Koo A S, Koyle M A, Hurwitz R S, Weese D, Applebaum H, Fonkalsrud E W, Ehrlich R M
Department of Surgery, UCLA Medical Center.
J Urol. 1990 Aug;144(2 Pt 2):416-7; discussion 422. doi: 10.1016/s0022-5347(17)39477-6.
Surgical exploration of the contralateral kidney in unilateral Wilms tumor has been the standard of surgical practice. During the last decade advances in noninvasive imaging techniques (ultrasound, computerized tomography and magnetic resonance imaging) have led to more accurate definition of intrarenal pathological conditions. The intuitive question presently is whether contralateral exploration remains mandatory in Wilms tumor patients. We reviewed the records of 52 consecutive children at our institutions who underwent radiological and operative staging of the Wilms tumor from 1979 to 1988. All 48 evaluable patients underwent either preoperative computerized tomography, ultrasound and/or magnetic resonance imaging. Five bilateral Wilms tumors were diagnosed preoperatively and confirmed surgically, whereas extensive operative exploration of the contralateral kidney in the other 43 cases of radiologically diagnosed unilateral disease failed to reveal any contralateral abnormality. Thus, in all patients preoperative radiological investigation was accurate to stage the disease regarding bilaterality. With modern imaging techniques and effective chemotherapy, extensive contralateral renal exploration may no longer be mandatory to manage Wilms tumor.
对单侧肾母细胞瘤患者的对侧肾脏进行手术探查一直是外科手术的标准做法。在过去十年中，非侵入性成像技术（超声、计算机断层扫描和磁共振成像）的进步使得肾内病理状况的定义更加准确。目前直观的问题是，对肾母细胞瘤患者进行对侧探查是否仍然是必要的。我们回顾了1979年至1988年在我们机构连续接受肾母细胞瘤放射学和手术分期的52例儿童的记录。所有48例可评估患者均接受了术前计算机断层扫描、超声和/或磁共振成像检查。术前诊断出5例双侧肾母细胞瘤并经手术证实，而在其他43例经放射学诊断为单侧疾病的病例中，对侧肾脏的广泛手术探查未发现任何对侧异常。因此，在所有患者中，术前放射学检查在判断疾病双侧性方面分期准确。随着现代成像技术和有效化疗的应用，广泛的对侧肾脏探查可能不再是治疗肾母细胞瘤的必要手段。
