Terrone C, Favro M, Neira D, Rocca Rossetti S
Clinica Urologica dell'Università di Torino, Italy.
Ann Urol (Paris). 1997;31(3):137-44.
Conservative surgery was initially limited to patients with localized RCC present bilaterally or in a solitary kidney, in whom radical nephrectomy would necessitate immediate renal replacement therapy. Today, the widespread use of abdominal ultrasound as screening modality in patients with nonspecific or unrelated symptoms allows the detection of renal parenchymal tumors rarely seen before: asymptomatic, small and unilateral neoplasms, often surrounded by a thick and complete pseudocapsule. Global renal function and contralateral kidney are usually normal and the patients show good performance status. For these reasons and because of the generally good results of the first experiences, several authors advocate conservative surgery as an elective indication. Recently, some studies have reported promising results with this approach. On the other hand, some controversial issues persist (multifocality of RCC, low risk of local relapse and renal failure after radical surgery, low incidence of tumor in the contralateral kidney) reducing the opportunity to perform nephron-sparing surgery when the contralateral kidney is normal. In the present study, we report our experience of nephron-sparing surgery for RCC and we review the current and international opinion concerning this treatment.
保守性手术最初仅限于双侧出现局限性肾细胞癌（RCC）或孤立肾患者，对于这些患者，根治性肾切除术将需要立即进行肾脏替代治疗。如今，腹部超声作为一种筛查手段广泛应用于有非特异性或无关症状的患者，这使得能够检测到以前很少见到的肾实质肿瘤：无症状、小的单侧肿瘤，通常被厚且完整的假包膜所包围。总体肾功能和对侧肾脏通常正常，患者表现出良好的身体状况。由于这些原因以及首次经验总体良好的结果，一些作者主张将保守性手术作为一种选择性适应症。最近，一些研究报告了这种方法取得的有前景的结果。另一方面，一些有争议的问题仍然存在（RCC的多灶性、根治性手术后局部复发和肾衰竭的低风险、对侧肾脏肿瘤的低发病率），当对侧肾脏正常时，减少了进行保留肾单位手术的机会。在本研究中，我们报告了我们对RCC进行保留肾单位手术的经验，并回顾了有关这种治疗的当前国际观点。
