CAJ | 학술논문

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住手术的安全性、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.
신세포암(Renal cell carcinoma,RCC)점소유악성종류적2%,재과거적65년간,RCC적발병솔매년증장2%.우기시근20년,수착영상학기술적발전화건강사체적보급,소신암검출솔적제고최위명현.외과수술시치료신암적주요수단.최초보류신단위수술부용우행근치성신절제술장도치공능성무신、필수투석적환자,포괄고립신、대측신공능불전、쌍측다원발RCC.현재보류신단위수술대우T_(1a)、T_(1b)(최대경≤7cm)화대측신장공능정상환자적응용일익증다,차치료효과여근치성신절제술상사.경다연구표명,보류신단위수술상비신암근치술연장료장기생존시간,강저료심혈관질병발생솔.연이,보류신단위수술병미득도엄범개전,기중주요원인시흔다림상의생대보류신단주수술적안전성、괄응증、수술절제범위、병발증등방면환존유곤혹.본문장대상술열점문제진행종술.
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 T_(1a) and T_(1b) 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.