Lee S E, Kim H H
Department of Urology, Seoul National University College of Medicine, Korea.
Eur Urol. 1994;25(3):204-8. doi: 10.1159/000475284.
A study was performed to evaluate whether kidney-preserving surgery would be appropriate or not, and in the affirmative for which indications. Eighty-one kidneys removed at Seoul National University Hospital between January 1987 and June 1991 were serially cut into 5-mm slices to probe for any small renal lesions. Of the 81 kidneys, 15 (18.5%) renal units contained 39 satellite nodules with histological patterns identical to the primary tumor. The number of satellite nodules was 2.6 per kidney (range 1-6). The size of the satellite nodules ranged from 0.5 to 2 cm (mean 0.9 cm). The presence of satellite nodules increased with increasing T stage and size of the primary tumor (p < 0.05 by Fisher's exact test). The presence of satellite nodules was significantly different between kidneys with primary tumors larger than 7 cm and less than 7 cm (p < 0.05 by the chi 2 test). Especially, no satellite nodules were found in 23 kidneys whose primary tumors were less than 5 cm. These observations suggest that kidney-preserving surgery could be a valuable treatment option for small localized renal cell carcinoma not only in patients with a single kidney or deteriorated contralateral kidney function but also in patients with normal contralateral kidneys, especially when the size of the tumor is less than 5 cm.
进行了一项研究以评估保肾手术是否合适，若合适则针对哪些适应症。对1987年1月至1991年6月在首尔国立大学医院切除的81个肾脏进行连续切片，切成5毫米厚的薄片以探查任何小的肾脏病变。在这81个肾脏中，15个（18.5%）肾单位含有39个卫星结节，其组织学模式与原发肿瘤相同。每个肾脏的卫星结节数量为2.6个（范围为1 - 6个）。卫星结节的大小在0.5至2厘米之间（平均0.9厘米）。卫星结节的出现随着原发肿瘤T分期和大小的增加而增加（通过Fisher精确检验，p < 0.05）。原发肿瘤大于7厘米和小于7厘米的肾脏之间卫星结节的出现情况有显著差异（通过卡方检验，p < 0.05）。特别是，在23个原发肿瘤小于5厘米的肾脏中未发现卫星结节。这些观察结果表明，保肾手术可能是小局限性肾细胞癌的一种有价值的治疗选择，不仅适用于单肾患者或对侧肾功能恶化的患者，也适用于对侧肾功能正常的患者，尤其是当肿瘤大小小于5厘米时。
