靶向药物结合手术治疗双侧同时性肾癌的探索  

Multi - target therapy with operation for the treatment of bilateral renal cell carcinoma

作　　者：戴军[1] 沈周俊[1] 孙福康[1] 黄欣[1] 何竑超[1] 周文龙[1] 祝宇[1] 赵菊平[1] 吴瑜璇[1] 王浩飞[1] 邵远[1] 芮文斌[1] 

机构地区：[1]交通大学医学院附属瑞金医院泌尿外科,上海200025

出　　处：《国际泌尿系统杂志》2012年第3期294-296,共3页International Journal of Urology and Nephrology

摘　　要：目的总结靶向药物结合手术治疗双侧同时性肾细胞癌的成功经验。方法2011年1月至2011年12月采用靶向药物（舒尼替尼）结合手术共治疗双侧肾癌患者3例。男性2例，女性1例。年龄40～59，平均48岁。1例患者因腰背部酸痛就诊，2例体检发现双肾占位，经B超、CT等影像学检查后确诊。肿瘤位于肾上极3枚，中极1枚，下极2枚；左肾3枚，右肾3枚。肿瘤直径2．0～5．5cm，平均3．5cm。3例均分期行保留肾单位手术，间隔8～10周。分期手术间隔时间内均服用舒尼替尼治疗。结果手术顺利，术中出血约为200～400ml，平均300ml，患者均未输血。术后病理分期均为T1期，3例患者病理结果均为透明细胞癌。手术间期服用舒尼替尼后，所有的肿瘤都有一定程度的缩小或病灶稳定。术后均未发生尿瘘、再出血、伤口感染。3例随访5—11个月，平均9个月。无1例出现肿瘤局部复发及转移。结论靶向药物辅助手术治疗双侧同时性肾细胞癌，能够降低肿瘤分期，增加保留肾单位手术的成功率，并可使原先需根治性肾切除的肾癌患者接受保留肾单位手术。Objectives To introduce our successful experience on treating synchronous bilateral renal ceil carcinoma（BRCC） with operation and multi - target drug. Methods From Jan 2011 to Dec 2011,3 cases of BRCC were treated by multi - target drug（Sunitinib） combined with operation in our institute. There were 2 males and 1 females with the average age of 48 years old（ ranging from 40 to 59 years old）. Two cases were found bilateral renal tumor during annual physical examination ,while 1 case complained of sore waist. All cases were confirmed by ultra- sounography and CT scan pre - operatively. Among the 3 cases,3 tumors were located at the upper pole of kidney, 1 at the middle and 2 at the lower pole. Three tumors were on the left kidney ,3 on the right side. The mean tumor size was 3.5 cm in diameter（ 2.0 - 5.5 cm）. All of the 3 cases underwent bilateral nephron sparing surgery（NSS） with an in- terval of 8 to 10 weeks. Sunitinib were administrated during the intervals. Results NSS was successfully performed in all 3 cases with no blood transfusion. The estimated blood loss ranged from 200 - 400ml. The pathologic findings of all 6 tumors were clear cell carcinoma. After taking sunitinib during intervals, all tumors volume decreased at a certain degree. No case suffered urinary fistula,bleeding, or infection postoperatively. Local recurrence or distal metastasis were not observed during a mean follow -up period of 9 months（5 ~ 11 months）. Conclusions Targeted drug- assisted NSS treatment for the synchronous bilateral renal cell carcinoma could reduce the tumor stage and increase the success rate of NSS. Furthermore, this method could allow NSS treatment in patients deemed to receive radical nephrectomy.

关 键 词：肾肿瘤 药物载体 

分 类 号：R737.11[医药卫生—肿瘤]