切缘大小对早期肾癌保肾手术远期临床效果的影响  

Margin Size Has No Impact on Patients′ Long-term Outcomes after Nephron Sparing Surgery for Early Localized Renal Cell Carcinoma

作　　者：李泉林[1] 关宏伟[2] 秦杰[1] 姜涛[1] 宋希双[1] 

机构地区：[1]大连医科大学附属第一医院泌尿外科,辽宁大连116011 [2]大连医科大学附属第一医院病理科,辽宁大连116011

出　　处：《中国医科大学学报》2011年第9期791-793,共3页Journal of China Medical University

基　　金：辽宁省教育厅高校科研计划(202203256)

摘　　要：目的比较不同切缘保肾手术患者远期临床效果,探讨小切缘保肾手术治疗早期肾癌的安全性及有效性。方法回顾分析325例对侧肾脏正常T1a期肾癌保肾手术,依切缘大小分为≤5 mm组125例,5～10 mm组102例及〉10 mm组98例。病理评估切缘状态并随访远期疗效。结果全部病例切缘病理均阴性,3组切缘大小平均为,≤5 mm组2.2 mm,5～10 mm组6.7mm,〉10 mm组11.8 mm,差异有统计学意义（P〈0.05）。平均随访79个月（15~132个月）,≤5 mm组1例出现同侧肾脏异位复发（0.74%）,5～10 mm组1例出现原位局部复发（0.98%）,2者经肾癌根治术治愈并存活至今。〉10 mm组无局部复发（0%）。各组复发率差异无统计学意义（均P〉0.05）。3组患者均无远处转移及癌特异性死亡发生。Kaplan-Meier生存分析5年总体生存率为≤5 mm组99.2%,5～10 mm组99.0%,〉10 mm组98.0%（P〉0.05）。结论不同切缘大小保肾手术远期临床效果相当,而小切缘保肾手术难度降低,并发症减少,且有利于保留更多的功能性肾单位,是早期肾癌有效的治疗手段。Objective To explore the safety and efficacy of mini margin nephron sparing surgery for early localized renal cell carcinoma（RCC）.Methods Total of 325 cases of RCC 4 cm or less with normal contralateral kidneys and staged as T1a were included in the study.According to the margin size,125 of them were with surgical margin 5 mm or less（group ≤5 mm）,102 with margin 5～10 mm（group 5 to 10 mm） and 98 with margin 10 mm or more（group10 mm）.The margin was pathologically evaluated and clinical results were followed and analyzed.Results None of the patients had positive surgical margins.The mean and median margin width was 2.2 and 2.0 mm（range 0 to 5） for group≤5 mm,6.7 and 6.0 mm for group 5 to 10 mm and 11.8 and 12.0 mm for group10 mm.The difference was statistically significant（P = 0.025）.The mean and median followup for all the patients was 79 and 83 months（range 15 to 132）,and that was 69 and 73 months（range 15~130） for group≤5 mm,83 and 86（range 17 to 132） for group 5~10 mm and 82 and 82（range 60~103） for group10 mm.Three patients in group≤5 mm,5 in group 5 to 10 mm and 2 in group10 mm died of non-cancer related disease during followup.One patient in group≤5 mm（0.74%） experienced ectopic local recurrence in the same kidney and one in group 5 to 10 mm was detected local recurrence in the tumor bed（0.98%）.No distant metastasis was detected in all the patients.The over-all 5-year survival was 99.2% for group≤5 mm,99.0% for group 5 to 10 mm and 98.0% for group10 mm,respectively.Kaplan-Meier survival analysis,Log Rank,χ2=1.511,P =0.470.Conclusion Mini margin nephron sparing surgery was as well safe and effective in treating stage T1a RCC,It provided excellent renal function preservation,favorable long-term progression-free survival,lower complication rate,and was not associated with an increased risk of local recurrence.

关 键 词：肾细胞癌 治疗 保肾手术 手术切缘 随访 

分 类 号：R737.11[医药卫生—肿瘤]