Clark Aaron T D, Breau Rodney H, Morash Chris, Fergusson Dean, Doucette Steve, Cagiannos Ilias
Division of Urology, Department of Surgery, University of Ottawa, Ontario, Canada.
Eur Urol. 2008 Jul;54(1):143-49. doi: 10.1016/j.eururo.2008.03.037. Epub 2008 Mar 27.
To compare the effect on renal function of partial and radical nephrectomy using creatinine clearance measurements from 24-hr urine collection.
All patients with a solid enhancing renal mass suspicious for renal cell carcinoma, a normal contralateral kidney, and not dialysis dependent were enrolled in this prospective cohort study. Patients were treated with partial or radical nephrectomy by one urologist. Creatinine clearance (CrCl) measurements were prospectively obtained by 24-hr urine collection preoperatively, and at 3, 6, and 12 mo postoperatively. Mean change in creatinine clearance from baseline was compared at 3, 6, and 12 mo. Serum creatinine and Cockcroft-Gault calculations were also performed for comparison. Mixed model analysis incorporating patient and tumor characteristics and the procedure type was performed in SAS Version 9.1.
Sixty-three consecutive patients were enrolled in this study. The partial nephrectomy (n=26) and radical nephrectomy (n=37) groups were similar with respect to age, sex, presence of hypertension, vascular disease, diabetes mellitus, and angiotensin converting enzyme inhibitor or receptor blocker use. The postoperative change in creatinine clearance was significantly less (p-value < 0.0001) in the partial nephrectomy group (-0.09mL/s, -6.1%) compared to the radical nephrectomy group (-0.56mL/s, -31.6%). Linear regression analysis showed intervention type (partial vs. radical nephrectomy) was the most significant predictor of change in creatinine clearance (p-value < 0.0001).
There is significantly less deterioration in the overall renal function of patients who are treated with partial nephrectomy compared to radical nephrectomy. This highlights the importance of performing nephron-sparing surgery on appropriate patients.
通过收集24小时尿液测量肌酐清除率，比较部分肾切除术和根治性肾切除术对肾功能的影响。
所有患有疑似肾细胞癌的实性强化肾肿块、对侧肾脏正常且非透析依赖的患者均纳入本前瞻性队列研究。患者由一名泌尿外科医生进行部分或根治性肾切除术。术前以及术后3、6和12个月通过收集24小时尿液前瞻性地获得肌酐清除率（CrCl）测量值。比较术后3、6和12个月时肌酐清除率相对于基线的平均变化。还进行了血清肌酐和Cockcroft-Gault计算以作比较。在SAS 9.1版中进行了纳入患者和肿瘤特征以及手术类型的混合模型分析。
本研究连续纳入了63例患者。部分肾切除术组（n = 26）和根治性肾切除术组（n = 37）在年龄、性别、高血压、血管疾病、糖尿病以及血管紧张素转换酶抑制剂或受体阻滞剂使用情况方面相似。与根治性肾切除术组（-0.56mL/s，-31.6%）相比，部分肾切除术组（-0.09mL/s，-6.1%）术后肌酐清除率的变化显著更小（p值<0.0001）。线性回归分析表明，干预类型（部分肾切除术与根治性肾切除术）是肌酐清除率变化的最显著预测因素（p值<0.0001）。
与根治性肾切除术相比，接受部分肾切除术的患者总体肾功能恶化明显更少。这凸显了对合适患者进行保留肾单位手术的重要性。
