Açık Parsiyel Nefrektomi Deneyimlerimiz ve Literatürün Gözden Geçirilmesi

Abstract

Amaç:Böbrek kanseri tüm ürolojik kanserler içerisinde 3. Sırada olmasına rağmen mortalitesi en yüksek olanıdır. Görüntüleme tekniklerinin artması ile görülme sıklığı artmaktadır. Böbrek kitlelerinde parsiyel nefrektomi; radikal nefrektomi ile eşit onkolojik sonuçlar göstermesi ile uygun renal kitlelerde gereksiz organ kaybını önlemektedir. Biz bu çalışmamızda kliğinimizde renal kitle nedenli yapılan açık parsiyel nefrektomi (APN) sonuçlarımızı değerlendirmeyi amaçladık.

Materyal ve metod:Kliniğimizde Ocak 2011- Temmuz 2017 yılları arasında renal kitle nedeni ile APN yapılan hastaların dosyalarını geriye dönük olarak değerlendirmeye aldık. Hastalarımızın tümör çapı, hastanede kalış süresi, patoloji sonuçları, postoperatif takiplerimizi değerlendirdik. 

Bulgular: Kliniğimizde toplam 132 hasta çalışmaya alındı. Yaş ortalaması 54 ± 1.2 yıldı ve bu hastaların 69’u erkek (%52.2), 63’ü kadındı (%43.8). Bu hastaların 64 (%48.4) tanesinin kitle sol tarafında iken 68(%51.6) tanesinde sağ tarafta idi. Patoloji sonuçlarında ise 132 hastanın 106 ‘sı (%79.1) renal hücreli karsinom (RCC) , 12‘si (%8.9) anjiomyolipom, 5‘i (%3.7) apse-kronik pyelonefrit, 5’i (%3.7) onkositoma, 3’ü (%2.2) leomiyoma ve 1’i (%0.75) malign epitelyal tümör olarak raporlandı. 3 (%2.2) hastada cerrahi sınır pozitif olarak raporlandı. Ancak hiçbir hastanın takiplerinde lokal nüks veya sistemik metastaz saptanmadı. 

Sonuç: Böbrek koruyucu cerrahide, hemoraji çok ciddi bir komplikasyondur. Hemorajiyi engellemek için klasik yöntem olan geçici klemplemenin yanında, parankim kompresyonunun da etkin ve güvenilir bir yöntem olarak kullanılabileceğini düşünmekteyiz.

Keywords

• Böbrek kanseri,parsiyel nefrektomi,nefron koruyucu cerrahi

Our Experiences of the Open Partial Nephrectomy and Review of The Literature

Abstract

Background: Kidney cancer has the highest mortality in despite of being the 3rd most common types of urological cancers. The increase in the number of imaging techniques increases the rate of incidence. Partial nephrectomy in renal masses demonstrates similar oncologic outcomes with radical nephrectomy which preventing unnecessary organ loss in appropriate renal masses. In this study, we aimed to evaluate our results of open partial nephrectomy (OPN) in our clinic due to renal mass. 

 Methods: We retrospectively evaluated the files of patients who underwent open partial nephrectomy for renal masses between January 2011 and July 2017 in our clinic. We assessed our patients' tumor size, duration of hospital stay, pathology results, and postoperative follow-up.

Results: A total of 132 patients were enrolled in the study. The mean age was 54 ± 1.2 years and 69 of these patients were male (52.2%) and 63 were female (43.8%). The mass was on the left side of 64 (48.4%) of these patients and 68 (51.6%) on the right side. In pathology results, 106 (79.1%) renal cell carcinoma (RCC), 12 (8.9%) angiomyolipoma, 5 (3.7%) abscess-chronic pyelonephritis, 5 (3.7%) oncocytomas, 3 (2.2%) leiomyomas, 1 (0.75%) malignant epithelial tumor were reported in 132 patients. 3 (2.2%) patients were reported to have positive surgical margin. However no local recurrence or systemic metastasis was detected in any of the patients. 

Conclusions: In nephron sparing surgery, haemorrhage is a very serious complication. In our opinion, parenchymal compression can be used as an effective and reliable method besides the temporary clamp, which is the classical method to prevent hemorrhage.

Keywords

• renal tumor,partial nephrectomy,nephron sparing surgery

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