保留肾单位手术治疗小肾癌

目前,开放性肾部分切除术仍被认为是治疗小肾癌的标准术式,而腹腔镜下肾部分切除术是一种保留肾单位治疗小肾癌的微创方法.单纯肿瘤剜除术对于选择性的小肾癌患者是一项可接受的、安全的保留肾单位治疗方法,相对于肾部分切除术,它并不增加局部复发的风险.消融技术则给微创下进行保留肾单位手术带来新的方法和新的思路.     

保留肾单位手术治疗肾癌14例临床分析

目的:探讨保留肾单位手术治疗肾癌的安全性和疗效.方法: 回顾性分析1996年6月至2007年6月间14例行肾单位保留手术的肾癌患者的临床资料,其中双侧肾癌1例,孤立肾肾癌2例,对侧肾有病变或潜在功能损害的肾癌4例,对侧肾正常的肾癌7例.肿瘤直径1.6cm-6.8cm,平均4.2cm.14例中行肿瘤剜除术3例,行肾部分切除术6例,肾楔形切除术5例.结果: 14例患者手术均成功.术后随访9-88个月,平均40个月,1例出现远处转移死亡(双侧肾癌患者),1例患者于术后12个月局部复发改行根治性肾切除术,2例术后出现暂时性肾功能不全.结论: 保留肾单位手术治疗肾癌安全有效,尤其适用于低分期小肾癌患者.     

后腹腔镜下保留肾单位肾癌切除术21例

目的探讨后腹腔镜下保留肾单位手术治疗早期肾癌的方法及疗效。方法对21例肾外型局限性肾癌患者行腹腔镜下保留肾单位的肾癌切除术。结果21例手术均成功，术后平均随访11个月，均无瘤生存。结论腹腔镜下保留肾单位的肾癌切除术安全、有效。适用于对侧肾功能正常、肿瘤直径≤4．0cm的肾外型局限性肾癌。     

保留肾单位手术与根治性肾切除术治疗小肾癌疗效的对照研究

评价保留肾单位手术与根治性肾切除术治疗小肾癌疗效,回顾性分析83例肿瘤直径≤4 cm的小肾癌手术治疗的效果,其中保留肾单位手术44例,根治性肾切除术39例.保留肾单位手术与根治性肾切除术相比,术中平均出血量、术后3 d引流量、并发症的发生率以及术后肿瘤复发和转移情况作为评价指标.结果两组患者均顺利完成手术.NSS组与RN组术中出血量分别为[(130±11.5) mL vs (110±10.7) mL];术后3 d引流量两组分别为[(110±8.6) mL vs (96±8.1) mL];并发症发生率(1/44 vs 1/39),两组之间差异无统计学意义.NSS组随访6～86个月(平均46个月),RN组随访8～86个月(平均48个月),均未发现局部复发和远处转移.初步研究结果提示,保留肾单位手术可以最大限度地保存残肾的肾单位和功能,是小肾癌患者有效和可靠的治疗方法,目前仍被认为是小肾癌治疗的金标准.中华肿瘤防治杂志,2009,16(13):1033-1035     

保留肾单位手术治疗双肾细胞癌十例临床分析

目的:观察保留肾单位手术治疗双侧肾细胞癌的疗效.方法:回顾性分析10例双侧肾细胞癌患者的临床资料.7例同时性肾癌中,1例行双侧Ⅰ期手术,6例行分期手术.其中3例行双肾肿瘤剜除术,1例行双肾部分切除及右肾上腺切除术,2例行一侧肾癌根治性切除术及对侧肾肿瘤剜除术,1例行一侧肾癌根治性切除术、下腔静脉切开取癌栓术及对侧肾肿瘤剜除术.3例异时性肾癌均分期手术,其中2例行双肾肿瘤剜除术,1例行一侧肾癌根治性切除术,对侧肾肿瘤剜除术.所有患者术后均行生物学治疗3个月.10例获随访3个月～8年,平均19个月.结果:7例未见肿瘤复发和转移.1例术后6个月出现肺转移,已带瘤生存3个月;1例术后1年出现残肾肿瘤复发,经生物学治疗,已带瘤生存3个月;1例术后3个月后死于肾衰竭.异时性肾癌者的先发一侧行肾癌根治术,对侧肾出现肿瘤的时间分别为9个月、2年和6年.结论:保留肾单位的肾切除术是目前双侧肾癌较为理想的治疗方法,它对肾功能的影响较少.双侧肾癌的预后和单侧肾癌一样,与肿瘤的分期和分级有关,而与肿瘤是否多发无关.     

