保留肾单位手术的研究进展

Research Progress in Nephron-sparing Surgery

肾细胞癌(Renal cell carcinoma,RCC )占所有恶性肿瘤的2%,在过去的65年间,RCC的发病率每年增长2%。尤其是近20年,随着影像学技术的发展和健康查体的普及,小肾癌检出率的提高最为明显。外科手术是治疗肾癌的主要手段。最初保留肾单位手术仅用于行根治性肾切除术将导致功能性无肾、必须透析的患者,包括孤立肾、对侧肾功能不全、双侧多原发RCC。现在保留肾单位手术对于T_(1a)、T_(1b)(最大径≤7cm)和对侧肾脏功能正常患者的应用日益增多,且治疗效果与根治性肾切除术相似。更多研究表明,保留肾单位手术相比肾癌根治术延长了长期生存时间,降低了心血管疾病发生率。然而,保留肾单位手术并未得到广泛开展,其中主要原因是很多临床医生对保留肾单位手术的安全性、适应证、手术切除范围、并发症等方面还存有困惑。本文将对上述热点问题进行综述。

Renal cell carcinoma （RCC） accounts for approximately 2% of all malignancies. The incidence of RCC has increased by 2% per year for the past 65 years. Over the past two decades, with the widespread use of imaging methods, the frequency of incidental detection of RCC has increased. Surgery is an important therapeutic method for renal cell carcinoma. Originally, nephron-sparing surgery was indicated only for those treated with radical nephrectomy which would render the patients functionally anephric and requiring dialysis. These settings include RCC in a solitary kidney, RCC in one kidney with contralateral inadequate renal fuction, and bilateral synchronous RCC. However, nephron-sparing surgery has been used increasingly in patients with T1a and T1b renal tumors （i.e. up to 7 cm in the greatest dimension） and a normal contralateral kidney, with equivalent outcomes to radical nephrectomy. Compared with radical nephrectomy, nephron-sparing surgery can increase patient survival and reduce the risk of cardiovascular events. However, nephron-sparing surgery has not been widely used yet because most surgeons are confused of its safety, indication, resection range and complications.