Cozzi F, Zani A, Schiavetti A, Morini F, Degaetano V, Matrunola M, Cozzi D A
Department of Pediatric Surgery Unit, University of Rome La Sapienza, Viale Regina Elena 324, Rome, Italy.
Eur J Pediatr Surg. 2007 Dec;17(6):382-6. doi: 10.1055/s-2007-989219.
In children with an unilateral renal tumor, nephron-sparing surgery (NSS) results in a more adequate renal function adaptation compared to nephrectomy. In the present study, we investigated whether nephron-sparing surgery is followed by a different renal structure adaptation compared to nephrectomy.
Sixteen patients with unilateral renal tumor treated by nephrectomy (Group 1) and 10 treated by nephron-sparing surgery (Group 2) were enrolled in the study. Kidney volume was estimated by ultrasonography, using the formula for a prolate ellipsoid. Kidney volume was adjusted to the patient's weight and kidney laterality and expressed as a percentage of the expected volume of two kidneys in a healthy child. Total kidney volume (TKV) corresponded to the volume of the contralateral kidney in Group 1 patients, and to the volume of contralateral kidney + kidney remnant in Group 2 patients. Renal function was evaluated by serum creatinine values adjusted for sex and age and expressed as standard deviation scores (SDS).
Group 2 patients presented with a greater indexed TKV compared to Group 1 patients, (97.4 +/- 18.8 % vs. 77.0 +/- 17.7 %; p = 0.005). Indexed TKV below the reference range for healthy controls with two kidneys was found in 4 of 10 Group 2 patients vs. 14 of 16 Group 1 patients (p = 0.017). In both patient groups, correlation analysis of indexed TKV and creatinine SDS showed a negative correlation (r = - 0.47; p = 0.01).
In children with unilateral renal tumor, NSS is followed by a more adequate compensatory restoration of TKV compared with nephrectomy.
对于单侧肾肿瘤患儿，与肾切除术相比，保留肾单位手术（NSS）能使肾功能得到更充分的适应性改变。在本研究中，我们调查了与肾切除术相比，保留肾单位手术后肾脏结构的适应性改变是否有所不同。
本研究纳入了16例接受肾切除术的单侧肾肿瘤患者（第1组）和10例接受保留肾单位手术的患者（第2组）。采用超声检查，根据长椭球体公式估算肾脏体积。将肾脏体积根据患者体重和肾脏位置进行调整，并表示为健康儿童双侧肾脏预期体积的百分比。第1组患者的总肾体积（TKV）相当于对侧肾脏的体积，第2组患者的TKV相当于对侧肾脏体积与肾残余体积之和。通过根据性别和年龄调整后的血清肌酐值评估肾功能，并表示为标准差评分（SDS）。
与第1组患者相比，第2组患者的TKV指数更高（97.4±18.8%对77.0±17.7%；p = 0.005）。10例第2组患者中有4例的TKV指数低于健康对照双侧肾脏的参考范围，而16例第1组患者中有14例低于该范围（p = 0.017）。在两组患者中，TKV指数与肌酐SDS的相关性分析均显示为负相关（r = - 0.47；p = 0.01）。
对于单侧肾肿瘤患儿，与肾切除术相比，保留肾单位手术后TKV的代偿性恢复更为充分。
