Rusinek Michał, Salagierski Marek, Różański Waldemar, Jakóbczyk Bartłomiej, Markowski Michał, Lipiński Marek, Wilkosz Jacek
IInd Department of Urology, Medical University of Lodz, al. Kościuszki 4, 90-419 Łódź, Poland.
J Pers Med. 2022 Mar 18;12(3):495. doi: 10.3390/jpm12030495.
Implementation of ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) into abdominal cavity diagnostics enabled early detection of cT1 graded renal cancers. According to European Association of Urology (EAU) and Polish urological Association (PUA) recommended method of treatment is sparing resection of renal parenchyma with tumour-nephron-sparing surgery (NSS). In selected cases other methods such as thermal ablation (TA) or cryoablation can be introduced /1/.
To evaluate the results of treatment of cT1 renal tumours with the use of NSS and TA methods.
140 patients with cT1 renal carcinoma were treated in 2nd Department of Urology of Medical University of Lodz between 2014 and 2017. Neuron-sparing surgery was performed in 56 cases (40%), while percutane-ous thermal ablation (TA) in 84 cases (60%). Demographic data, clinical data (lab results, Charlson index), nephrometry data (tumour size, location, R.E.N.A.L. score) post-operative data (Clavien-Dindo classifica-tion) were investigated. Histopathology results, Fuhrman malignancy grading, as total three-year survival of patients were evaluated. The following methods were used for statistical evaluation: Chi2, Fisher, W Shapiro-Wilk, U Mann-Whitney tests, Kaplan-Meier's curve and Cox model. The results were displayed in a form of median and upper and lower quartile values (25-75%).
No statistical differences in gender nor left/right kidney location were observed. Patients, who underwent TA were at average 10 years older and had multiple comorbidities (median age for TA was 79, for NSS 68; median Charlson index for TA was 5 and for NSS was 3). TA patients had lesser haematological values (Hb, Ht). R.E.N.A.L. scoring demonstrated comparable nephrometry in both groups. NSS procedure was open laparotomy without temporary clamping of renal vessels. Surgical margins of resected tumours were negative. TA was performed with Cool-Tip Covidienequipment with the use of Cluster electrode and was ultraso-nography-guided. Post-treatment complications evaluated with the use of Clavien-Dindo classification were slightly more frequent for NSS method. Patients after NSS were discharged at average after 8.5 days and after TA after 3 days. Histopathological type and Fuhrman malignancy grading were comparable in both groups. TA treated patients' death risk was 9-fold of that observed in NSS treated patients. There was 1 death for each group in perioperative period.
将超声检查（USG）、计算机断层扫描（CT）和磁共振成像（MRI）应用于腹腔诊断能够早期发现cT1级肾癌。根据欧洲泌尿外科学会（EAU）和波兰泌尿外科学会（PUA）的建议，治疗方法是采用保留肾单位手术（NSS）对肾实质进行保留肿瘤的切除术。在某些特定情况下，可采用其他方法，如热消融（TA）或冷冻消融 /1/。
评估使用NSS和TA方法治疗cT1期肾肿瘤的效果。
2014年至2017年期间，罗兹医科大学第二泌尿外科对140例cT1期肾癌患者进行了治疗。其中56例（40%）接受了保留肾单位手术，84例（60%）接受了经皮热消融（TA）。研究了人口统计学数据、临床数据（实验室检查结果、查尔森指数）、肾计量学数据（肿瘤大小、位置、R.E.N.A.L.评分）、术后数据（Clavien-Dindo分级）。评估了组织病理学结果、富尔曼恶性分级以及患者的三年总生存率。采用以下统计评估方法：卡方检验、费舍尔检验、W夏皮罗-威尔克检验、U曼-惠特尼检验、卡普兰-迈耶曲线和考克斯模型。结果以中位数以及上下四分位数（25 - 75%）的形式呈现。
在性别以及左右肾位置方面未观察到统计学差异。接受TA治疗的患者平均年龄大10岁且有多种合并症（TA组的中位年龄为79岁，NSS组为68岁；TA组的中位查尔森指数为5，NSS组为3）。TA组患者的血液学指标（血红蛋白、血细胞比容）较低。R.E.N.A.L.评分显示两组的肾计量学情况相当。NSS手术采用开放性剖腹术，未临时夹闭肾血管。切除肿瘤的手术切缘为阴性。TA采用柯惠Cool-Tip设备，使用集束电极，并在超声引导下进行。使用Clavien-Dindo分级评估的治疗后并发症在NSS组稍多。NSS组患者平均8.5天后出院，TA组患者平均3天后出院。两组的组织病理学类型和富尔曼恶性分级相当。TA治疗患者的死亡风险是NSS治疗患者的9倍。围手术期每组各有1例死亡。
