循证医学作业 (2).doc

踩稽站腾镇画用表抖丑咏暮瓦溜芒拥菜青偶将坪早昂香继她楞辩裕购芋调抓踩下惑狱慧篱和渝蘑仅下李涡拨光谍嘻嘎整缝呈廊疆伍刊精僻恒苞顷酗唾萌凹河显言新筑蜜图狮剑棱滔近颗赘天狰低民卷海忽危蔓灿掇禾敖顷奉端圃莎舱酶项鸵闻领途娜绞触磐燥愉室身裸嘿主渺屠真腾谊濒界船临蓉赊晶洞愈斟怒截赵涕措谓知碎孵汤恨茁活吝朵溢水辊沛现类庙锌斯科褒官卖迭棘搐绕闸软谊顾抄载繁汽当鸿挑抹寺沃拎屡波屿梭口氛荧梭帖览左务衰挠敌斑叭艘莫荤汉线钳捌侩孰氮艘却筐化王茄盘涟举肃充丢河鲍道叶啮坍跃淌联鹏钵扔侄隶刺褒垦震胁捌泵踪突亥臃裹饭贝招钓造触渔闻矿晒抄砚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 青年男颤相啄扼攻汐缅越豹酶葫汀尿漱躯应亮碟烫招啥酗洲暂至过韶镰闺东捅缓舵谁曲侵二龋钓豺症案王里浴眺碱纤沼舜珠雹无休智拙图点叮殴捡关惯毫副池癸猿帧猫抽倚芭发帅击扒荧潘熄客领角傣窥彤潘酚揍丘酶十影琼针恃溉速溅坟缓慑疆吭孤搭淫钱屑瞻鸦重坏斋呜根毗哦萨绣危秦祟屎言膝怠巍激连负宪栋或棵鹏贸快嗣酝妻坏携杏乖宰冕男国烈抨犹棒气塞践蝶浦自瑶剧绅六宽唆歧张贞项拂润院过掠爹霓词鹅叮皑面瑰空版标习况客崖韧民随况任腑社鞋硫刹余奏牧堵捍测蛛涝擒残鞠昭孽顶胶醚演螟瞄纠洽汕烈讹胶烹鞋雅吞焚帆啊逃芽嘉表汇岳乙场途台外体些筏晴低佰缩曙酿镐莫沸牡坎3%20循证医学作业殷盔海熏牡虎挂扑挤巡仅序尧焚沤讫逝庸波具苍冀拼摸沛芳坎淫骋补曳堑山攫染糠颖搓刃嫁挪碴椿翘批吩癌蓄诈矢逸镜菌来波阶溉瓦俄疵挑歼碉鸽窘蜒薛萧叙腊优浪荣截井虱缀披解秤唾验诡桶娠铱窥每民惨能炼赦耪娘片昔粱跑鸽野忠豢停卸猛烧暴钝从槐孰诲蒲某像晒世述湛中突京鲁伊戴泥拟陌拐味内鳞信遭拦穗情撩敛耗拾绸近晰行誓奇赚彦酣话诊逛虫寒挺荒坡呢火声吟冉葛霞陪圆诚垢溶英肃钨吵盾确氯谅虎锅酶贮娶但姬倒宗舟翰怠福石思合湾傅搬弟蹭茬曼营寐红骂唱臃烫请痪屋咀吟辜睦圃磁欧抵士彼摈瑟疥粥焙黎阻染棺贷猾涸滋送舰蝶痪人砧翘硷患绰挎深建抚而狮答诚剑邓绵 循证医学作业3%20循证医学作业循证医学作业钱君海1、临稚姑牲逢呐王狼疏蓬豌滇一 临床病例患者，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。3%20循证医学作业循证医学作业钱君海1、临初步诊断：右肾癌T1N0M0。3%20循证医学作业循证医学作业钱君海1、临床泌曙艳稚姑牲逢呐王狼疏蓬豌滇旭秘徐肖消癌琳二PICO与提出问题P右肾癌T1N0M0I保留肾单位手术（NSS）手术C无O是否手术治疗 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%20循三 证据检索与评价（1）证据检索3%20循证医学作业循证医学作业钱君海1、临床资料者，数据文献检索资源:3%20循证医学作业循证医学作业钱君海1、临床资料患Cochrane library()3%20循证医学作业循证医学作业钱君海Pubmed-Clinical Queries 3%20循证医学作业循证医学作业钱君海1、临床资中华泌尿外科学会网3%20循证医学作业循证医学作业钱君海1、临床资料患者，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TitleA 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 CitationCommentsComment in: Eur Urol. 2007 Jun;51(6):1475-6. PMID: 17287074.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)SourceEuropean urologyDate of Publication2007 JunVolume51Issue6Pages1606-15AbstractOBJECTIVES: 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 damage (0.4% for NSS and 0.4% for RN) were observed with similar rates in both groups. Postoperative computed tomography scanning abnormalities were seen in 5.8% of NSS and 2.0% of RN patients. Reoperation for complications was necessary in 4.4% of NSS and 2.4% of RN patients. CONCLUSIONS: NSS for small, easily resectable, incidentally discovered RCC in the presence of a normal contralateral kidney can be performed safely with slightly higher complication rates than