探讨直径-轴距-极距（DAP）评分系统在肾癌后腹腔镜肾部分切除术中的临床应用价值。

回顾性分析2016年1月至2019年12月在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119例肾癌患者的临床病历资料。依据DAP评分系统将其分为低度复杂组、中度复杂组和高度复杂组。比较各组手术时间、术中出血量、术中热缺血时间、术后住院时间、术后血肌酐变化及术后并发症情况。

在119例患者中，低度复杂组40例，中度复杂组58例，高度复杂组21例。3组患者在年龄、性别、术前血肌酐水平及体质量指数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、术中热缺血时间及术中出血量不断增加（P＜0.05），而术后住院时间及术后血肌酐水平无明显变化（P＞0.05）。在并发症方面，随着复杂程度的提高并发症的发生率增加（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11.69倍（OR值=11.69，95%CI：2.19~62.27，P=0.004），但是，不同组间并发症Clavien分级比较，差异无统计学意义（P＞0.05）。DAP评分系统预测术后并发症发生的精度较高（AUC=0.725，P=0.004），敏感度和特异度分别为87.5%和63.1%。

DAP评分系统在肾癌后腹腔镜肾部分切除术中，对预估肿瘤复杂性、手术难度及术后并发症发生风险有较好的临床应用价值。

To investigate the clinical value of the diameter-axial-polar (DAP) scoring system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma.

The clinical data of 119 patients with renal cell carcinoma who underwent retroperitoneal laparoscopic partial nephrectomy at Department of Urology, Huai'an Hospital Affiliated to Xuzhou Medical University from January 2016 to December 2019 were retrospectively analyzed. According to the DAP scoring system, they were divided into three groups: low complexity group, moderate complexity group, and high complexity group. The operation time, intraoperative blood loss, intraoperative warm ischemia time, postoperative hospital stay, postoperative serum creatinine changes, and postoperative complications were compared among the groups.

Among the 119 patients, 40 were in the low complexity group, 58 in the moderate complexity group, and 21 in the high complexity group. There were no significant differences in age, gender, preoperative serum creatinine level, or body mass index among the three groups (P＞0.05). With the increase of complexity, the operation time, warm ischemia time, and blood loss also signficantly increased (P＜0.05), but postoperative hospital stay and serum creatinine level had no significant change (P＞0.05). In terms of complications, the incidence of complications increased with the increase of complexity (P＜0.05), and the risk of postoperative complications in the high complexity group was 11.69 times higher than that in the low complexity group (odds ratio =11.69, 95% confidence interval: 2.19-62.27, P=0.004). However, there was no significant difference in the Clavien classification of complications among different groups (P＞0.05). The accuracy of DAP scoring system in predicting postoperative complications was high (area under the curve = 0.725, P=0.004), and the sensitivity and specificity were 87.5% and 63.1%, respectively.

The DAP scoring system in retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma has good clinical application value in predicting the complexity of tumor, the difficulty of operation, and the risk of postoperative complications.