肾周脂肪梅奥粘连概率评分系统在肾癌后腹腔镜肾部分切除术中的应用

目的探讨肾周脂肪梅奥粘连概率评分系统（MAP）在肾癌后腹腔镜肾部分切除术中的临床应用价值。 方法回顾性分析2015年1月至2020年6月徐州医科大学附属淮安医院泌尿外科收治的行后腹腔镜肾部分切除术的153例肾癌患者的临床病例资料。依据MAP评分系统将其分为低度复杂组、中度复杂组和高度复杂组三组。比较各组间的手术时间、术中出血量、术中及术后并发症、术中热缺血时间、术后住院时间及术后血肌酐变化情况。 结果在153例患者中，低度复杂组68例，中度复杂组58例和高度复杂组27例。三组患者在年龄、性别、术前血肌酐水平、肿瘤最大径、肿瘤位置、BMI、RENAL评分等方面差异无统计学意义（P>0.05）。随着复杂程度的提高，手术时间、术中出血量也在不断增加（P<0.05）；而术中热缺血时间、术后住院时间及术后血肌酐水平无明显变化（P>0.05）。在术中并发症方面，随着复杂程度的提高，术中并发症的发生率也在增加（P<0.05），且高度复杂组的术后并发症发生风险是低度复杂组的13.895倍（P=0.002)，MAP评分系统预测术中并发症发生的精度较高（AUC=0.757，P=0.002）。但是术后并发症各组比较差异无统计学意义（P>0.05）。 结论MAP评分系统在肾癌后腹腔镜肾部分切除术中，对预估手术难度及术中并发症发生风险有较好的临床应用价值。

Clinical application of perirenal fat Mayo adhesion probability (MAP) score system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma

ObjectiveTo investigate the clinical value of perirenal fat Mayo adhesion probability (MAP) score system in retroperitoneal laparoscopic partial nephrectomy for renal cancer. MethodsThe clinical data of 153 patients with renal cell carcinoma who underwent retroperitoneal laparoscopic partial nephrectomy in Department of Urology, Huai'an Hospital Affiliated to Xuzhou Medical University from January 2015 to June 2020 were retrospectively analyzed. According to the MAP score system, they were divided into three groups: low complexity group, moderate complexity group and high complexity group. The operation time, intraoperative blood loss, intraoperative and postoperative complications, intraoperative warm ischemia time, postoperative hospital stay and postoperative serum creatinine were compared among the groups. ResultsAmong 153 patients, 68 were in low complexity group, 58 in moderate complexity group and 27 in high complexity group. There was no significant difference in age, gender, preoperative serum creatinine level, tumor diameter, tumor location, body mass index and renal score among the three groups (P>0.05). With the increase of complexity, the operation time and blood loss were also increasing (P<0.05), while the warm ischemia time, postoperative hospital stay and serum creatinine level had no significant change (P>0.05). In terms of intraoperative complications, the incidence of intraoperative complications increased with the increase of complexity (P<0.05), and the risk of postoperative complications in high complexity group was 13.895 times higher than that in low complexity group (P=0.002). The accuracy of MAP scoring system in predicting intraoperative complications was higher (AUC=0.757, P=0.002). However, there was no significant difference in postoperative complications among the groups (P>0.05). ConclusionMAP score system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma has good clinical application value in predicting the difficulty of operation and the risk of intraoperative complications.