保留肾单位的肾癌切除术探讨  

Evaluation of nephron-sparing surgery for renal cell carcinoma

作　　者：万群[1] 沈周俊[1] 李忠义[1] 蓝伟峰 毛养成 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003 [2]浙江省遂昌人民医院

出　　处：《中华泌尿外科杂志》2006年第7期437-438,共2页Chinese Journal of Urology

摘　　要：目的探讨保留肾单位的肾癌切除术的适应证及术中处理。方法肾癌患者53例。男32例,女21例。年龄21～76岁。病程1周～13个月。均经B超检查发现为单侧肾脏肿瘤,均除外对侧肾病变。肿瘤位于肾上极和下极者38例行肾部分切除术,肿瘤位于肾中部者15例行肾楔形切除术。术中肾血管全阻断,10～15min放松肾蒂钳,肾创面采用止血纱布填塞加可吸收线涤纶布外固定缝合。术后行干扰素治疗(500万U皮下注射,隔日1次,共3个月),每3个月复查。结果肿瘤切除时间7～21min,平均12min。53例患者均经术中冰冻切片及术后病理学检查确诊为肾细胞癌,切缘阴性。肾癌最大直径6cm者1例,余均＜4cm。临床分期均为T_1N_0M_0。术后随访6～48个月。肿瘤无复发,术侧肾脏功能良好。结论肾癌的快速切除可缩短肾血管全阻断时间,手术效果满意。对于直径＜4cm单发肿瘤或肿瘤直径＞4cm但位于肾浅表呈外凸性生长的T_1肾癌,保留肾单位的肾癌切除术是值得积极尝试的治疗方式之一。Objective To evaluate the indications and intraoperative management of nephron-sparing surgery （NSS） for renal ceil carcinoma （RCC）. Methods A total of 53 patients （32 men and 21 women;age range,21 -76 years） with unilateral RCC and a normal contralateral kidney underwent NSS. The disease course ranged from 1 week to 13 months. The unilateral RCCs were detected by B-ultrasonography. Partial nephrectomy was performed on 38 cases of polar RCC and wedge nephrectomy was performed on 15 cases of central RCC. Both renal vein and artery were blocked for 10 - 15 min,and unclamped for 1 -2 rain if necessary. The resections were finished within 7 -21 min （mean,12 min）. No inosine and regional hypothermia were used during operation. Absorbable hemostatic gauze and terylene flake were used to suture renal wound surface. After operation all patients were treated with interferon hypodermic injection of 5 000 000 U every other day for 3 months. Results The diagnosis of RCC with negative cutting margin was confirmed by pathological examination in all patients. The greatest dimension of the renal cancers were 〈 4 cm except for one of 6 cm. The clinical stage was T1N0M0 in all patients. During the follow-up of 6 - 48 months, all patients were alive without recurrence and had normal renal function. Conclusions NSS can be rapidly performed for T1 stage renal cancer 〈 4 cm or single clearly localized cancer 〉 4 cm in diameter. The follow-up results are satisfactory.

关 键 词：保留肾单位手术 癌 肾细胞 

分 类 号：R737.11[医药卫生—肿瘤]