Department of Urology, Miller School of Medicine, University of Miami, PO Box 016960 (M814), Miami, FL 33101, USA.
World J Urol. 2010 Aug;28(4):507-12. doi: 10.1007/s00345-010-0510-1. Epub 2010 Jan 30.
To review trends in open partial nephrectomy (OPN) at our center, concentrating on patient selection, technique and perioperative complications.
A comprehensive database was developed by chart review of consecutive patients undergoing OPN for renal masses at our center. Patient selection, technical modifications, perioperative morbidity, and histopathology were compared in patients undergoing OPN between 1992-1999, 2000-2003, and 2004-2008. Complications were divided into procedure-specific (PSCs) and nonspecific medical complications (NMCs). They were graded using the Common Terminology Criteria for Adverse Events (CTCAE), version 3.0.
One hundred and sixty-three OPNs were performed. Temporal trends identified include: an increase in the mean patient BMI (p = 0.04), an increase in the percentage of patients with central tumors (p < 0.001), decrease in cold ischemia time (p = 0.045), increasing use of a sequential renal vein clamp (p = 0.03), increasing utilization of tissue sealants (p < 0.001), reduced EBL (p = 0.05), reduced length of stay (p = 0.005), and a decline in PSCs from 16 to 7% (p = 0.002). The incidence of histologically benign tumors declined from 34 to 10% (p = 0.001). Thirty-three (20.2%) patients experienced perioperative complications: 70% were CTCAE grade 1 or 2 adverse events. BMI was the only factor that was found to be associated with the risk of complications on multivariate analysis [odds ratio 1.067, CI 95% (1.002-1.136); p = 0.031].
Increasingly, OPN is being utilized for a cohort of challenging patients who are overweight and have centrally located tumors. Despite this, the risk of PSCs is low. Patients who are overweight are at increased risk for perioperative NMCs.
回顾我院开放式部分肾切除术（OPN）的趋势，重点关注患者选择、技术和围手术期并发症。
通过对我院连续接受 OPN 治疗的肾肿块患者的病历进行综述，建立了一个全面的数据库。比较了 1992-1999 年、2000-2003 年和 2004-2008 年 OPN 患者的患者选择、技术改进、围手术期发病率和组织病理学。并发症分为特定程序（PSCs）和非特异性医疗并发症（NMCs）。使用通用术语标准不良反应（CTCAE）版本 3.0 对并发症进行分级。
共进行了 163 例 OPN。时间趋势包括：患者平均 BMI 增加（p = 0.04），中央肿瘤患者比例增加（p < 0.001），冷缺血时间减少（p = 0.045），序贯肾静脉夹使用增加（p = 0.03），组织密封剂使用增加（p < 0.001），出血量减少（p = 0.05），住院时间缩短（p = 0.005），PSCs 从 16%降至 7%（p = 0.002）。组织学良性肿瘤的发生率从 34%降至 10%（p = 0.001）。33 例（20.2%）患者发生围手术期并发症：70%为 CTCAE 1 级或 2 级不良事件。多变量分析发现，BMI 是唯一与并发症风险相关的因素[比值比 1.067，95%置信区间（1.002-1.136）；p = 0.031]。
越来越多的 OPN 用于治疗超重和中央肿瘤患者这一具有挑战性的患者群体。尽管如此，PSC 的风险仍然很低。超重患者围手术期 NMC 的风险增加。
