단일신에 발생한 신세포암의 부분신절제술 후 신기능 변화
Renal Function after Partial Nephrectomy for Renal Cell Carcinoma in Solitary Kidney
장윤형, 김청수, 안한종,
소속 상세정보
장윤형 ( Jang Yun-Hyung )
국립경찰병원 비뇨기과
김청수 ( Kim Choung-Soo )
울산대학교 의과대학 비뇨기과학교실
안한종 ( Ahn Han-Jong )
울산대학교 의과대학 비뇨기과학교실
KMID : 0358320070480121213
Abstract
Purpose : Renal cell carcinoma(RCC) in solitary kidney is an absolute indication for partial nephrectomy. We evaluated the renal function after partial nephrectomy for renal cell carcinoma in a solitary kidney.
Materials and Methods : Partial nephrectomy was performed in 14 patients with localized sporadic RCCs that developed in a solitary kidney between January 1993 and December 2005. In 8 patients(57%), the contralateral kidney had been surgically removed. In the remaining 6 patients, 4 had a contralateral nonfunctioning kidney(29%) and 2 had nephrolithiasis (14%). Three patients were treated with enucleation, and partial nephrectomy was done in 11 patients. The recorded variables we studied were the preoperative and postoperative serum creatinine levels, whether renal ischemia and hypothermia was used, the duration of renal ischemia and the percent of renal parenchyma that was resected.
Results : At mean follow-up of 55.6 months(range: 16.3-106.6), the mean serum creatinine had increased from 1.03mg/dl preoperatively to 1.26 mg/dl postoperatively(p＞0.05). The mean serum creatinine had significantly increased at 3, 6 and 12 months after surgery(p＜0.05). The postoperative serum creatinine after 16 months was still increased compared to the preoperative serum creatinine, but there was no statistical significance(p＞0.05). None of the 14 patients required dialysis for end stage renal disease after surgery. The normal preoperative serum creatinine had increased above 1.5mg/dl in two patients, but not above 2.0mg/dl. One patient had multiple renal cell carcinoma masses and one had diabetes mellitus. The postoperative creatinine of the 9 patients who had renal warm ischemia was not significantly different from the 5 patients who had no ischemia(p＞0.05). The renal ischemia time, cold ischemia and the resected percent volume of the renal parenchyma were found to have no statistically significant impact on postoperative renal function(p＞0.05).
Conclusion : Partial nephrectomy safely preserves renal function in patients with solitary kidney. (Korean J Urol 2007;48:1213-1218)
키워드
Kidney;Nephrectomy;Carcinoma;Abnormalities
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