Thompson R Houston, Leibovich Bradley C, Lohse Christine M, Zincke Horst, Blute Michael L
Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2005 Sep;174(3):855-8. doi: 10.1097/01.ju.0000169453.29706.42.
Open nephron sparing surgery (NSS) is now the standard of care for small renal tumors irrespective of overall renal function. More recently laparoscopic NSS with hilar clamping has emerged, albeit with relatively longer ischemic times. We reviewed our experience with contemporary open NSS, comparing complication rates to those of historical controls and updating data for comparison with minimally invasive procedures.
From 1985 to 2001, 823 open NSSs were performed at our institution. Early (within 30 days of NSS) and late (30 days to 1 year) complications were compared using the chi-square and Wilcoxon rank sum tests between procedures performed in 1985 to 1995 (control group of 343 patients) and 1996 to 2001 (contemporary group of 480).
In the control vs the contemporary group there were significant decreases in intraoperative blood loss (median 550 vs 350 cc, p <0.001), chronic renal insufficiency/failure (14.6% vs 8.1%, p = 0.003), dialysis need (7.0% vs 2.1%, p <0.001) and any early (13.4% vs 6.9%, p = 0.002) or late (32.4% vs 24.6%, p = 0.014) complication. In the contemporary group 50% of patients did not require pedicle clamping, 32% underwent warm ischemia (median 12 minutes) and 18% underwent cold ischemia (median 27 minutes). In addition, patients with a warm ischemia time of 20 minutes or less had fewer early complications than patients with greater than 20 minutes of ischemia, although this did not attain statistical significance (3.8% vs 13.6%, p = 0.063).
Complications resulting from open NSS have significantly decreased with time. Contemporary open NSS is associated with minimal morbidity, and decreases the need for pedicle clamping and overall ischemia time.
开放性保留肾单位手术（NSS）目前是治疗小肾肿瘤的标准术式，无论患者的整体肾功能如何。最近，采用肾门阻断的腹腔镜NSS已出现，尽管其缺血时间相对较长。我们回顾了我们在当代开放性NSS方面的经验，将并发症发生率与历史对照进行比较，并更新数据以与微创手术进行对比。
1985年至2001年，我们机构共进行了823例开放性NSS。使用卡方检验和Wilcoxon秩和检验比较1985年至1995年（343例患者的对照组）和1996年至2001年（480例当代组）手术的早期（NSS后30天内）和晚期（30天至1年）并发症。
与当代组相比，对照组的术中失血量（中位数550 vs 350 cc，p<0.001）、慢性肾功能不全/衰竭（14.6% vs 8.1%，p = 0.003）、透析需求（7.0% vs 2.1%，p<0.001）以及任何早期（13.4% vs 6.9%，p = 0.002）或晚期（32.4% vs 24.6%，p = 0.014）并发症均显著降低。在当代组中，50%的患者无需肾蒂阻断，32%的患者接受了热缺血（中位数12分钟），18%的患者接受了冷缺血（中位数27分钟）。此外，热缺血时间在20分钟或更短的患者早期并发症少于缺血时间超过20分钟的患者，尽管这未达到统计学意义（3.8% vs 13.6%，p = 0.063）。
开放性NSS引起的并发症随时间显著减少。当代开放性NSS的发病率极低，并减少了肾蒂阻断的需求和总体缺血时间。
