RENAL评分系统和局限性肾脏肿瘤患者外科治疗方案选择的关系

摘要

Objective To investigate the relationship between RENAL scoring system and surgical treatment for local-ized renal tumors.Methods Retrospective analysis of the clinical data of 198 cases of renal tumor patients were conducted,total score and other items were evaluated by 3 observers using the RENAL scoring system,statistical analysis of different observation consistency were analyzed,and score were divided into low,middle,high groups,and in accordance with the relevant score correla-tion analysis the total score and the score and surgical selection.Results The consistent rate of 3 observers score was 96.9%,5 indexes of RENAL scoring system favorable rate was the lowest in L(91.3%),was the highest in R(96.4%).The total number of cases was low packet distribution in 31 cases,102 cases in middle packet,high packet in 65 cases,PN group patients with mid-dle and low packet,high packet and the proportion of patients in the group were 87.10%,50.98%,16.92%,there showed a sig-nificant decreasing trend,in the RN group patients with middle and low packet,high packet and the proportion of patients in the group were 12.90%,49.02%,83.08%,showed a rising trend.The average score of RN and PN were 9.41,7.41,operation using the average score and total score in patients with rank sum test analysis,there had statistically significant difference;there was a direct relationship with the choice of operative methods were age,R,N,L(P<0.05),R,N,L higher scores,and the older the pa-tients,the patient was more inclined to adopt RN technique,otherwise,it will tend to use PN technique.Conclusion The stability of RENAL scoring system used in this study has higher repeatability and has a direct relationship between levels,and important factors affecting surgical scoring option are age,R,N,L.%目的：探讨RENAL评分系统和局限性肾脏肿瘤患者外科治疗方案选择的关系。方法回顾性分析肾脏肿瘤患者198例的临床资料，由3位观察者采用RENAL评分系统分别对患者进行总分和各项评分，利用统计学分析不同观察者之间评价的一致性，根据总分将得分分为低、中、高3组，并根据相关评分分析总分以及各项评分与术式选择的相关性。结果3位观察者的总分的一致率为96．9％， RENAL 评分系统当中的5个评价指标一致率最低的是 L （91．3％），最高的是R（96．4％）。病例总数的分布为低分组31例，中分组102例，高分组65例。在PN组的患者中低分组、中分组以及高分组患者的比例分别为87．10％，50．98％，16．92％，呈明显的依次递减的趋势；在RN组的患者中低分组、中分组以及高分组患者的比例分别为12．90％，49．02％，83．08％，呈明显的上升趋势。 RN和PN的平均分分别为9．41分、7．41分，利用秩和检验分析总分的平均分与患者采取的术式，两者的差异具有明显的统计学意义。与术式的选择存在直接关系的是年龄、R、N、L（P＜0．05），R、N、L单项的得分越高以及患者的年龄越大，患者更倾向于采用RN术式治疗，反之，会倾向于采用PN术式治疗。结论本研究采用的RENAL评分系统具有较高的稳定性和重复性，评分的高低与术式的选择具有直接的关系，对于术式的选择影响较大的单项因素为患者的年龄、R、N、L4个项目。