3%20循证医学作业.docVIP

循证医学作业 钱君海 1、临床资料 患者，男性，34岁，因体检发现右肾下极占位一天，门诊拟“右肾癌”收入。入院检查未见有明显阳性体征。入院检查双肾CT提示“右肾下极4*4cm占位，肾癌首先考虑”。左肾功能良好。 初步诊断：右肾癌T1N0M0。 2、临床问题 青年男性患者体检发现右肾占位，临床分期T1aN0M0，且肾肿瘤位于肾下极，对侧肾功能正常。本例患者是否可以行保留肾单位手术（NSS）手术？ 3．文献证据检索 数据文献检索资源: Cochrane library( ) Pubmed-Clinical Queries 中华泌尿外科学会网 检索词： renal cell carcinoma RCC nephron-sparing surgery NSS 肾癌 保留肾单位手术 在Cochrane library( )检索到的文献 Title A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Links?? ?? Export Central Citation?? Comments Comment in: Eur Urol. 2007 Jun;51(6):1475-6. PMID: Author(s) Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R, European Organization for Research and Treatment of Cancer (EORTC), National Cancer Institute of Canada Clinical Trials Group (NCIC CTG), Southwest Oncology Group (SWOG), Eastern Cooperative Oncology Group (ECOG) Source European urology Date of Publication 2007 Jun Volume 51 Issue 6 Pages 1606-15 Abstract OBJECTIVES: This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (or=5 cm), solitary, low-stage N0 M0 tumour suspicious for renal cell carcinoma (RCC) and a normal contralateral kidney. METHODS: 541 patients were randomised in a prospective, multicentre, phase 3 trial to undergo NSS (n=268) or RN (n=273) together with a limited lymph node dissection. RESULTS: This publication reports only on the complications reported for both surgical methods. The rate of perioperative blood loss0.5l was slightly higher after RN (96.0% vs. 87.2%) and the rate of severe haemorrhage was slightly higher after NSS (3.1% vs. 1.2%). Ten patients (4.4%), all of whom were treated with NSS, developed urinary fistulas. Pleural damage (11.5% for NSS vs. 9.3% for RN) and spleen d