el Khader K, Ziadé J, Bansard J Y, Mhidia A, Patard J J, Guillé F, Lobel B
Service d'Urologie, CHU de Rennes, France.
Prog Urol. 1998 Jun;8(3):341-6.
To evaluate the medium-term and long-term impact of radical nephrectomy on renal function and to identify prognostic factors able to help predict deterioration of renal function in patients treated for renal cancer by radical nephrectomy, with a functionally and morphologically healthy remaining kidney.
Between January 1992 and June 1996, 114 patients (72 males, 42 females) with renal cancer were treated by radical nephrectomy. The contralateral kidney was healthy. The mean age of the patients was 64 years (31-85 years). Pre- and postoperative renal function was assessed by serum creatinine assay, in micromol/l.
105 patients were alive (16 with metastases) and 9 had died. The mean follow-up of the survivors was 19.6 months (3-53 months). A slight elevation of mean serum creatinine was observed in this group after nephrectomy compared to preoperative figures (117.9 micromol/l versus 95.6 micromol/l). 37 patients (35.2%) had a postoperative serum creatinine greater than or equal to 121 micromol/l, most of them were elderly, male (81%) and/or hypertensive (43%) and/or diabetic (11%). 6 (5.7%) of these 37 patients had a serum creatinine greater than or equal to 170 micromol/l and all were hypertensive and/or diabetic.
This study shows that HT, diabetes, advanced age and male sex constitute risk factors for deterioration of renal function. The indication for conservative surgery for T1 T2 N0 M0 tumours should be discussed in the presence of these factors. In their absence and provided the remaining kidney is healthy, renal function remains relatively stable after radical nephrectomy for cancer.
评估根治性肾切除术对肾功能的中长期影响，并确定能够帮助预测接受根治性肾切除术治疗的肾癌患者肾功能恶化的预后因素，这些患者的剩余肾脏在功能和形态上均健康。
1992年1月至1996年6月期间，114例肾癌患者（72例男性，42例女性）接受了根治性肾切除术。对侧肾脏健康。患者的平均年龄为64岁（31 - 85岁）。术前和术后肾功能通过血清肌酐测定进行评估，单位为微摩尔/升。
105例患者存活（16例有转移），9例死亡。存活者的平均随访时间为19.6个月（3 - 53个月）。与术前数据相比，该组患者肾切除术后平均血清肌酐略有升高（117.9微摩尔/升对95.6微摩尔/升）。37例患者（35.2%）术后血清肌酐大于或等于121微摩尔/升，其中大多数为老年人、男性（81%）和/或高血压患者（43%）和/或糖尿病患者（11%）。这37例患者中有6例（5.7%）血清肌酐大于或等于170微摩尔/升，且均为高血压和/或糖尿病患者。
本研究表明，高血压、糖尿病、高龄和男性是肾功能恶化的危险因素。对于存在这些因素的T1 T2 N0 M0肿瘤患者，应讨论保守手术的指征。在不存在这些因素且剩余肾脏健康的情况下，肾癌根治性肾切除术后肾功能相对稳定。
