Power Nicholas E, Silberstein Jonathan L, Touijer Karim
Urology Service, Department of Surgery, University of Western Ontario, London, Ontario, Canada.
Arch Esp Urol. 2013 Jan-Feb;66(1):90-8.
To examine the role of laparoscopic partial nephrectomy in the management of small renal masses.
We searched MEDLINE (through March 2012) using PubMed, the Cochrane Central Search Library (though March 2012), and Web of Science (through March 2012). We retrieved citations using the text terms "small renal mass," "laparoscopic," "partial nephrectomy,"and "radical nephrectomy." We limited the search to articles in the English language, to T1a renal tumors, and expanded the search using the related articles function. We also performed hand searches of references identified in electronically abstracted articles.
There is a paucity of well conducted clinical trials to elucidate laparoscopic partial nephrectomy's role. A number of assumptions had to be made to complete the review. Other than possibly less operative blood loss, less operative time, less inpatient stay time, and less cost, there was insufficient evidence to support laparoscopic partial nephrectomy over other modalities. Laparoscopic partial nephrectomy appears to have a higher rate of radical nephrectomy conversion.
There is insufficient evidence to clearly state that laparoscopic partial nephrectomy is the gold standard in the management of small renal masses. If this skill is part of a surgeon's armamentarium, it is certainly not inferior to other modalities, and may offer some benefit to patients.
探讨腹腔镜下肾部分切除术在小肾肿瘤治疗中的作用。
我们通过PubMed检索MEDLINE（截至2012年3月）、Cochrane中心检索库（截至2012年3月）以及Web of Science（截至2012年3月）。我们使用“小肾肿瘤”“腹腔镜”“肾部分切除术”和“根治性肾切除术”等文本词检索文献。检索限于英文文章、T1a期肾肿瘤，并使用相关文章功能进行扩展检索。我们还对手检电子文摘文章中识别出的参考文献进行了手工检索。
缺乏设计良好的临床试验来阐明腹腔镜下肾部分切除术的作用。为完成本综述，不得不做出一些假设。除了可能术中失血更少、手术时间更短、住院时间更短以及费用更低外，没有足够证据支持腹腔镜下肾部分切除术优于其他治疗方式。腹腔镜下肾部分切除术转为根治性肾切除术的比例似乎更高。
没有足够证据明确表明腹腔镜下肾部分切除术是小肾肿瘤治疗的金标准。如果这项技术是外科医生的技能储备之一，它肯定不逊色于其他治疗方式，并且可能给患者带来一些益处。
