Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2011 Nov;186(5):1786-90. doi: 10.1016/j.juro.2011.07.036. Epub 2011 Sep 25.
Partial nephrectomy is the recommended management for small renal masses. Percutaneous ablation is safe and effective with comparable short-term cancer specific survival. Currently to our knowledge data are lacking on the impact of thermal ablation on renal function preservation. We examined the impact on renal function of partial nephrectomy vs percutaneous ablation in patients with a solitary kidney.
We performed a retrospective review to identify patients with a solitary kidney who underwent partial nephrectomy or percutaneous ablation at Mayo Clinic Rochester between 2003 and 2009. Preoperative characteristics and 3-month posttreatment renal function were compared using the Wilcoxon rank sum, chi-square and Fisher exact tests.
During the study period 50 patients underwent percutaneous ablation and 62 underwent partial nephrectomy. At partial nephrectomy no ischemia was used in 30 cases (48%), a median of 28 minutes of cold ischemia was used in 26 (42%) and a median of 18 minutes of warm ischemia was used in 6 (10%). Patients who underwent partial nephrectomy were younger (median age 62.5 vs 68.5 years, p = 0.01) and harbored larger tumors (median 3.5 vs 2.5 cm, p = 0.005) with higher nephrometry scores (median 9 vs 7, p = 0.03). At 3-month posttreatment followup no differences were noted between the 2 groups in glomerular filtration rate (p = 0.91), change in glomerular filtration rate (p = 0.77) or change in chronic kidney disease stage (p = 0.87). Similar results were observed when adjusting for age, tumor size and nephrometry score on multivariate analysis.
With judicious use of ischemia partial nephrectomy, even for more complex tumors, has short-term renal function outcomes similar to those of percutaneous ablation.
部分肾切除术是治疗小肾肿瘤的推荐方法。经皮消融术安全有效，短期癌症特异性生存率相当。目前据我们所知，关于热消融术对肾功能保护的影响的数据尚缺乏。我们研究了在单肾患者中，部分肾切除术与经皮消融术对肾功能的影响。
我们进行了一项回顾性研究，以确定 2003 年至 2009 年在梅奥诊所罗切斯特分校接受部分肾切除术或经皮消融术的单肾患者。使用 Wilcoxon 秩和检验、卡方检验和 Fisher 精确检验比较术前特征和治疗后 3 个月的肾功能。
在研究期间，50 例患者接受了经皮消融术，62 例患者接受了部分肾切除术。在部分肾切除术中，30 例（48%）未使用缺血，26 例（42%）使用了 28 分钟的冷缺血，6 例（10%）使用了 18 分钟的热缺血。接受部分肾切除术的患者年龄较小（中位年龄 62.5 岁 vs 68.5 岁，p = 0.01），肿瘤较大（中位直径 3.5 厘米 vs 2.5 厘米，p = 0.005），肾肿瘤评分较高（中位数 9 分 vs 7 分，p = 0.03）。在治疗后 3 个月的随访中，两组的肾小球滤过率（p = 0.91）、肾小球滤过率变化（p = 0.77）或慢性肾脏病分期变化（p = 0.87）无差异。在多变量分析中，调整年龄、肿瘤大小和肾肿瘤评分后，也观察到了类似的结果。
在明智地使用缺血的情况下，即使是更复杂的肿瘤，部分肾切除术的短期肾功能结果与经皮消融术相似。
