Zorn Kevin C, Gong Edward M, Mendiola Frederick P, Mikhail Albert A, Orvieto Marcelo A, Gofrit Ofer N, Steinberg Gary D, Shalhav Arieh L
Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
Urology. 2007 Jul;70(1):28-34. doi: 10.1016/j.urology.2007.02.059.
The intraoperative complexity of laparoscopic partial nephrectomy (LPN) for upper pole renal tumors is recognized. We report on the technical feasibility and operative outcomes of LPN for upper pole tumors (UPLPN) and lower pole tumors (LPLPN), and open partial nephrectomy (UPOPN) for upper pole tumors.
We retrospectively reviewed our database of LPNs performed by a single surgeon from October 2002 to February 2006. All solitary, upper and lower pole tumors in patients with a normal contralateral kidney were included. The perioperative outcomes were assessed. UPOPNs performed in the same institution by a separate surgeon were analyzed and compared separately with the UPLPN group.
Three groups, UPLPN (20 patients), LPLPN (33 patients), and UPOPN (24 patients), were analyzed. The UPLPN and LPLPN groups had similar perioperative outcomes. The intraoperative and postoperative major complications were also comparable between the UPLPN and LPLPN groups (17% versus 12%, P = 0.68 and 22% versus 6%, P = 0.07, respectively). The mean pathologic tumor size was larger (3.2 versus 2.3 cm, P = 0.05) and the mean operative time significantly shorter (187 versus 244 minutes, P = 0.02) in the UPOPN group than in the UPLPN group. The UPOPN group had a trend toward fewer intraoperative complications compared with the UPLPN group (4% versus 17%, P = 0.17). The final pathologic surgical margins were negative in all three groups.
LPN for upper pole renal tumors is technically feasible and may have comparable outcomes to LPN for lower pole tumors. However, performing open nephron-sparing surgery is still the standard of care because it may offer fewer complications and reduce the risk of ischemic damage to the kidney.
腹腔镜肾部分切除术（LPN）治疗上极肾肿瘤的术中复杂性已得到公认。我们报告了LPN治疗上极肿瘤（UPLPN）和下极肿瘤（LPLPN）以及开放性上极肿瘤肾部分切除术（UPOPN）的技术可行性和手术结果。
我们回顾性分析了2002年10月至2006年2月由一名外科医生实施的LPN数据库。纳入所有对侧肾脏正常的患者的孤立性上、下极肿瘤。评估围手术期结果。对由另一名外科医生在同一机构实施的UPOPN进行分析，并与UPLPN组分别进行比较。
分析了三组，即UPLPN组（20例患者）、LPLPN组（33例患者）和UPOPN组（24例患者）。UPLPN组和LPLPN组的围手术期结果相似。UPLPN组和LPLPN组的术中及术后主要并发症也相当（分别为17%对12%，P = 0.68；22%对6%，P = 0.07）。UPOPN组的平均病理肿瘤大小大于UPLPN组（3.2 cm对2.3 cm，P = 0.05），平均手术时间显著短于UPLPN组（187分钟对244分钟，P = 0.02）。与UPLPN组相比，UPOPN组术中并发症有减少趋势（4%对17%，P = 0.17）。三组的最终病理手术切缘均为阴性。
LPN治疗上极肾肿瘤在技术上是可行的，其结果可能与LPN治疗下极肿瘤相当。然而，进行开放性保肾手术仍是治疗的标准方法，因为它可能并发症更少，并降低肾脏缺血损伤的风险。
