肾癌患者同时切除同侧肾上腺的必要性研究  

Study of Necessary to Perform Radical Nephrectomy and Ipsilateral Adrenalectomy Simultaneously

作　　者：杨志尚[1] 杜岳峰[1] 吴大鹏[1] 

机构地区：[1]西安交通大学医学院第一附属医院泌尿外科,710061

出　　处：《医学研究杂志》2014年第2期73-76,共4页Journal of Medical Research

摘　　要：目的探讨传统肾细胞癌手术时同时切除同侧肾上腺的必要性。方法回顾性分析2006年1月-2008年1月共247例肾细胞癌患者行手术治疗的临床资料。202例患者行保留肾上腺的肾切除术或肾部分切除术，45例肾切除及同侧肾上腺切除。分析肾癌手术治疗同时切除肾上腺对术后5年生存率的影响。结果纳入研究的247例肾癌患者中，202例T1N0M0患者保留同侧肾上腺，术后无一例出现术后肾上腺转移，随访中12例死亡，9例死于肿瘤进展，3例死因不明，5年生存率为94．1％。45例施行同时切除同侧肾上腺患者中，34例T1N0M0患者无一例死亡，5年存活率100％，其余11例T1N0M0患者中4例在随访的不同时间出现淋巴结转移或肺转移死亡，5年存活率为63．6％。在T1N0M0患者中，同时切除肾上腺组与保留肾上腺组间的5年存活率比较无统计学差异。45例施行同时切除同侧肾上腺患者无一例出现对侧肾上腺转移。结论切除同侧肾上腺并不能预防术后肿瘤进展，影响患者的主要因素为肿瘤的生物学特性和临床分期。除非术前影像学检查或术中探查发现同侧肾上腺被侵犯或转移．术中应尽可能保留同侧肾上腺。Objective To discuss the necessity of ipsilateral adrenalectomy when performing conventional nephrectomy, which is recommended by 2011 Guidelines. Methods Totally 247 patients underwent radical or partial nephrectomy in our department from Fanu- ary 2006 to January 2008, and the data were collected and retrospectively analyzed. Based on the 2011 Guidelines, 63 cases should have nephrectomy and ipsilateral adrenalectomy simultaneously. Actually 45 cases were resected both of the organs, while the other 18 cases had their adrenal left due to clear structure, normal morphology and texture of adrenal indicated on the preoperative CT scan. The rest of 184 cases just had nephrectomy or partial nephrectomy. All the patients had follow - up for more than 5 years and the 5 - year survival rates were analyzed. Results In the group of 202 patients who underwent only radical nephrectomy, metastasis in the adrenal and other sites was not found and 12 patients died （9 cases died from primary tumor progress and 3 from uncertain causes） ,and the 5 - year survival rate esd 94. 1% . In the group of 45 patients who underwent radical nephrectomy and ipsilateral adrenalectomy simultaneously, no patient died in 34 cases with T~ No Mo and 4 patients died from metastases in 11 cases with T~ NO M0. Contralateral adrenal metastasis was not pres- ent and the .5 - year survival rate was 100% and 63.6% , respectively. There was not significant difference in 5 - year survival rate be- tween two groups of patients with T1 NO M0. Conclusion Postoperative renal cancer progress may not be prevented by ipsilateral adrenalec- tomy and the prognosis is mainly influenced by tumor biological characteristics and clinical stage. Ipsilateral adrenaleetomy should not be performed routinely in patients with renal carcinoma unless abnormal structure is found intraoperatively or by preoperative imaging studies.

关 键 词：肾癌治疗 肾上腺切除 

分 类 号：R737.11[医药卫生—肿瘤]