Kural Ali Riza, Demirkesen Oktay, Onal Bulent, Obek Can, Tunc Burcin, Onder Ali Ulvi, Yalcin Veli, Solok Vural
Department of Urology, University of Istanbul, Cerrahpasa School of Medicine, Istanbul, Turkey.
Urol Int. 2003;71(2):190-6. doi: 10.1159/000071845.
The increase in the detection of renal tumors incidentally in earlier stages has enhanced the enthusiasm for nephron-sparing surgery (NSS).
We performed NSS in 76 patients (53 male, 23 female) with a mean age 52.3 between December 1988 and September 2001. Patients were sub-classified into 2 groups as elective or imperative indication group. They were compared regarding surgical technique, time of surgery, pathological analysis, complications, and disease free status.
Elective indication group (group I) with a normal contralateral kidney consisted of 50 patients, whereas there were 26 patients in the imperative indication group (group II). Tumors were incidentally detected in 63%; 74% in group I and 42% in group II. Although the mean diameter of the tumor was slightly higher in group II (39.1 vs. 36.3 mm), this difference did not reach statistical significance (p > 0.05). The partial nephrectomy was performed more frequently compared to enucleation in group I (90 vs. 69%, p = 0.050). However, the mean operation time as well as the mean clamping time did not differ significantly between the two groups (p > 0.05). In the histological evaluation tumors were benign in 16 (21%) and malignant in 60 patients. All of the patients but one with renal cell carcinoma had stage T1-T2 disease. Major complications were observed in 14 (18%) and 12 were from group II. Complication rate was significantly higher in group II (p = 0.000). Of 60 patients with renal cell carcinoma, 2 died of unrelated causes. One patient died with multiple visceral metastases. One patient was lost to follow-up. In the remaining 56 patients with a mean follow-up of 37.1 months (1-152), local recurrence or distant metastases were not detected. Serum creatinine levels have remained almost the same compared to preoperative levels (1.2 +/- 0.6 vs. 1.5 +/- 0.9). Overall and cancer-specific survivals were 100 and 100% in group I, 85 and 95% in group II, and 94 and 98% for the entire patient population, respectively.
NSS is an effective and reliable treatment in low stage renal tumors. It prevents unnecessary nephrectomy in benign lesions that could not be diagnosed preoperatively. However, the patients who underwent NSS with elective indication outcome with better results, compared to those with imperative indication.
早期偶然发现的肾肿瘤病例增多，这激发了人们对保留肾单位手术（NSS）的热情。
1988年12月至2001年9月期间，我们对76例患者（男53例，女23例）实施了NSS，平均年龄52.3岁。患者被分为两组，即择期手术组或紧急手术组。比较了两组患者的手术技术、手术时间、病理分析、并发症及无病状态。
对侧肾脏正常的择期手术组（I组）有50例患者，紧急手术组（II组）有26例患者。63%的肿瘤是偶然发现的；I组为74%，II组为42%。虽然II组肿瘤的平均直径略大（39.1对36.3毫米），但差异无统计学意义（p>0.05）。与剜除术相比，I组更常进行部分肾切除术（90%对69%，p=0.050）。然而，两组的平均手术时间及平均阻断时间差异无统计学意义（p>0.05）。组织学评估显示，16例（21%）肿瘤为良性，60例为恶性。除1例肾细胞癌患者外，所有患者的疾病分期均为T1-T2期。观察到14例（占18%）出现主要并发症，其中12例来自II组。II组的并发症发生率显著更高（p=0.000）。60例肾细胞癌患者中，2例死于无关原因。1例患者死于多发内脏转移。1例患者失访。其余56例患者平均随访37.1个月（1-152个月），未发现局部复发或远处转移。与术前水平相比，血清肌酐水平几乎保持不变（1.2±0.6对1.5±0.9）。I组的总体生存率和癌症特异性生存率分别为100%和100%，II组分别为85%和95%，全体患者分别为94%和98%。
NSS是治疗低分期肾肿瘤的一种有效且可靠的方法。它避免了对术前无法诊断的良性病变进行不必要的肾切除术。然而，择期手术组接受NSS的患者比紧急手术组患者的预后更好。
