Frees S K, Mager R, Borgmann H, Jäger W, Thomas C, Haferkamp A
Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
Urologe A. 2018 Mar;57(3):280-284. doi: 10.1007/s00120-018-0583-9.
Several new treatment strategies have emerged in the treatment of small renal masses (<4 cm in diameter). Active surveillance and ablative techniques have been introduced but it remains unclear which patients will benefit the most from these new treatment options. A surgical approach remains standard of care. In recent decades, radical nephrectomy has been replaced by nephron-sparing surgery for the management of small renal masses.
In addition to the open partial nephrectomy, which is considered the standard approach, the number of surgeries performed using minimally invasive techniques is increasing. Recent data show that there might be some benefits such as less blood loss. The disadvantages shown by laparoscopic partial nephrectomy such as prolonged warm ischemia, longer operation times, and postoperative renal impairment might be negligible for the robotic approach. Therefore, current guidelines allow these approaches in addition to open partial nephrectomy if sufficient surgical expertise is given.
在小肾肿块（直径<4厘米）的治疗中出现了几种新的治疗策略。主动监测和消融技术已被引入，但仍不清楚哪些患者将从这些新的治疗选择中获益最大。手术方法仍然是标准的治疗方式。近几十年来，根治性肾切除术已被保留肾单位手术所取代，用于治疗小肾肿块。
除了被认为是标准方法的开放性部分肾切除术外，使用微创技术进行的手术数量正在增加。最近的数据表明，可能存在一些益处，如失血较少。腹腔镜部分肾切除术所显示的缺点，如长时间的热缺血、更长的手术时间和术后肾功能损害，对于机器人手术方法来说可能微不足道。因此，如果有足够的手术专业知识，目前的指南除了开放性部分肾切除术外，也允许采用这些方法。
