Weight Christopher J, Fergany Amr F, Gunn Paul W, Lane Brian R, Novick Andrew C
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2008 Jul;180(1):84-8. doi: 10.1016/j.juro.2008.03.049. Epub 2008 May 15.
With the advent of minimally invasive, nephron sparing surgical options we hypothesized that the indications, perioperative parameters and complication rates of open partial nephrectomy may have changed significantly during a 10-year period.
Open partial nephrectomy was compared during 2, 3-year periods. From 1994 to 1996 (before laparoscopic partial nephrectomy, cryoablation and radio frequency ablation) 208 cases were compared vs 347 open partial nephrectomies performed from 2004 to 2006 with regard to indications, perioperative parameters and complication rates.
There were no significant differences between the groups with regard to age (59 vs 58 years), gender (65.5% vs 65.0% male) and tumor size (3.9 vs 3.6 cm). Tumors removed in the recent era were more often in a solitary kidney (40.0% vs 15.6%) and centrally located (55.6% vs 37.3%), and pathological evaluation more often revealed higher grade (Fuhrman 3 or 4) (43.1% vs 27.8%, each p <0.0001). Despite increased technical difficulty ischemia time in the more recent era was shorter (19.1 vs 40.6 minutes, p = 0.0000), and the urological and overall complication rates were statistically similar (7.5% vs 8.9%, p = 0.6071 and 19.1% vs 14.4%, p = 0.1723, respectively).
At a tertiary referral center the introduction of minimally invasive, nephron sparing surgical techniques has drawn away less complicated, less aggressive tumors, reserving the bulk of more complicated central tumors for open partial nephrectomy without decreasing the total number of open cases. With experience these more difficult central tumors are being successfully treated with decreased warm ischemia time and complication rates that are comparable to those in historical series.
随着微创、保留肾单位手术方式的出现，我们推测开放性部分肾切除术的适应证、围手术期参数及并发症发生率在10年期间可能发生了显著变化。
对两个3年期的开放性部分肾切除术进行比较。将1994年至1996年（腹腔镜部分肾切除术、冷冻消融和射频消融之前）的208例病例与2004年至2006年进行的347例开放性部分肾切除术在适应证、围手术期参数及并发症发生率方面进行比较。
两组在年龄（59岁对58岁）、性别（男性分别为65.5%对65.0%）和肿瘤大小（3.9cm对3.6cm）方面无显著差异。近期切除的肿瘤更常位于孤立肾（40.0%对15.6%）和中央部位（55.6%对37.3%），病理评估更常显示为高级别（Fuhrman 3或4级）（分别为43.1%对27.8%，P<0.0001）。尽管技术难度增加，但近期的缺血时间较短（19.1分钟对40.6分钟，P=0.0000），泌尿外科并发症发生率和总体并发症发生率在统计学上相似（分别为7.5%对8.9%，P=0.6071；19.1%对14.4%，P=0.1723）。
在三级转诊中心，微创、保留肾单位手术技术的引入使较简单、侵袭性较小的肿瘤被分流，将大部分较复杂的中央型肿瘤留给开放性部分肾切除术，且未减少开放性手术的总数。随着经验的积累，这些更具挑战性的中央型肿瘤正得到成功治疗，热缺血时间缩短，并发症发生率与历史系列相当。
