肾肿瘤治疗方法待改变
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Report Suggests Changing Kidney Tumor1 Treatment

报告建议改变肾肿瘤治疗方法

  For more than 40 years, American surgeons have treated small localized tumors of the kidney the same way:with nephrectomy, the removal of the entire kidney. But new research strongly suggests that the procedure does not improve survival.

  在超过40年的时间里,美国外科医生都用同样的办法——肾切除术,即完全切除整个肾,治疗那些已经发现的小的肾肿瘤。但是新的研究强烈建议说这一方法并不能提高病患者的生存几率。

  Chronic2 Kidney Disease After Nephrectomy in Patients With Renal Cortical Tumours:A Retrospective Cohort Study(The Lancet Oncology)Removing an entire kidney instead of just the tumor and nearby tissue is more likely to result in impaired3 function in the remaining kidney.

  患有肾部皮层肿瘤的患者在实施肾切除术后会患慢性肾病:柳叶刀肿瘤学会的群组研究回顾:完全切除整个肾脏而不是肿瘤本身和邻近的组织更可能损伤另外一个违背切除肾。

  In 2006, the researchers report, more than 35,000 people will develop such lesions, called renal cortical tumors. About half of the tumors are malignant4, and more than 60 percent are smaller than four centimeters in diameter. It is these small tumors that should probably be treated by partial nephrectomy, rather than the radical5 procedure.

  研究人员报告说,在2006年超过35000人将会罹患这种叫做肾表层肿瘤的疾病。一般的肿瘤是恶性的肿瘤,超过60%的肿瘤直径小于4厘米。就是这些小肿瘤可以采用部分切除法而不是采取完全切除法。

  The researchers analyzed6 data from more than 2,000 patients with two functioning kidneys who underwent surgery for small renal tumors over a 16-year period. They excluded patients with metastatic disease.

  研究人员分析了超过2000个患者的资料,这些患者都是在过去十六年中因为小的肾部肿瘤而采取手术治疗,但都保持了两个功能正常的肾。研究人员并没有把那些病情发生转移的患者包含在内。

  After adjusting for age, kidney function, diabetes7, hypertension and other factors, they found that the three-year probability of a patient suffering a new onset8 of chronic kidney disease was 65 percent for those undergoing the radical procedure, and 20 percent for those who had only the partial nephrectomy.

  经过平衡年龄、肾功能、糖尿病、高血压和其他的一些因素,他们发现,在3年存续期中采用完全切除法的患者开始患慢性肾病的比例为65%,而采用部分切除法的只有20%。

  “Even in those having partial nephrectomies, there's a continued diminution9 in kidney function,”said Dr. Paul Russo, the senior author of the paper,“but much less than in those who have the radical operation.”If kidney function deteriorates10 so that dialysis becomes necessary, he said,“you've got about a 50 percent chance of three-year survival-much worse than with cancer.”

  “即便是采用了部分切除法,患者的肾功能都会持续的减弱,”论文的高级作者保罗·鲁索博士说,“但是这要比采用完全切除法的好的多。”如果肾功能恶化,就有必要对此进行分析,他说,“你会有大约50%的几率活过3年,这比癌症要情况要糟得多。”

  One reason for the radical procedure, the researchers say, may be that a partial nephrectomy is a technically11 more difficult operation. Yet the frequency of complications in the two operations was no different in their study. The report appears in the September issue of The Lancet Oncology.

  研究人员说,采用完全切除的一个原因可能是部分切除在技术上更加困难。但是,调查显示,因为手术产生的并发症两者却没有什么区别。报告刊登在柳叶刀肿瘤学9月号上。

  Dr. Russo, a professor of urology at Memorial Sloan-Kettering Cancer Center in New York, said another reason surgeons have opted12 for a total nephrectomy is that until now they have assumed a patient with two working kidneys would not have problems with kidney function after a radical nephrectomy. But that assumption is based on testing kidney function by measuring serum13 creatinine levels, a measure too crude to pick up subtle deficiencies in function.

