T1b期肾癌保留肾单位手术的适应证选择与疗效分析  

Indication and effectiveness of nephron-sparing surgery for stage T1b renal carcinoma

作　　者：龚宇[1] 杜传军[1] 陈继民[1] 经宵[1] 文甲明[1] 王鸣[1] 薛翀[1] 冯志骏[1] 郑一春[1] 

机构地区：[1]浙江大学医学院附属第二医院泌尿外科,杭州310009

出　　处：《临床外科杂志》2013年第11期835-837,共3页Journal of Clinical Surgery

摘　　要：目的 探讨T1b期肾癌行NSS的适应证选择、安全性及其临床效果.方法 对47例T1b期肾癌患者实施肾部分切除术.结果 OPN及LPN的热缺血时间分别为（15.3±5.8）min,（22.1±7.2）min.术后并发症：迟发性肾脏出血1例,术后肾动脉瘤1例,下肢深静脉血栓1例,分别予二次手术、选择性肾动脉栓塞术、抗凝等治疗.术后随访时间5个月～10年,5例失访,14例肿瘤转移.结论 T1b期肾癌选择肾部分切除术是安全可行的.需要综合考虑患者意愿、主要脏器功能状况、肿瘤与肾血管的解剖关系、残留肾单位的比例及术者擅长的术式等多种因素.因此,NSS有望成为T1b期肾癌的标准术式之一.Objective To nvestigate the indicationsafety and clinical effectiveness of nephron- sparing surgery（NSS） for stage T1 b renal cell carcinoma（RCC）. Methods A total of 47 Tlb RCC pa- tients in our hospital received partial nephrectomy. The mean diameter of the carcinomas was （49.3 ± 14.5 ）ram. The controlateral kidney was normal in 31 ,benign in 14 and malignant in 2 cases. Open partial nephrectomy（OPN） and laparoscopic partial nephrectomy（LPN） were performed in 35 and 12 cases. The renal artery was clamped during resection. The size of surgical margin was 5 mm. Collecting system was su- tured in 4t cases. Results The operation was successfully performed in all patients. The mean warm is- chemia time（WIT） was（ 15.3 -± 5.8 ）rain in OPN and（22.1 ± 7.2）rain in LPN. The postoperative compli- cations included delayed renal hemorrhage in 1 case, renal artery aneurysm in 1 case and deep venous thrombosis of lower extremity in 1 case. These patients were treated with reoperation, Selective renal artery embolization and anticoagulants. During the follow-up of 5 - 120 months ,5 cases were missing and 14 ca- ses were diagnosed as metastases. Conclusion The WIT can be achieved in 30 minutes for T1 b NSS. The postoperative complications, injury on renal function and metastases are not increased in this group. NSS is effective and safe in treating stage T1 b renal carcinomas. Patient preference, functions of the main organ, a- natomy of tumor and vessels,ratio of residual nephron and other factors should be considered comprehen- sively. Therefore, NSS might be the standard surgical procedures for stage 1 RCC in the future.

关 键 词：肾癌 保留肾单位 手术 

分 类 号：R737.11[医药卫生—肿瘤]