局限性肾肿瘤的保肾手术治疗25例临床分析  

Nephron-sparing Surgery for Localized Kidney Neoplasms——a Report of 25 Cases

作　　者：李永红[1] 周芳坚[1] 秦自科[1] 韩辉[1] 刘卓炜[1] 王斌[1] 余绍龙[1] 王欢[1] 

机构地区：[1]华南肿瘤学国家重点实验室

出　　处：《癌症》2006年第1期76-79,共4页Chinese Journal of Cancer

摘　　要：背景与目的:保肾手术首先用于孤肾和双肾肾癌的治疗,取得了良好的疗效,保肾手术用于对侧肾完全正常的局限性肾癌,也获得了满意的远期疗效。本研究总结我院采用保肾手术治疗25例局限性肾肿瘤的经验。方法:1999年11月至2004年12月对术前诊断为局限性肾癌的25例患者施行了保肾手术治疗,术中阻断肾蒂8例,冰泥局部降温3例,切缘多点快速冰冻切片病理检查16例。结果:全部手术顺利,平均手术时间129min(65～205min),术中平均出血310ml(100～800ml),输血1例,术后切口漏尿1例,经保守治愈,无其它并发症。术中切缘多点快速冰冻切片病理检查均为阴性。术后病理报告透明细胞癌19例,颗粒细胞癌2例,错构瘤4例,21例肾癌患者术后病理分期为pT1N0M0。平均随访22个月(6～55个月),无局部复发,全部患者无瘤生存。结论:保肾手术治疗局限性肾癌疗效确切,对于肿瘤直径小于4cm的非中央型和/或局限性肾肿瘤、术前诊断考虑为肾癌、对侧肾完全正常的肾肿瘤,我们主张行保肾手术。BACKGROUND ＆ OBJECTIVE： Nephron-sparing surgery （NSS） was initially used in treating bilateral renal cell carcinoma （RCC） or RCC in a solitary functioning kidney with good effectiveness. The satisfied long-term outcome was also obtained in patients with unilateral localized RCC and a normal contralateral kidney after NSS. This paper was to report our experiences in treating localized renal tumor with NSS. METHODS. From Nov. 1999 to Dec. 2004, 25 patients were diagnosed with localized RCC preoperatively, and treated with NSS. During operation, renal circulation was temporarily interrupted in 8 patients, surface cooling of the kidney with ice slush was performed in 3 patients, frozen section pathology was performed in 16 patients. RESULTS： The operation was technically successful in all cases. The median operating time was 129 min （ranged 65-205 min）. The mean blood loss was 310 ml （ranged 100-800 ml） with 1 case of blood transfusion. Except for 1 case of urinary fistula which was cured conservatively, there was no other postoperative complication. Intraoperative pathology confirmed that the surgical margin of all cases were negative. Of the 25 cases, 19 were renal clear cell carcinoma, 2 were renal granular cell carcinoma, 4 were hamartoma. The pathologic stage was pT1N0M0 in 21 patients. The mean follow-up time was 22 months （ranged 6-55 months）. No local tumor recurred, and all patients survived disease-freely. CONCLUSIONS： NSS is effective in treating localized RCC. We recommend NSS to patients with unilateral localized, but not center, kidney tumor less than 4 cm and a normal contralateral kidney.

关 键 词：肾肿瘤/外科手术 保肾手术 临床分析 

分 类 号：R737.11[医药卫生—肿瘤]