本文選題：腎腫瘤 + DAP評(píng)分系統(tǒng)��； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討DAP腎腫瘤評(píng)分系統(tǒng)對(duì)行保留腎單位手術(shù)患者的臨床應(yīng)用價(jià)值。同時(shí),對(duì)該評(píng)分系統(tǒng)的可信度和可重復(fù)性進(jìn)行研究,評(píng)估該評(píng)分系統(tǒng)的評(píng)分穩(wěn)定性。方法:收集2013年10月至2015年8月安徽醫(yī)科大學(xué)第一附屬醫(yī)院泌尿外科收治的110例行開放、腹腔鏡及機(jī)器人輔助腹腔鏡腎部分切除手術(shù)患者的臨床及影像學(xué)資料。術(shù)前應(yīng)用DAP評(píng)分系統(tǒng)進(jìn)行評(píng)分,并根據(jù)腫瘤的復(fù)雜程度將其分為高分、中分及低分組,分析該評(píng)分與手術(shù)方式及手術(shù)時(shí)間、熱缺血時(shí)間和估計(jì)失血量等圍手術(shù)期結(jié)局之間的相關(guān)性。另由5名泌尿外科醫(yī)師(2名主治醫(yī)師和3名住院醫(yī)師)采用DAP系統(tǒng)獨(dú)立進(jìn)行評(píng)分,其中,兩名住院醫(yī)師間隔3個(gè)月后再次進(jìn)行評(píng)分。分別利用Kappa和Kendall tau-b分析法評(píng)估同一評(píng)分者和兩名評(píng)分者間DAP各參數(shù)及總分的一致性。利用ICC檢驗(yàn)分析不同資歷醫(yī)師之間評(píng)分結(jié)果的一致性。結(jié)果:本研究中開放、腹腔鏡及機(jī)器人輔助腹腔鏡保留腎單位手術(shù)分別為18例、62例、30例。其中,男性患者54例、女性患者56例�；颊叩钠骄挲g為(50.9±12.2)歲,體質(zhì)指數(shù)為(23.4±3.3)kg/m2,ASA麻醉評(píng)分為(1.4±0.5)分。在所有患者中,左側(cè)腎腫瘤55例,右側(cè)腫瘤55例,所有腫瘤均為單發(fā)。DAP評(píng)分與手術(shù)方式、手術(shù)時(shí)間、熱缺血時(shí)間和估計(jì)失血量顯著相關(guān)(P0.05),而與術(shù)后住院天數(shù)和圍手術(shù)期腎小球率過濾的的變化率之間無明顯相關(guān)性(P0.05)。同一評(píng)分者DAP各參數(shù)及總分的Kappa值分別為0.889、0.817、0.787和0.693;0.897、0.834、0.830和0.708。兩名評(píng)分者之間DAP各參數(shù)及總分的Kendall tau-b值分別為0.896、0.832、0.847、0.832。在Bland-Altman圖中,D、A、P三個(gè)參數(shù)均有超過90%的位點(diǎn)在95%的置信區(qū)間的參考線內(nèi)。高年資醫(yī)師間的評(píng)分一致性較低年資醫(yī)師高。結(jié)論:DAP腎腫瘤評(píng)分系統(tǒng)對(duì)相關(guān)圍手術(shù)期結(jié)局具有較好的臨床預(yù)測(cè)價(jià)值,有助于指導(dǎo)手術(shù)方式的合理選擇。同時(shí),DAP腎腫瘤評(píng)分系統(tǒng)在同一評(píng)分者及不同評(píng)分者間的一致性好,具有良好的可信度和可重復(fù)性。
[Abstract]:Objective: to evaluate the clinical value of DAP renal tumor scoring system in patients undergoing nephron-sparing surgery. At the same time, the reliability and repeatability of the scoring system were studied to evaluate the stability of the scoring system. Methods: from October 2013 to August 2015, 110 patients with open, laparoscopic and robot-assisted laparoscopic partial nephrectomy were collected from the first affiliated Hospital of Anhui Medical University. DAP scoring system was used to score the tumor before operation. According to the complexity of the tumor, the tumor was divided into three groups: high score, middle score and low score. Correlation between warm ischemic time and perioperative outcomes such as estimated blood loss. In addition, 5 urologists and 2 attending physicians and 3 resident physicians were assessed independently by DAP system, in which the two resident physicians were graded again after 3 months' interval. Kappa and Kendall tau-b analysis were used to evaluate the consistency of DAP parameters and total scores between the same score and two raters. ICC test was used to analyze the consistency of scoring results among doctors with different qualifications. Results: in this study, the open, laparoscopic and robotic assisted laparoscopic nephron sparing surgery were 18 cases (62 cases) and 30 cases (30 cases), respectively. Among them, 54 cases were male and 56 cases were female. The average age of the patients was 50.9 鹵12.2 years, and the body mass index (BMI) was 23.4 鹵3.3 kg / m ~ 2 ASA score of 1.4 鹵0.5). Among all the patients, 55 cases were left renal tumor, 55 cases were right tumor, all tumors were single .DAP score, operation method, operation time. There was a significant correlation between the time of hot ischemia and the estimated amount of blood loss (P0.05), but there was no significant correlation between the duration of hospitalization and the change rate of perioperative glomerular filtration. The Kappa values of each parameter and total score of DAP in the same score were 0.88170.87 and 0.6930.8970.834 / 0.830 and 0.708 respectively. The Kendall tau-b values of DAP parameters and total scores between the two scores were 0.896 鹵0.832 and 0.847 鹵0.832, respectively. In the Bland-Altman diagram, more than 90% of the three parameters are in the reference line of 95% confidence interval. The consistency of scores among senior physicians was higher than that among junior physicians. Conclusion the renal tumor score system with the weight DAP has a good clinical value in predicting the perioperative outcome and is helpful to guide the rational selection of surgical methods. At the same time, DAP renal tumor scoring system has good consistency and good reliability and repeatability.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.11

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 徐建兵;王飛;王為服;;腎腫瘤評(píng)分系統(tǒng)的臨床應(yīng)用新進(jìn)展[J];臨床泌尿外科雜志;2016年02期

2 張永貞;楊國慶;張思維;鄭榮壽;曹凌;陳萬青;;中國2009年腎及泌尿系統(tǒng)其他癌發(fā)病和死亡分析[J];中國腫瘤;2013年05期

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本文編號(hào)：1831150