保留肾单位肾癌切除术的疗效与随访  

Long-term results and follow-up of nephron-sparing surgery for renal cell carcinoma

作　　者：宋希双[1] 毕波 殷积斌[1] 张仁科[1] 吴洪昌[1] 王建伯[1] 张日强[1] 李泉林[1] 车翔宇[1] 

机构地区：[1]大连医科大学附属第一医院泌尿外科,116011 [2]盘锦市第二人民医院泌尿外科

出　　处：《中华泌尿外科杂志》2005年第10期683-685,共3页Chinese Journal of Urology

摘　　要：目的探讨保留肾单位的肾癌手术疗效. 方法26例行保留肾单位的肾癌切除术患者,男16例,女10例,平均年龄47岁.肿瘤直径1.1～4.0 cm,平均2.8 cm.T121例,T25例.透明细胞癌22例,颗粒细胞癌3例,囊性肾癌1例.10例有腰痛、血尿、低热等症状,无症状16例.单侧24例,双侧1例,术后孤立肾癌1例.对侧肾功能正常22例,对侧肾有病变或潜在病变4例.术后定期行腹部CT、超声及尿常规检查,复查肾功能.结果26例手术均成功.术后平均随访41个月,除1例肾转移癌术后16个月因肺癌广泛转移死亡外,余25例肿瘤无复发,无瘤生存至今.结论保留肾单位的肾癌剜除术安全有效.适用于对侧肾功能正常肿瘤直径≤4.0 cm的局限性肾癌,对于对侧肾脏有病变或孤立肾癌是必要的选择.Objective To investigate the clinical effects of nephron-sparing surgery in renal cell carcinoma （RCC） patients. Methods Nephron-sparing enucleation of renal carcinoma was performed in 26 RCC patients （16 males and 10 females;mean age,47 years）. The tumor diameter ranged from 1. 1 to 4. 0 cm with a mean of 2.8 cm. Among them 21 cases were classified to have T1 stage tumor and 5 cases,T2 stage according to TNM classification, Pathological examination showed that 22 cases had clear cell carclnoma;3 had granule cell carcinoma and 1 had cystic renal carcinoma. Sixteen patients had no symptoms,while the other 10 complained of flank pain,hematuria and low fever. Among them 24 RCC patients had unilateral tumor, 1 had bilateral tumor,and 1 had tumor in a solitary kidney. The contralateral kidney functioned well in 22 patients,while in the other 4 patients a compromised contralateral kidney existed. After operation all the patients underwent abdominal CT,ultrasound,urine test and renal function examination regularly. Results The operation was performed successfully in all the 26 patients. The mean follow-up was 41 months. Follow-up showed that 25 patients lived without tumor recurrence and only l patient died of lung cancer metastasis. Conclusions Nephron-sparing enucleation of renal carcinoma is an effective and safe procedure for RCC patients under specific circumstances. It is selective for RCC patients with localized （ ≤4.0 cm in diameter） unilateral tumor and a normal contralateral kidney ;however,it is imperative if the contralateral kidney is functionally compromised or RCC exists in a solitary kidney.

关 键 词：肾癌切除术 保留肾单位手术 肾功能 肿瘤剜除术 免疫能力 

分 类 号：R737.11[医药卫生—肿瘤] R730.56[医药卫生—临床医学]