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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 2% of all malignancies and the incidence of RCC has increased by 2% per year over the past 65 years. Especially in the past 20 years, with the development of imaging technology and the popularity of medical examination, the detection rate of small kidney cancer is most obvious. Surgery is the primary means of treating kidney cancer. Initial preservation of nephron surgery for radical nephrectomy alone will lead to functional non-renal, dialysis patients, including isolated kidney, contralateral renal insufficiency, and bilateral multiple primary RCC. Now retained nephron surgery for T_ (1a), T_ (1b) (maximum diameter ≤ 7cm) and contralateral renal function in patients with normal use of increasing, and the treatment effect and radical nephrectomy similar. More studies show that nephron-sparing surgery compared to radical nephrectomy prolongs long-term survival and reduces the incidence of cardiovascular disease. However, the surgery to retain nephrons has not been extensively carried out. The main reason is that many clinicians are still confused about the safety of nephron-preserving surgery, the indications, the scope of resection, and complications. This article will review the above hot issues.