肾细胞癌保留肾单位手术的长期随访  

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

作　　者：宋希双[1] 陈峰[1] 吴东军[1] 何中舟[1] 李泉林[1] 车翔宇[1] 王建伯[1] 殷积斌[1] 李先承[1] 张志伟[1] 

机构地区：[1]大连医科大学附属第一医院泌尿外科,116001

出　　处：《中华泌尿外科杂志》2010年第3期153-156,共4页Chinese Journal of Urology

摘　　要：目的探讨保留肾单位手术治疗肾细胞癌的长期疗效及安全性。方法回顾性分析243例保留肾单位手术的肾癌患者临床资料。男159例，女84例。平均年龄58（24～77）岁。肿瘤直径平均3．4（1．1～6．7）cm。孤立肾肾癌3例，双侧肾癌11例。TNM分期T1a 237例，T1b b6例；无区域淋巴结及远处转移，无肾静脉、腔静脉癌栓。术后随访行超声、CT、肾功能等检查。应用Kaplan-Meier方法行肿瘤特异性生存率估计并进行对数秩检验。结果243例中232例获随访，平均随访31（1～147）个月。术后应用于扰素继续治疗52例。死亡4例（因癌死亡1例，非癌死亡3例），总体生存率和肿瘤特异性生存率分别为98．3％和100．0％；肿瘤复发5例，远处转移1例。总并发症发生率为5．6％（13／232）。结论保留肾单位手术治疗肾细胞癌局部复发率低，远期生存率高，并发症发生率低；可以最大限度地保留功能性肾单位，降低并发慢性。肾衰竭的危险性，提高患者生活质量，增加患者满意度。Objective To evaluate the long-term therapeutic results and the safety of nephron sparing surgery（NSS） for the treatment of renal cell carcinoma. Methods Clinical data of 243 NSS for renal cell carcinoma were retrospectively analysed. Of them, 159 were males and 84 were females with average age of 58 years （range from 24--77 years）. The average tumor size was 3.4 cm （range from 1.1 to 6.7 cm）. Three cases were solitary renal cell carcinoma, 11 were bilateral renal cell carcinoma; 237 cases were in stage T1a and 6 cases were in stage T1b. No lymph node and distant metastasis, no renal vein cancer tumor embolus and inferior vena cava tumor embolus was found. Postoperative follow up was carried out by ultrasound, CT and renal function. Cancer specific survival was esti- mated using Kaplan-Meier method and log-rank test. Results After a mean 31 months（1 -147 months） follow up, long-term follow up data were obtained in 232 cases because the other 11 did not live in Dalian, 52 were treated with interferon. Four of the 232 patients treated with NSS had died; 1 died from lung cancer 16 months after lung cancer treatment, the other 3 died from cardiovascular discases. The total survival rate and cancer specific survival rate were 98.3% and 100.0%, respectively. Local tumor recurrences were detected in 5 patients and tumor metastasis was detected in 1 patient. The recurrence rate was 2.2%, and the metastasis rate was 0.4%. The complications included temporary renal failure and urine leakage. The complication rate was 5.6%. Conclusions NSS for renal cell carcinoma is a safe and feasible treatment option. It has the advantages of low local recurrence, good long-term survival rate and low complication rate. NSS can maximally reserve functional nephron, reduce the risk of chronic renal failure, preserve patient＇s quality of life and increase patient＇s satisfaction.

关 键 词：癌 肾细胞 保留肾单位手术 预后 

分 类 号：R737.11[医药卫生—肿瘤]