Morávek P, Navrátil P, Base J
Urologická klinika FN a LF UK, Hradec Králové.
Cas Lek Cesk. 1996 Sep 11;135(17):555-7.
Radical surgery is considered standard treatment of renal tumours confined to the organ without detectable multiple metastases. In some circumstances, however, imperative or elective conservative surgery is indicated. The objective of the present work was, based on the authors' experience, to define more accurately indications for conservative surgery and evaluate the rate of local relapses of tumours and the patients' survival.
The method of conservative surgery was used in 58 patients (34 men, 24 women, mean age 26-76 years, range 56 years). The indications for surgery were as follows: bilateral tumour (11x), tumour in solitary kidney (4x), tumour in kidney of abnormal shape (2x), and tumour defined by a capsule growing extrarenally reaching a size up to 3 cm (39x). In small tumours, less than 3 cm, 29x enucleation was performed and 10 times resection of the kidney. In patients with a bilateral tumour, with a tumour in a solitary kidney in kidneys with an abnormal shape or functionally impaired kidneys 15x resection and 4x enucleation of the tumour was performed. On histological examination 20% of the tumours were classified as benign. One to five-year survival after operation was evaluated in patients with histologically confirmed malignant tumours. On comparison with five-year survival of patients with a malignant tumour after radical nephrectomy (patients of the authors), it was revealed that after conservative surgery 85% patients survived, while after a radical operation only 57%. This difference is according to the authors due among others to a low biological activity of small tumours, their low staging and grading.
An imperative or elective conservative operation is beneficial in particular in patients with a small tumour and low grading. This is suggested by the higher percentage of patients surviving five years after operation without evidence of a local relapse of the tumour.
根治性手术被认为是局限于器官且无可检测到的多处转移的肾肿瘤的标准治疗方法。然而，在某些情况下，需要进行紧急或选择性保守手术。基于作者的经验，本研究的目的是更准确地界定保守手术的适应症，并评估肿瘤局部复发率和患者生存率。
58例患者（34例男性，24例女性，平均年龄26 - 76岁，范围56岁）采用了保守手术方法。手术适应症如下：双侧肿瘤（11例）、孤立肾肿瘤（4例）、形态异常的肾脏中的肿瘤（2例）以及由包膜界定的肾外生长且大小达3 cm的肿瘤（39例）。对于小于3 cm的小肿瘤，29例进行了剜除术，10例进行了肾脏切除术。对于双侧肿瘤、孤立肾肿瘤、形态异常的肾脏中的肿瘤或功能受损的肾脏中的肿瘤患者，15例进行了肿瘤切除术，4例进行了肿瘤剜除术。组织学检查显示20%的肿瘤为良性。对组织学确诊为恶性肿瘤的患者进行了术后1至5年生存率评估。与作者所做的根治性肾切除术后恶性肿瘤患者的5年生存率相比，发现保守手术后85%的患者存活，而根治性手术后仅57%的患者存活。作者认为，这种差异尤其归因于小肿瘤的低生物学活性、低分期和低分级。
紧急或选择性保守手术尤其对小肿瘤且分级低的患者有益。这一点由术后5年存活且无肿瘤局部复发证据的患者比例较高所表明。
