Drewniak Tomasz, Juszczak Kajetan, Maciukiewicz Piotr, Wyczółkowski Marek
Oddział Urologii Szpitala Specjalistycznego im. Ludwika Rydygiera w Krakowie.
Pol Merkur Lekarski. 2011 Oct;31(184):209-11.
In nephron sparing surgery (NSS) procedures the most important is oncological outcome and also the preservation of maximum renal function. Renal scyntygraphy using 99mTc-DTPA allows for assessment of renal function and its changes after surgery because of tumor.
To assess the loss of kidney function operated using 99mTc-DTPA scyntygraphy, depending on the location of the tumor, type of growth, and time of warm ischemia of the operated kidney.
Renal scyntygraphy was performed in 30 patients who underwent NSS procedures for renal cortical tumors of its diameter of about 3.2 cm (range: 2.5-4.1 cm) before surgery and after surgery at an average of 3.8 months (range: 2.3-5.4 months). All patients were stratified according to time of warm ischemia (up to and above 10 mines), type of tumor growth (endo- and egzophytic) and tumor location (upper, middle and lower pole).
The relative loss of kidney function operated depending on the type of kidney tumor growth when egzophytic and endophytic was amounted to 16% (range: 12-22%) and 29% (range: 24-46%) respectively (p < 0.01), in contrast depending on the location in the upper, middle and lower pole of the kidney 24% (range: 12-36%), 31% (range: 26-46%) and 25% (range: 15-38%), respectively (p < 0.05) Depending on the time of warm ischemia for up to and above 10 mines a relative loss of kidney function of surgery was set at 21% (range: 12-24%) and 31% (range: 29-46%), respectively (p < 0.1).
The results of this study suggest that the loss of kidney function after NSS procedures for renal cortical tumor is the largest in the middle field of tumor endophytic growth where, during the operation the time of warm ischemia is the longest. Tumors of this type should be operating in the centers performing these procedures on a routine basis.
在保留肾单位手术（NSS）中，最重要的是肿瘤学结局以及最大程度保留肾功能。使用99mTc - DTPA的肾闪烁造影术可用于评估肾功能及其在手术后因肿瘤导致的变化。
根据肿瘤位置、生长类型以及手术肾热缺血时间，使用99mTc - DTPA闪烁造影术评估接受手术的肾脏的肾功能丧失情况。
对30例接受NSS手术治疗肾皮质肿瘤的患者进行肾闪烁造影术，肿瘤直径约3.2 cm（范围：2.5 - 4.1 cm），术前及术后平均3.8个月（范围：2.3 - 5.4个月）。所有患者根据热缺血时间（10分钟及以内和超过10分钟）、肿瘤生长类型（内生性和外生性）以及肿瘤位置（上极、中极和下极）进行分层。
根据肾脏肿瘤生长类型，外生性和内生性肿瘤手术后肾功能的相对丧失分别为16%（范围：12 - 22%）和29%（范围：24 - 46%）（p < 0.01）；相比之下，根据肿瘤位于肾脏上极、中极和下极，分别为24%（范围：12 - 36%）、31%（范围：26 - 46%）和25%（范围：15 - 38%）（p < 0.05）。根据热缺血时间10分钟及以内和超过10分钟，手术肾功能的相对丧失分别为21%（范围：12 - 24%）和31%（范围：29 - 46%）（p < 0.1）。
本研究结果表明，肾皮质肿瘤NSS手术后肾功能丧失在肿瘤内生性生长的中间区域最大，在此区域手术期间热缺血时间最长。此类肿瘤应在常规开展这些手术的中心进行手术。
