrectomy, 4 cases of open-partial cystectomy, and 39 cases of laparoscopic partial cystectomy. Modified system and selection of surgical treatment were significantly related (P<0.05). Conclusion The modified R.E.N.A.L. nephrometry scoring system has good stability, and can guide the selection of surgical methods of renal tumors.
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