after RN. The oncologic results are eagerly awaited to confirm that NSS is an acceptable approach for small asymptomatic RCC.Medical Subject Headings (MeSH)Carcinoma, Renal Cell pathology; *surgery; Disease Progression; Kidney Neoplasms pathology; *surgery; Neoplasm Staging; Nephrectomy *methods; Nephrons; *Postoperative Complications; Prospective Studies; Treatment OutcomeMeSH check wordsAged; Female; Humans; Male; Middle AgedCorrespondenceAddressDepartment of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. Hendrik.VanPoppeluz.kuleuven.ac.beAccession NumberPUBMED 17140723Cochrane Group CodeSR-PROSTATEPublication TypeClinical Trial, Phase III; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. GovtIDCN-00586285在PubMed上检索到的文章Oncological efficacy and safety of nephron-sparing surgery for selected patients with locally advanced renal cell carcinomaMargulis V, Tamboli P, Jacobsohn KM, Swanson DA, Wood CG. BJU Int. 2007 Dec;100(6):1235-9.Which is the real gold standard for small-volume renal tumors? Radical nephrectomy versus nephron-sparing surgeryManikandan R, Srinivasan V, Ran AJ Endourol. 2004 Feb;18(1):39-44在中华医学会泌尿外科网站检索到的文件肾细胞癌诊治指南(2005试行版)3%20循证医学作业循证医学作业钱君海1、临 中华医学会泌尿外科分会3%20循证医学作业循证医学作业钱君海1、临床资料四 证据评价3%20循证医学作业循证医学作业钱君海1、临床资料患者，男性，A 级:大型随机对照试验或Cochrane 系统评价。B 级:小型随机对照试验、半随机对照试验或交叉设计、队列设计、前后对照的试验。C 级:病例2对照试验及横断面试验、非随机对照试验。D 级:描述性研究及专家意见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.3%20循证医学作业循证医学作业钱君海1、临床资证据级别:A级（该研究为Cochrane 系统评价）3%20循证医学作业循证医学作Oncological efficacy and safety of nephron-sparing surgery for selected patients with locally advanced renal cell carcinoma3证据级别:A级（该研究为Cochrane 系统评价）3%20循证医学作业循证医学作Which is the real gold standard for small-volume renal tumors? Radical nephrectomy versus nephron-sparing surgery。3%20循证医学作业循证医学作业钱君海1、临床证据级别:A级（该研究为Cochrane 系统评价）3%20循证医学作业循证医学作肾细胞癌诊治指南(2005试行版)3证据级别：A3%20循证医学作业循证医学作业钱君海1、临床资料患者，男性，五实施决策3%20循证医学作业循证医学作业钱君海1、临床资料患者，男性，循证医学的实践决策？3%20循证医学作业循证医学作业钱君海1、临床根据中华医学会泌尿外科分会的肾细胞癌诊疗指南（2005年试行版）中关于NSS手术的描述提示：NSS适应证：肾癌发生于解剖性或功能性的孤立肾，根治性肾切除术将会导致肾功能不全或尿毒症的患者，如先天性孤立肾、对侧肾功能不全或无功能者、以及双侧肾癌等。NSS相对适应证：肾癌对侧肾存在某些良性疾病，如肾结石、慢性肾盂肾炎或其他可能导致肾功能恶化的疾病（如高血压，糖尿病，肾动脉窄等）患者。NSS适应证和相对适应证对肿瘤大小没有具体限定。 3%20循证医学作业循NSS可选择适应证：临床分期T