USC Institute of Urology, Hillard and Roclyn Herzog Center for Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, USA.
Curr Opin Urol. 2013 Mar;23(2):112-7. doi: 10.1097/MOU.0b013e32835d6b29.
Presently, there is debate over what drives ultimate postoperative function after partial nephrectomy. Some argue that volume of preserved parenchyma and baseline renal function virtually exclusively drive functional outcomes. Others contend that global renal ischemic injury also matters. Herein, we critically review recent literature, with particular focus on emerging data of functional outcomes after ischemia-free partial nephrectomy.
Recent retrospective reports suggest the primacy of renal volume preservation and baseline renal function over ischemia time in impacting post-partial nephrectomy function. These studies rely on historical series when the technique of selective clamping was not available. Data from more contemporary series indicate superior functional outcomes when partial nephrectomy is performed without global ischemia, even after correcting for volume loss. Elimination of global ischemia is made possible through novel technical refinements, such as anatomical partial nephrectomy surgery.
Amount of kidney excised and ischemia time are inseparably interlinked; the larger/deeper the tumor, the longer the ischemia time. Post-partial nephrectomy kidney quantity and quality are surgically nonmodifiable; however, ischemia time is. Anatomical tumor-specific devascularization opens the door to more sophisticated partial nephrectomy surgery, wherein we can now tailor the technique to the individual tumor and patient.
目前，对于部分肾切除术术后最终功能的驱动因素仍存在争议。一些人认为保留的肾实质体积和基线肾功能几乎完全决定了功能结果。另一些人则认为整体肾缺血损伤也很重要。本文批判性地回顾了近期文献，特别关注无缺血性部分肾切除术的功能结果的新数据。
最近的回顾性报告表明，在影响部分肾切除术后功能方面，肾体积保留和基线肾功能比缺血时间更为重要。这些研究依赖于选择性夹闭技术不可用时的历史系列。来自更现代系列的数据表明，即使在纠正体积损失后，当不进行整体缺血时，部分肾切除术可获得更好的功能结果。通过新的技术改进，如解剖性部分肾切除术，实现了整体缺血的消除。
切除的肾脏量和缺血时间是不可分割地相互关联的；肿瘤越大/越深，缺血时间越长。部分肾切除术后的肾脏数量和质量是手术无法改变的；然而，缺血时间是可以改变的。肿瘤特异性解剖性去血管化为更复杂的部分肾切除术手术打开了大门，我们现在可以根据肿瘤和患者的个体情况调整技术。
