Steinbach F, Stöckle M, Hohenfellner R
Department of Urology, Mainz Medical School, Germany.
World J Urol. 1995;13(3):163-5. doi: 10.1007/BF00184872.
The role of nephron-sparing surgery for renal cell carcinoma is well established in patients with an anatomical or functional solitary kidney (imperative indication) in which a radical nephrectomy would render the patient anephric with subsequent need for hemodialysis. This also encompasses patients with a unilateral renal cell carcinoma and a functioning contralateral kidney when the opposite renal unit is affected by a disease that might threaten its future function, such as renal artery stenosis, chronic pyelonephritis, stone disease or systemic conditions such as diabetes. A functioning renal remant of at least 20% of normal renal parenchyma seems to be necessary to avoid end-stage renal failure in these patients [16]. There have been several reports in the literature of excellent 5-year cancer-specific survival rates of over 80% in such circumstances [12, 15]. These results were confirmed in our institution, with a 5-year cancer-specific survival rate of 83% in over 70 patients with an imperative indication for nephron-sparing surgery. Thereby the prognosis was significantly influenced by the local tumor stage and the grade of malignancy. These data support the efficacy of nephron-sparing surgery in this clinical situation.
保留肾单位手术在解剖学或功能上为孤立肾（绝对适应证）的肾细胞癌患者中的作用已得到充分确立，在这类患者中，根治性肾切除术会使患者无肾，随后需要进行血液透析。这也包括单侧肾细胞癌且对侧肾功能正常，但对侧肾单位受到可能威胁其未来功能的疾病影响的患者，如肾动脉狭窄、慢性肾盂肾炎、结石病或糖尿病等全身性疾病。对于这些患者，为避免终末期肾衰竭，保留至少20%正常肾实质的有功能肾残余似乎是必要的[16]。文献中有几篇报道称，在这种情况下5年癌症特异性生存率超过80%，效果极佳[12, 15]。我们机构也证实了这些结果，70多名有保留肾单位手术绝对适应证的患者5年癌症特异性生存率为83%。因此，预后受到局部肿瘤分期和恶性程度的显著影响。这些数据支持了保留肾单位手术在这种临床情况下的疗效。
