探讨DDD评分系统在肾癌患者行后腹腔镜肾部分切除术中，对预估肿瘤复杂性、手术难度及并发症发生风险的实际应用价值。

收集2015年1月至2019年10月我科住院的行后腹腔镜肾部分切除术的51例肾癌患者的临床资料。根据DDD评分系统分为低度复杂组、中度复杂组、高度复杂组，并收集比较各组患者的年龄、性别、肿瘤位置、体质量指数（BMI）、手术时间、术中热缺血时间、术中出血量、手术前后血肌酐差值、术后住院天数及并发症情况。

51例患者中，低度复杂组21例、中度复杂组15例、高度复杂组15例。三组患者年龄、性别、肿瘤位置及BMI差异无统计学意义（P>0.05）。平均手术时间分别为（74.6±13.1） min、（88.0±31.5） min、（111.0±25.0）min，平均术中热缺血时间分别为（10.4±1.8）min、（13.0±2.9）min、（20.6±5.6）min，平均术中出血量分别为（47±27）ml、（56±27） ml、（68±20） ml，复杂程度越高，术中出血量越多，热缺血时间越长，手术时间越长（P<0.05）。各组平均术后血肌酐增加值分别为（4.8±6.7） μmol/L、（10.2±4.9）μmol/L、（10.6±5.3） μmol/L，平均术后住院天数分别为（6.7±0.9）d、（10.4±5.6）d、（10.4±2.1） d，低度复杂组与其他两组比较，术后血肌酐变化小，术后住院时间短，差异有统计学意义（P<0.05）。另外，高度复杂组的术后并发症发生风险是低度复杂组的3.65倍（P<0.05），并且DDD评分系统预测术后并发症发生的精度较高（AUC=0.894）。

DDD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 value of DDD scoring system in retroperitoneoscopic partial nephrectomy for patients with renal cell carcinoma to estimate the tumor complexity, surgical difficulty and risk of complications.

The clinical data of 51 patients with renal cell carcinoma who underwent retroperitoneoscopic partial nephrectomy from January 2015 to October 2019 were collected. The patients were divided into low-grade complex group, moderate-complex group and high-complex group according to DDD scoring system. The age, gender, tumor location, body mass index (BMI), operation time, intraoperative warm ischemia time, intraoperative blood loss, preoperative and postoperative serum creatinine difference, postoperative hospital stay and complications were collected and compared among the three groups.

Of the 51 patients, 21 cases were in the low-grade complex group, 15 cases were in the moderate-complex group, and 15 cases were in the high-grade complex group. There was no statistically significant difference in age, gender, tumor location and BMI among the three groups (P>0.05). The average operation time was (74.6±13.1) min, (88.0±31.5) min and (111.0 ±25.0) min, the average intraoperative warm ischemia time was (10.4±1.8) min, (13.0±2.9) min and (20.6 ± 5.6) min, and the average intraoperative blood loss was (47.1±27.2) ml, (56.0±26.7) ml and (68.0±20.1) ml, respectively. The higher the DDD score, the blood loss was more, the warm ischemia time was longer, and the operation time was longer (P<0.05). The mean postoperative increase of serum creatinine in each group was (4.8±6.7) μmol/L, (10.2 ±4.9) μmol/L and (10.6±5.3) μmol/L, respectively, and the mean postoperative hospital stay was (6.7±0.9) d, (10.4 ±5.6) d and (10.4±2.1) d, respectively. Compared with the other two groups, the postoperative change of serum creatinine was small and the postoperative hospital stay was short, and the differences had statistical significance (P<0.05). In addition, the risk of postoperative complications was 3.65 times higher in the highly complex group than in the low-complex group (P<0.05), and the DDD scoring system had a higher accuracy in predicting the occurrence of postoperative complications (AUC=0.894).

DDD scoring system in retroperitoneoscopic partial nephrectomy for renal cell carcinoma has a good clinical value in predicting the complexity of the tumor, the difficulty of surgery and the risk of postoperative complications.