孤立肾肿瘤采用消融或切除术治疗的肾功能结果。
Renal functional outcomes for tumours in a solitary kidney managed by ablative or extirpative techniques.
机构信息
Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
出版信息
BJU Int. 2010 Feb;105(4):496-500. doi: 10.1111/j.1464-410X.2009.08776.x. Epub 2009 Aug 13.
OBJECTIVE
To present the renal functional outcomes for patients treated with open partial nephrectomy (OPN) or radiofrequency ablation (RFA) for tumours in a solitary kidney, as renal masses in a solitary kidney present a challenging treatment dilemma.
PATIENTS AND METHODS
A retrospective review of institutional databases identified 89 patients with 98 renal tumours in a solitary kidney managed by RFA or OPN under cold ischaemia between January 1997 and September 2007. The choice of therapy was based on patient and surgeon preference, tumour characteristics and comorbidities. Renal function was calculated using the modified Modification of Diet in Renal Disease equation.
RESULTS
Outcomes from 47 patients treated by RFA and 42 by OPN were analysed at a median follow-up of 18.1 and 30.0 months, respectively (P = 0.02). The median age (65.9 vs 59.6 years, P = 0.03) and American Society of Anesthesiology score (3.0 vs 2.0, P = 0.01) were both higher in patients treated with RFA. The median tumour size was greater for tumours managed by OPN (3.9 vs 2.8 cm, P = 0.001), while the median preoperative glomerular filtration rate (GFR) was lower in the RFA group (46.5 vs 55.9 mL/min/1.73 m(2) for OPN, P = 0.04). Compared to RFA, patients treated with OPN had a greater decline in GFR at all times evaluated, including soon after the procedure (15.8% vs 7.1%), 12 months after surgery (24.5% vs 10.4%) and at the last follow-up (28.6% vs 11.4%, all P < 0.001). For patients with a pretreatment GFR of > 60 or > 30 mL/min/1.73 m(2), there was a new onset of decline in GFR of <60 and <30 mL/min/1.73 m(2) in none and 7% of patients after RFA, and in 35% and 17% after OPN.
CONCLUSION
Ablative techniques, which obviate ischaemic insults, might be a particularly attractive option for managing tumours in solitary renal units at risk of declining function. Renal functional outcomes compare favourably to extirpative surgery using cold ischaemia.
目的
介绍在孤立肾中，因肿瘤而接受开放式部分肾切除术（OPN）或射频消融（RFA）治疗的患者的肾功能结果，因为孤立肾中的肾肿瘤治疗存在很大的挑战。
方法
对机构数据库进行回顾性分析，确定了 1997 年 1 月至 2007 年 9 月期间，因冷缺血下的 RFA 或 OPN 治疗孤立肾中的肿瘤而接受治疗的 89 例患者和 98 个肾脏肿瘤的患者资料。治疗方法的选择基于患者和外科医生的偏好、肿瘤特征和合并症。使用改良肾脏病饮食修正公式（Modification of Diet in Renal Disease equation）计算肾功能。
结果
对接受 RFA 治疗的 47 例患者和接受 OPN 治疗的 42 例患者的结果进行了中位随访 18.1 个月和 30.0 个月的分析（P = 0.02）。RFA 组的中位年龄（65.9 岁 vs 59.6 岁，P = 0.03）和美国麻醉医师协会评分（3.0 分 vs 2.0 分，P = 0.01）均较高。OPN 组的肿瘤中位大小较大（3.9 cm vs 2.8 cm，P = 0.001），而 RFA 组的中位术前肾小球滤过率（GFR）较低（OPN 组为 46.5 mL/min/1.73 m2 vs 55.9 mL/min/1.73 m2，P = 0.04）。与 RFA 相比，接受 OPN 治疗的患者在所有评估时间点的 GFR 下降均更大，包括手术后即刻（15.8% vs 7.1%）、术后 12 个月（24.5% vs 10.4%）和末次随访（28.6% vs 11.4%，均 P < 0.001）。对于术前 GFR > 60 或 > 30 mL/min/1.73 m2 的患者，RFA 组无一例和 7%的患者新出现 GFR < 60 和 < 30 mL/min/1.73 m2，而 OPN 组则分别有 35%和 17%的患者新出现 GFR < 60 和 < 30 mL/min/1.73 m2。
结论
对于有发生功能下降风险的孤立肾单位中的肿瘤，避免缺血损伤的消融技术可能是一种特别有吸引力的治疗选择。与冷缺血下的根治性手术相比，肾功能结果相当。
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