Metwalli Adam R, Linehan William M
Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Curr Opin Urol. 2014 Sep;24(5):466-73. doi: 10.1097/MOU.0000000000000094.
Despite the controversy surrounding the benefits of nephron-sparing surgery, multiple absolute indications for nephron-sparing surgery still exist, including the classic indications of hereditary and bilateral kidney tumors.
Multiple genetic mutations have been identified which lead to hereditary kidney cancer conditions. These are briefly reviewed because the surgical management of hereditary kidney tumors depends on the genetic and histologic subtypes involved. Clear understanding of these hereditary conditions is crucial for proper surgical management of these tumors.
Complex partial nephrectomy for multiple renal tumors, or multiplex partial nephrectomy, requires not only exceptional surgical skills but expertise of numerous nonsurgical methodologies, such as hands-on intraoperative ultrasonography and interpretation of multiple imaging modalities. In addition, multidisciplinary management is crucial for optimal outcomes in patient care. This review evaluates the most advanced surgical techniques and perioperative management required to successfully care for these challenging cases.
尽管围绕保留肾单位手术的益处存在争议，但保留肾单位手术仍有多个绝对适应证，包括遗传性和双侧肾肿瘤的经典适应证。
已鉴定出多种导致遗传性肾癌的基因突变。由于遗传性肾肿瘤的手术管理取决于所涉及的基因和组织学亚型，因此对这些突变进行简要综述。清楚了解这些遗传性疾病对于这些肿瘤的正确手术管理至关重要。
对于多发肾肿瘤进行复杂的部分肾切除术，即多重部分肾切除术，不仅需要卓越的手术技能，还需要多种非手术方法的专业知识，如术中亲手操作超声检查以及解读多种影像学检查结果。此外，多学科管理对于患者护理的最佳结果至关重要。本综述评估了成功处理这些具有挑战性病例所需的最先进手术技术和围手术期管理。
