影响T1期肾癌患者肾部分切除术疗效的因素分析

Factors affecting the outcome of partial nephrectomy in patients with stage T1 renal cancer

摘要:

目的 分析影响T₁期肾癌患者肾部分切除术（partial nephrectomy，PN）疗效的因素。方法 回顾性分析重庆医科大学附属第一医院2020年9月至2022年5月行PN的219例T₁期肾癌患者的资料。依据肿瘤分期将患者分为2组：T_1a期组和T_1b期组。分析患者的一般资料、肿瘤特征、术中和术后资料。将同时满足手术切缘阴性、肾脏热缺血时间<30 min、无3级及以上术后并发症且未中转为肾根治性切除术四项要素的PN视为疗效好的PN，并以此为观察终点对影响手术疗效的因素做logistic回归分析。结果 2组患者的肿瘤最大直径、RENAL评分（the RENAL nephrometry score）、手术时间、估计出血量、肾脏热缺血时间、中转为肾根治性切除例数、肌酐上升值、满足4项要素例数等存在统计学差异。logistic回归分析显示，RENAL评分是影响手术疗效的主要因素。结论 RENAL评分是T₁期肾癌患者PN疗效的关键影响因素。

Abstract:

Objective To analyze the factors affecting the outcome of partial nephrectomy（PN） in patients with stage T₁ renal cancer.Methods A retrospective analysis was conducted on the data of 219 patients with stage T₁ renal cancer who underwent PN in the First Affiliated Hospital of Chongqing Medical University from September 2020 to May 2022. Patients were divided into two groups according to tumor stage：T_1a group and T_1b group. Patients’ general data，tumor characteristics，intraoperative and postoperative data were analyzed. PN that simultaneously met four elements of negative surgical margins，renal warm ischemia time <30 min，no grade 3 or higher postoperative complications，and no intermediate conversion to radical nephrectomy was considered as a PN with good outcome，and with this as the observation endpoint，a logistic regression analysis was performed to analyze the factors affecting surgical outcome.Results Significant differences existed between the two groups in terms of maximum tumor diameter，RENAL score，operative time，estimated bleeding，renal warm ischemia time，number of cases with intermediate conversion to radical nephrectomy，creatinine uptake value，and number of cases meeting the four elements. The logistic regression analysis showed that RENAL score was the main factor affecting surgical outcome.Conclusion RENAL score is a key influencing factor for the outcome of PN in patients with stage T₁ renal cancer.