  纽约纪念斯隆-凯特林癌症中心的泌尿科教授卢梭博士说医生更愿意采用传统的完全切除法的原因在于直到现在,他们还认为有两个功能正常的肾的患者即便在切除一个肾也不会影响其肾功能。但是这一观点建立在检验血清肌酸酐的水平基础上,但这一检验对于找到细微的功能障碍来讲就太草率了。

  For the new study, the scientists used a more sensitive test called estimated glomerular filtration rate, which factors in creatinine level, along with age, sex and race. They looked at this rate before and after nephrectomy to see if kidney function had deteriorated14. The researchers found that about a quarter of patients with the small tumors had pre-existing chronic kidney disease. Losing a kidney under such circumstances presents a significant danger of kidney failure.

  在新的研究中,科学家们使用了一种更加精密的检测手段,即肾小球的滤过功能比率检测,这与肌氨酸酐水平以及年龄、性别和种族都有关系。他们在切除手术前后对比了这一水平,用来检验肾功能是否恶化。研究人员发现大约有1/4的患有小肿瘤的患者事先就已经患有了慢性肾病。在这种情况下,失去一个肾将可能增加患肾衰竭的危险。

  Kidney donors15 generally have no problems functioning with one kidney, but, Dr. Russo said, this is because donors are a carefully selected population, younger and healthier than those with kidney tumors.

  一个肾对于大部分肾捐献者没有影响,但是卢梭博士说,这是因为肾捐献者往往是经过精挑细选,比患肾肿瘤的患者更加年轻,也更加健康。

  “Survival is no better with radical or partial nephrectomy with tumors up to seven centimeters in diameter,”Dr. Russo said.“The risk of new tumor formation is minimal16 compared to the benefits of kidney preservation17.”

  “对于直径大于7厘米的肿瘤患者,完全切除和部分切除在生存的几率上是一样的,”卢梭博士说。“与(部分切除法)保留一个肾相比,(外全切除法使)新的肿瘤生长的可能性被降到了最低。”

  He added that about 70 percent of the small tumors are discovered incidentally, when doctors using various imaging techniques to assess other medical problems find lesions that might otherwise go unnoticed. But they have typically continued to treat even the smallest tumors by removing the entire kidney. This, Dr. Russo believes, is a mistake, and at least some hospitals now concentrate more on organ preservation.“If you look at our center, at least 70 percent are getting partials here,”he said.“But you look at national databases, it's the exact opposite-80 percent of people with two-centimeter tumors are getting radical nephrectomies. That's not good, in our opinion.”

  他补充说,70%的小的肿瘤是在偶然的情况下发现的。当医生在使用各种成像技术认定其他的健康问题的时候,他们发现一些可能被忽略的这些器官损害。但是他们按照传统的办法来治疗这种小的肿瘤,就是把整个肾给切除。卢梭博士认为,这是一个错误,至少现在在一些医院里,医生们在集中精力想办法如何保有原来的器官。“如果你来看看我们的中心,至少有70%的患者采用部分切除法,”他说。“但是你再看看整个国家的数据,恰恰相反,80%的2厘米肿瘤的患者的肾正被完全切除。在我们看来,这是不对的。”



