Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, c4830B, Hershey, PA 17033, USA.
Curr Urol Rep. 2013 Apr;14(2):102-8. doi: 10.1007/s11934-013-0305-1.
While radical nephroureterectomy represents the gold standard for managing upper-tract urothelial carcinoma, nephron-sparing approaches have increasingly been utilized in the elective setting. Such considerations are accentuated by contemporary studies highlighting sequelae related to chronic kidney disease following nephrectomy. Kidney sparing treatments including segmental ureteral resection and endoscopic ablation may therefore be appropriate in select patients with small, solitary, low-grade upper-tract tumors. Bladder and ipsilateral upper-tract recurrences are frequent after nephron-sparing treatments for UTUC, thereby underscoring the need to maintain strict radiographic and endoscopic surveillance protocols in patients amenable to this rigorous compliance program.
虽然根治性肾输尿管切除术是治疗上尿路上皮癌的金标准，但保肾手术在选择性治疗中已越来越多地被采用。当代研究强调了肾切除术后慢性肾脏病相关的后遗症，这使得这种考虑更加突出。因此，对于患有小的、单发的、低级别上尿路上皮肿瘤的特定患者，包括节段性输尿管切除和内镜消融在内的保肾治疗可能是合适的。保肾治疗后，膀胱癌和同侧上尿路复发很常见，因此，对于适合这种严格依从性方案的患者，需要保持严格的影像学和内镜监测方案。
