保留肾单位手术治疗双肾细胞癌十例临床分析  

Clinical research of the nephron sparing surgery for bilateral renal cell carcinoma:Report of 10 cases

作　　者：迟强[1] 于满[1] 王志勇[1] 辛立升[1] 马光[1] 徐辉[1] 刘英[1] 王磊[1] 宋殿宾[1] 李俊鹏[1] 周逢海[2] 王养民[2] 

机构地区：[1]承德医学院附属医院泌尿外科,河北承德067000 [2]兰州军区兰州总医院全军泌尿外科中心,甘肃兰州730050

出　　处：《中华肿瘤防治杂志》2012年第22期1745-1747,1760,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:观察保留肾单位手术治疗双侧肾细胞癌的疗效。方法:回顾性分析10例双侧肾细胞癌患者的临床资料。7例同时性肾癌中,1例行双侧Ⅰ期手术,6例行分期手术。其中3例行双肾肿瘤剜除术,1例行双肾部分切除及右肾上腺切除术,2例行一侧肾癌根治性切除术及对侧肾肿瘤剜除术,1例行一侧肾癌根治性切除术、下腔静脉切开取癌栓术及对侧肾肿瘤剜除术。3例异时性肾癌均分期手术,其中2例行双肾肿瘤剜除术,1例行一侧肾癌根治性切除术,对侧肾肿瘤剜除术。所有患者术后均行生物学治疗3个月。10例获随访3个月～8年,平均19个月。结果:7例未见肿瘤复发和转移。1例术后6个月出现肺转移,已带瘤生存3个月;1例术后1年出现残肾肿瘤复发,经生物学治疗,已带瘤生存3个月;1例术后3个月后死于肾衰竭。异时性肾癌者的先发一侧行肾癌根治术,对侧肾出现肿瘤的时间分别为9个月、2年和6年。结论:保留肾单位的肾切除术是目前双侧肾癌较为理想的治疗方法,它对肾功能的影响较少。双侧肾癌的预后和单侧肾癌一样,与肿瘤的分期和分级有关,而与肿瘤是否多发无关。OBJECTIVE： To evaluate the efficacy of nephron sparing surgery for bilateral renal cell carcinoma. METHODS ： Ten cases of bilateral renal cell carcinoma were retrospectively analyzed. Ten patients undergone open operation. Of 7 synchronous BRCC, 1 case undergone first-stage operation, 6 cases undergone two-stage operation. The treatment included bilateral tumor enucleation （3 cases）,bilateral partial nephrectomy plus right adrenalectomy （1 case）, unilateral radical nephrectomy plus contralateral tumor enueleation （2 cases）, unilateral radical nephreetomy plus thrombectomy and contralateral tumor enucleation （1 case）. Three patients with asynchronous BRCC undergone two-stage operation. The treatment included bilateral tumor enucleation （2 cases） and unilateral radical nephrectomy plus contralateral tumor enucleation （1 case）. All of patients received biological therapy for 3 months. Ten patients were followed up of 3 months to 8 years, and the mean time was 19 months. RESULTS：Seven patients were alive without tumors recurrence or meatastasis. One had lung meatastasis at 6 months after surgery but was still alive for 3 months after that. One had local recurrence 1 year after operation but was still alive for 3 months after the biological therapy. One died of renal function failure after operation. After 9 months, 2 years and 6 years, tumors on contralateral kidney appeared in patients who had undergone radical nephrectomy of asynchronous BRCC. CONCLUSIONS： The nephron sparing surgery is a safe and reasonable method at present with the bilateral renal cell carcinoma. The Prognosis of the carcinoma relates to the stage and grade. It is no difference between the bilateral renal cell carcinoma and the single one.

关 键 词：肾肿瘤 外科学 双侧 肾单位 

分 类 号：R737.11[医药卫生—肿瘤]