Urology Department, Mubarak Al Kabeer Hospital &Sabah Al Ahmad Urology Centre, PO Box 43787, State of Kuwait.
Department of Surgery - Urology Clinic, University of Padua, Via Giustiniani 35100, Padua, Italy.
Nat Rev Urol. 2016 Nov;13(11):674-683. doi: 10.1038/nrurol.2016.185. Epub 2016 Oct 18.
Nephron-sparing surgery for the removal of small renal masses delivers equivalent oncological outcomes and better functional outcomes compared with those associated with radical nephrectomy. All contemporary partial nephrectomy techniques including open, laparoscopic and robotic approaches involve the use of hilar clamping in order to facilitate haemostasis, and to enable accurate tumour excision and parenchymal reconstruction. Zero ischaemia was subsequently introduced as a technique to eliminate the renal ischaemia induced by hilar clamping. Following the introduction of zero ischaemia techniques, researchers have arbitrarily applied this term to techniques ranging from no use of clamping to selective clamping of renal arteries and/or veins, or their branches. Substantial variations exist in the way that zero ischaemia and other renal preservation techniques are described in the literature. Similarly, further diversity exists in the measurement and reporting of functional outcomes after surgery. The introduction of standard and reproducible classifications or guidelines will ensure consistency and uniformity. Establishing consensus on the terminology used to describe techniques and functional outcomes will not only facilitate improved communication and surgical practice, but will also enable critical appraisal of surgical techniques.
保肾手术切除小肾肿瘤可获得与根治性肾切除术相当的肿瘤学结果和更好的功能结果。所有现代的部分肾切除术技术，包括开放、腹腔镜和机器人方法，都涉及使用肾门夹闭来促进止血，并实现准确的肿瘤切除和实质重建。随后引入了无缺血技术来消除肾门夹闭引起的肾缺血。在引入无缺血技术后，研究人员随意将这个术语应用于从不使用夹闭到选择性夹闭肾动静脉及其分支的技术。在文献中，无缺血和其他保肾技术的描述方式存在很大差异。同样，手术后功能结果的测量和报告也存在进一步的多样性。引入标准和可重复的分类或指南将确保一致性和统一性。就描述技术和功能结果的术语达成共识，不仅将有助于改善沟通和手术实践，还将能够对手术技术进行批判性评估。
