Açık Parsiyel Nefrektomi Deneyimlerimiz ve Literatürün Gözden Geçirilmesi

Year 2019, Volume: 16 Issue: 1, 89 - 92, 22.03.2019

Erbay Tümer , Mehmet Eflatun Deniz , Umut Ünal , Güçlü Gürlen Adem Altunkol , Nevzat Can Şener Zafer Gökhan Gürbüz

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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