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1 tumor fKxzm     
n.(肿)瘤,肿块(英)tumour
参考例句:
  • He was died of a malignant tumor.他死于恶性肿瘤。
  • The surgeons irradiated the tumor.外科医生用X射线照射那个肿瘤。
2 chronic BO9zl     
adj.(疾病)长期未愈的,慢性的;极坏的
参考例句:
  • Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
  • Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。
3 impaired sqtzdr     
adj.受损的;出毛病的;有(身体或智力)缺陷的v.损害,削弱( impair的过去式和过去分词 )
参考例句:
  • Much reading has impaired his vision. 大量读书损害了他的视力。 来自《现代汉英综合大词典》
  • His hearing is somewhat impaired. 他的听觉已受到一定程度的损害。 来自《现代汉英综合大词典》
4 malignant Z89zY     
adj.恶性的,致命的;恶意的,恶毒的
参考例句:
  • Alexander got a malignant slander.亚历山大受到恶意的诽谤。
  • He started to his feet with a malignant glance at Winston.他爬了起来,不高兴地看了温斯顿一眼。
5 radical hA8zu     
n.激进份子,原子团,根号;adj.根本的,激进的,彻底的
参考例句:
  • The patient got a radical cure in the hospital.病人在医院得到了根治。
  • She is radical in her demands.她的要求十分偏激。
6 analyzed 483f1acae53789fbee273a644fdcda80     
v.分析( analyze的过去式和过去分词 );分解;解释;对…进行心理分析
参考例句:
  • The doctors analyzed the blood sample for anemia. 医生们分析了贫血的血样。 来自《简明英汉词典》
  • The young man did not analyze the process of his captivation and enrapturement, for love to him was a mystery and could not be analyzed. 这年轻人没有分析自己蛊惑著迷的过程,因为对他来说,爱是个不可分析的迷。 来自《简明英汉词典》
7 diabetes uPnzu     
n.糖尿病
参考例句:
  • In case of diabetes, physicians advise against the use of sugar.对于糖尿病患者,医生告诫他们不要吃糖。
  • Diabetes is caused by a fault in the insulin production of the body.糖尿病是由体內胰岛素分泌失调引起的。
8 onset bICxF     
n.进攻,袭击,开始,突然开始
参考例句:
  • The drug must be taken from the onset of the infection.这种药必须在感染的最初期就开始服用。
  • Our troops withstood the onset of the enemy.我们的部队抵挡住了敌人的进攻。
9 diminution 2l9zc     
n.减少;变小
参考例句:
  • They hope for a small diminution in taxes.他们希望捐税能稍有减少。
  • He experienced no diminution of his physical strength.他并未感觉体力衰落。
10 deteriorates b30c21764ac9925504e84b9cba3f7902     
恶化,变坏( deteriorate的第三人称单数 )
参考例句:
  • After a few years' planting, the quality of the potato crop deteriorates. 土豆种了几年之后就会退化。
  • Virus activity deteriorates in plasma stored at room temperature. 在室温下储藏的血浆中病毒活动逐渐衰退。
11 technically wqYwV     
adv.专门地,技术上地
参考例句:
  • Technically it is the most advanced equipment ever.从技术上说,这是最先进的设备。
  • The tomato is technically a fruit,although it is eaten as a vegetable.严格地说,西红柿是一种水果,尽管它是当作蔬菜吃的。
12 opted 9ec34da056d6601471a0808ebc89b126     
v.选择,挑选( opt的过去式和过去分词 )
参考例句:
  • She was co-opted onto the board. 她获增选为董事会成员。
  • After graduating she opted for a career in music. 毕业后她选择了从事音乐工作。
13 serum 8seyS     
n.浆液,血清,乳浆
参考例句:
  • The serum is available to the general public.一般公众均可获得血清。
  • Untreated serum contains a set of 11 proteins called complement.未经处理的血清含有一组蛋白质,共11种,称为补体。
14 deteriorated a4fe98b02a18d2ca4fe500863af93815     
恶化,变坏( deteriorate的过去式和过去分词 )
参考例句:
  • Her health deteriorated rapidly, and she died shortly afterwards. 她的健康状况急剧恶化,不久便去世了。
  • His condition steadily deteriorated. 他的病情恶化,日甚一日。
15 donors 89b49c2bd44d6d6906d17dca7315044b     
n.捐赠者( donor的名词复数 );献血者;捐血者;器官捐献者
参考例句:
  • Please email us to be removed from our active list of blood donors. 假如你想把自己的名字从献血联系人名单中删去,请给我们发电子邮件。
  • About half this amount comes from individual donors and bequests. 这笔钱大约有一半来自个人捐赠及遗赠。 来自《简明英汉词典》
16 minimal ODjx6     
adj.尽可能少的,最小的
参考例句:
  • They referred to this kind of art as minimal art.他们把这种艺术叫微型艺术。
  • I stayed with friends, so my expenses were minimal.我住在朋友家,所以我的花费很小。
17 preservation glnzYU     
n.保护,维护,保存,保留,保持
参考例句:
  • The police are responsible for the preservation of law and order.警察负责维持法律与秩序。
  • The picture is in an excellent state of preservation.这幅画保存得极为完好。
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