腹膜后腹腔镜下肾部分切除术和根治性肾切除术治疗小肾癌的临床比较

目的探讨腹膜后腹腔镜下肾部分切除术和根治性肾切除术治疗小肾癌的临床疗效。方法将35例小肾癌患者依据手术治疗方式的不同分为A组(腹膜后腹腔镜下肾部分切除术组)20例和B组(腹膜后腹腔镜下根治性肾切除术组)15例。结果两组小肾癌患者手术时间、术中出血量、住院时间、术前和术后24h肌酐、1年、2年、3年生存率差异均无统计学意义(P>0.05)。结论腹膜后腹腔镜下肾部分切除术与根治性肾切除术治疗小肾癌无明显差异,效果较好,值得临床推广应用。     

泌尿外科——肾脏、输尿管

肾淋巴管肌瘸病一例报告;腹腔镜下保留肾单位手术治疗肾肿瘤现状（述评）;后腹腔镜下根治性肾切除术治疗肾癌的疗效观察;后腹腔镜下根治性肾切除术并区域淋巴结清扫术40例报告;非甾体类抗炎药NS398诱导肾癌细胞凋亡的作用及其机制     

小肾癌诊断与治疗(附12例报告)

目的　提高对小肾癌的诊断和治疗水平 ,探讨不同手术方法的优缺点。方法　通过对 1992年 2月～ 2 0 0 1年 2月收治的 12例小肾癌的临床表现、诊断、治疗及预后进行分析并结合有关文献进行讨论。结果　 12例中全部手术治疗 ,9例行根治性肾切除术 ,3例行保留肾单位肾肿瘤切除术 ,术后均经病理证实。 10例获得随访 ,8例无癌存活 ,最长已超过 7年。结论　小肾癌多为B超偶然发现 ,术前B超、CT肾动脉造影综合分析明确诊断 ;手术方式依据具体情况采取根治性切除术或保留肾单位手术 ;预后主要取决于肿瘤的分期和分级。     

泌尿、生殖系统

肾上腺髓性脂肪瘤诊断和治疗（附22例报告）；肾盂癌的监床诊断和治疗（附32例报告）；肾癌下腔静脉癌栓的诊断和手术方法的探讨；微创内视镜下肾癌根治性切除术；保留肾单位肾癌切除术的疗效与随访；伽玛刀治疗肿瘤引起急性肾损害的防治；复发性嗜铬细胞瘤的诊治分析；嗜铬细胞瘤诊疗对策；     

局限性肾癌保留肾单位手术治疗分析(附63例报告)

背景与目的:资料表明,小肾癌可行保留肾单位手术,其效果与根治性肾切除术相同.本研究拟探讨局限性肾癌保留肾单位手术的临床疗效及可行性.方法:对63例局限性肾癌患者行保留肾单位手术.肿瘤平均直径3.4cm.23例阻断肾蒂,其中冰泥降温8例;切缘多点快速冰冻切片病理学检查21例.评价手术时间、肾蒂阻断时间、出血量、并发症、肿瘤控制情况.结果:63例手术均顺利完成,平均手术时间110 min,平均肾蒂阻断时间15 min.21例切缘快速冰冻切片病理检查均为阴性.术后病理报告显示透明细胞癌53例、颗粒细胞癌3例、错构瘤7例.术后出血2例,尿漏1例.平均随访42个月,均无瘤生存.结论:局限性肾癌患者在密切随诊的基础上,应以行保留肾单位的手术治疗为主.     

Laparoscopic partial nephrectomy in the treatment of renal cell carcinoma: a minimally invasive means to nephron preservation

With the advent of cross-sectional imaging, the incidence of asymptomatic detected small renal masses, 'incidentalomas', has increased in the past 20 years. Recent studies have demonstrated that patients with renal masses have worse renal function at baseline and have more comorbidities than the general population. Nephron-sparing surgery allows for maximal preservation of functioning nephrons with comparable oncologic outcomes. Recently, laparoscopic partial nephrectomy has emerged as a minimally invasive nephron-sparing surgical option for treating the appropriately selected renal mass. While open-partial nephrectomy has undisputedly become standard of care for the management of the small renal mass (<4 cm), laparoscopic partial nephrectomy is becoming the preferred option for select patients in institutions in which advanced laparoscopic experience is available.     

Percutaneous radiofrequency ablation: minimally invasive therapy for renal tumors

Currently, up to 60% of renal tumors are detected incidentally by abdominal imaging. Most of these tumors are small and localized to the kidney. Owing to the shift to lower stage at diagnosis, radical nephrectomy has fallen out of favor and has been replaced by nephron-sparing surgery. Currently, partial nephrectomy is the treatment of choice for patients with small renal tumors. As the trend towards less invasive therapy continues, laparoscopic and percutaneous ablation techniques have gained popularity for the treatment of renal tumors in patients who are high-risk surgical candidates, or have a solitary kidney, limited renal function or multifocal disease. Percutaneous radiofrequency ablation is a safe, minimally invasive treatment option for those patients.     

Percutaneous radiofrequency ablation: minimally invasive therapy for renal tumors

Currently, up to 60% of renal tumors are detected incidentally by abdominal imaging. Most of these tumors are small and localized to the kidney. Owing to the shift to lower stage at diagnosis, radical nephrectomy has fallen out of favor and has been replaced by nephron-sparing surgery. Currently, partial nephrectomy is the treatment of choice for patients with small renal tumors. As the trend towards less invasive therapy continues, laparoscopic and percutaneous ablation techniques have gained popularity for the treatment of renal tumors in patients who are high-risk surgical candidates, or have a solitary kidney, limited renal function or multifocal disease. Percutaneous radiofrequency ablation is a safe, minimally invasive treatment option for those patients.     

