Partial nephrectomy for patients with a solitary kidney: the Memorial Sloan-Kettering experience
Partial nephrectomy for patients with a solitary kidney: the Memorial Sloan-Kettering experience
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DOI：
10.1111/j.1464-410x.2004.05165.x
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发表时间：
2004-12-01
影响因子：
4.5
通讯作者：
Russo, P
中科院分区：
文献类型：
--
作者：
Saranchuk, JW;Touijer, AK;Russo, P
CAPTIVETo报告的经验，在一个机构的孤立肾患者的肾部分切除术，与肾功能，并发症，肿瘤疗效和survival.Patients和METHODS分析，我们确定了54个连续的孤立肾谁有一个肾部分切除术1989年12月至2003年7月之间的患者。检查的变量包括患者年龄和性别、肾功能、肾缺血时间、手术切缘状态和并发症。还评估了病理学特征，例如肿瘤大小、组织学亚型和肿瘤分期。组织学类型：透明细胞型35例（65%），乳头状瘤型10例（19%），嗜酸细胞瘤型4例（7%），嫌色细胞型2例（4%），未分类型1例（2%），多种亚型2例（2%）。术前中位肌酐水平为14 mg/L，术后6个月升高至16 mg/L，术后1年和2年为15 mg/L。2例患者发生终末期肾病，需要血液透析，1例在手术后不久，另1例在保留肾单位手术后8年。总的来说，26%的患者发生了至少一种围手术期并发症，其中急性肾衰竭和尿瘘是最常见的。在5年的整体和癌症特异性生存率，和无病概率分别为68%，88%和73%，respectively. CONCLUSIONSPartial肾切除术是安全的患者孤立肾，肾功能下降，需要临时或永久性血液透析的可能性低，可接受的。在最初的下降之后，肾功能在第一年似乎稳定下来。
OBJECTIVETo report the experience of partial nephrectomy in patients with a solitary kidney at one institution, with analysis of renal function, complications, oncological efficacy and survival.PATIENTS AND METHODSWe identified 54 consecutive patients with a solitary kidney who had a partial nephrectomy between December 1989 and July 2003. Variables examined included patient age and gender, renal function, renal ischaemia time, surgical margin status and complications. Pathological features, e.g. tumour size, histological subtype and tumour stage, were also assessed. Disease-free probability and overall and cancer-specific survivals were determined.RESULTSThe histological subtype was clear cell in 35 cases (65%), papillary in 10 (19%), oncocytoma in four (7%), chromophobe in two (4%), unclassified in one (2%) and multiple subtypes in two (2%). The median creatinine level before surgery was 14 mg/L, which increased to 16 mg/L 6 months afterward, and at 1 and 2 years after surgery it was 15 mg/L. Two patients developed end-stage renal disease requiring haemodialysis, one soon after surgery and another 8 years after nephron-sparing surgery. In all, 26% of patients developed at least one perioperative complication, with acute renal failure and urinary fistula being the most common. At 5 years the overall and cancer-specific survival, and disease-free probability were 68%, 88% and 73%, respectively.CONCLUSIONSPartial nephrectomy is safe in patients with a solitary kidney, with an acceptable decline in renal function and low likelihood of requiring temporary or permanent haemodialysis. After an initial decline, renal function appears to stabilize during the first year.