Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Curr Opin Urol. 2013 Sep;23(5):394-8. doi: 10.1097/MOU.0b013e32836320be.
Partial nephrectomy for larger kidney tumors (T1b) has gained widespread acceptance in most academic institutions, with similar oncologic outcomes to radical nephrectomy. This review focuses on the factors that affect renal function after partial nephrectomy, and presents current information about the relative importance of each factor as well as chronic kidney disease (CKD) after renal surgery.
CKD occurs over the long term in a significant percentage of patients following partial nephrectomy. The interaction of different factors including baseline kidney function (influenced by age and medical comorbidity), amount of preserved renal parenchyma (influenced by surgical technique), and ischemia time (warm or cold) determines the ultimate functional outcome. De-novo CKD resulting from surgery in previously healthy individuals may not place these patients at increased risk of progression or mortality.
Urologists continue to strive towards improved kidney function after partial nephrectomy, particularly for larger tumors. Careful identification of factors involved in functional outcome, and optimization of modifiable factors, will remain at the forefront of efforts to minimize renal functional loss after partial nephrectomy.
对于大多数学术机构来说，部分肾切除术治疗较大的肾肿瘤（T1b）已被广泛接受，其肿瘤学结果与根治性肾切除术相似。本综述重点关注影响部分肾切除术后肾功能的因素，并介绍目前关于每个因素以及肾手术后慢性肾脏病（CKD）相对重要性的信息。
部分肾切除术后，相当一部分患者的 CKD 会长期存在。不同因素的相互作用，包括基线肾功能（受年龄和合并症影响）、保留的肾实质量（受手术技术影响）和缺血时间（温热或寒冷），决定了最终的功能结果。在原本健康的个体中，由于手术而导致的新发性 CKD 可能不会增加这些患者进展或死亡的风险。
泌尿科医生继续努力提高部分肾切除术后的肾功能，特别是对于较大的肿瘤。仔细识别与功能结果相关的因素，并优化可改变的因素，将仍然是努力的重点，以最大限度地减少部分肾切除术后肾功能的丧失。