Minimal-invasive Operationstechniken bei kleinen Nierentumoren

Radical tumor nephrectomy is the standard procedure for the treatment of renal cancer. Nowadays small renal solid masses are more frequently diagnosed that do not justify the radical approach of tumor nephrectomy, which is associated with the loss of the entire organ. Open partial nephrectomy still remains a challenging surgical approach which does not fulfil the criteria of minimal invasiveness. This opens the room for minimally invasive approaches in the sense of a “nephron-sparing therapy”. Laparoscopic partial nephrectomy is a very attractive, but technically challenging method for the definitive treatment of small renal masses. Beside this, tissue ablative methods such as cryotherapy or radiofrequency ablation have been developed and seem to be effective. The absence of long-term follow-up data for tumor control and patient survival is the current major concern of the general application of the new therapeutic strategies. Therefore, these therapies should only be tested in clinical trials.     

Current status and advances in nephron-sparing surgery

Localized renal cell carcinoma (RCC) remains a surgical disease, with excision of the tumor or tumor-bearing kidney offering the only chance of cure for affected patients. After the widespread acceptance of partial nephrectomy as equivalent treatment to radical nephrectomy in appropriately selected cases of RCC, a range of nephron-sparing procedures has become available to patients. These include laparoscopic partial nephrectomy, thermal ablative techniques, as well as open partial nephrectomy. These techniques offer the attraction of being minimally invasive, in some cases as outpatient procedures under sedation. This review attempts to clarify the current status of these nephron-sparing techniques. Case selection criteria, outcomes, and complications are presented with the aim of helping the modern urologist appreciate the benefits of these procedures as well as their limitations and role in the management of patients with RCC.     

Current Status and Advances in Nephron-Sparing Surgery

Localized renal cell carcinoma (RCC) remains a surgical disease, with excision of the tumor or tumor-bearing kidney offering the only chance of cure for affected patients. After the widespread acceptance of partial nephrectomy as equivalent treatment to radical nephrectomy in appropriately selected cases of RCC, a range of nephron-sparing procedures has become available to patients. These include laparoscopic partial nephrectomy, thermal ablative techniques, as well as open partial nephrectomy. These techniques offer the attraction of being minimally invasive, in some cases as outpatient procedures under sedation. This review attempts to clarify the current status of these nephron-sparing techniques. Case selection criteria, outcomes, and complications are presented with the aim of helping the modern urologist appreciate the benefits of these procedures as well as their limitations and role in the management of patients with RCC.     

Recent advances in nephron-sparing surgery for renal cell carcinoma

Although radical nephrectomy is a "standard" surgery for management of renal cell carcinoma, nephron-sparing surgery has become accepted for selected patients: those with solitary kidney, bilateral renal cell carcinoma or small renal cell carcinoma. Recently laparoscopic surgery has gradually come to include nephron-sparing surgery with minimum invasiveness. Furthermore, new methodologies such as cryoablation and radiowave ablation enable percutaneous management of nephron-sparing surgery. Thus, nephron-sparing surgery is becoming less invasive. However, its efficacy in controlling cancer needs to be discussed further.     

Laparoscopic cryotherapy for renal tumors

In an effort to decrease operative morbidity, energy based ablative procedures have triggered considerable interest in the treatment of select, small (<3 cm) renal tumors. Renal cryoablation for small renal tumors is a well-studied energy based ablative procedure that shows considerable promise as an alternative to partial nephrectomy. Cryoablation is minimally invasive and has demonstrated acceptable intermediate-term results. In this article we review key laboratory research and current clinical series of renal cryoablation.     

Minimal-invasive Therapieoptionen beim Nierenzellkarzinom

Radical tumor nephrectomy is the traditional standard procedure for the treatment of renal cancer. Nowadays, small renal solid masses are more frequently diagnosed, and elderly patients are often confronted with substantial co-morbidities. Given this situation, radical tumor nephrectomy with the loss of the entire organ no longer seems to be the treatment of choice. Open partial nephrectomy still remains a challenging surgical approach with a complication rate of up to 20%, which does not fulfill the criteria of minimally invasiveness. This opens the room for innovative, minimally invasive therapeutic approaches. Laparoscopic partial nephrectomy is a very attractive, but technically challenging method for the definite treatment of small renal masses. Compared to open partial nephrectomy, the laparoscopic approach is associated with a higher incidence of complications and re-operations. Therefore, laparoscopic partial nephrectomy is not yet accepted as a standard procedure and should currently be reserved for experienced centers. Beside this, tissue-destructive, so called tissue-ablative methods such as cryotherapy or radiofrequency ablation, are gaining more and more clinical importance and seem to be effective. The absence of long-term follow-up data for local tumor control and patient survival are the current major concerns for the routine application of the new ablative techniques. Therefore, these therapies should only be tested in clinical trials or for selected patients in whom a curative surgical approach is not possible. Another option for patients with small renal masses is active surveillance. Recent data have shown that the average growth rate of small tumors is only some millimeters per year. Given these observations, active surveillance might be an initial alternative option for selected high risk patients.