Gupta N P, Kumar A, Hemal A K, Dogra P N, Seth A, Kumar R
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Urol. 2007 Jan;23(1):18-22. doi: 10.4103/0970-1591.30259.
We present our eight-year experience with open nephron-sparing surgery (NSS) in renal tumors with contralateral normal kidney to assess its oncological efficacy and safety.
Thirty-six patients undergoing open NSS for small localized renal tumors with normal contralateral kidney from January 1998 to August 2006 were studied regarding demographic, clinical and pathological characteristics along with long-term follow-up.
The mean age was 48.28 +/- 9.5 years. The mean tumor size was 3.72 cm (range 1.5-6). The following surgeries were performed: Wedge resection-13, partial polar nephrectomy-15, segmental resection-eight. The following techniques were used for vascular control: clamping and cooling-eight, warm ischemia-12, a novel technique of serial encirclage-16. The mean warm ischemia time was 23.2 +/- 3.2 min. The mean operating time was 190.07 +/- 11.3 min. The mean estimated blood loss was 331 +/- 17.4 ml. The majority of renal tumors were renal cell carcinoma (97.22%). There were no positive surgical margins. There were no major intraoperative and postoperative complications. The mean follow up was 52.1 months (range 4-80) with no case showing progression to renal insufficiency (defined as serum creatinine > 2 mg/dl). There was only one local recurrence. However, four distant metastases were reported. The five-year cancer-specific survival, recurrence-free survival and overall survival were 94.4%, 88.88% and 86.11% respectively.
In patients with solitary, small localized, unilateral renal tumors with normal contralateral kidney, elective open NSS is feasible, safe and provides excellent long-term local control and oncological efficacy with functional benefits.
我们介绍了在对侧肾脏正常的肾肿瘤患者中进行开放性保留肾单位手术（NSS）的八年经验，以评估其肿瘤学疗效和安全性。
对1998年1月至2006年8月期间因小的局限性肾肿瘤且对侧肾脏正常而接受开放性NSS的36例患者的人口统计学、临床和病理特征以及长期随访情况进行了研究。
平均年龄为48.28±9.5岁。平均肿瘤大小为3.72厘米（范围1.5 - 6厘米）。实施了以下手术：楔形切除术 - 13例，部分肾极切除术 - 15例，节段性切除术 - 8例。用于血管控制的技术如下：夹闭和降温 - 8例，热缺血 - 12例，一种新型的连续环扎技术 - 16例。平均热缺血时间为23.2±3.2分钟。平均手术时间为190.07±11.3分钟。平均估计失血量为331±17.4毫升。大多数肾肿瘤为肾细胞癌（97.22%）。切缘均为阴性。术中及术后均无严重并发症。平均随访时间为52.1个月（范围4 - 80个月），无病例进展为肾功能不全（定义为血清肌酐>2毫克/分升）。仅1例局部复发。然而，报告了4例远处转移。五年癌症特异性生存率、无复发生存率和总生存率分别为94.4%、88.88%和86.11%。
对于对侧肾脏正常的孤立性、小的局限性、单侧肾肿瘤患者，选择性开放性NSS是可行、安全的，并且能提供良好的长期局部控制和肿瘤学疗效，同时具有功能益处。
