腹腔镜根治性肾切除术治疗小儿肾脏恶性肿瘤的初步经验  

Laparoscopic radical nephrectomy of Wilms＇ tumor and renal cancer in children： preliminary experiences of two children＇s hospitals

作　　者：刘江斌[1] 肖现民[3] 谢华[2] 陈方[2] 吕志宝[1] 

机构地区：[1]上海市儿童医院/上海交通大学附属儿童医院普外科,200040 [2]上海市儿童医院/上海交通大学附属儿童医院泌尿外科,200040 [3]复旦大学附属儿科医院外科

出　　处：《中华小儿外科杂志》2014年第6期448-451,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结腹腔镜肾根治性切除术（LRN）治疗小儿肾脏恶性肿瘤的初步经验，评估其安全性和有效性。方法回顾性分析2010年1月至2013年9月，上海市儿童医院／上海交通大学附属儿童医院和复旦大学附属儿科医院采用LRN治疗的7例小儿肾脏恶性肿瘤患儿的临床资料、手术方法和疗效。其中，男5例，女2例；年龄1．5～11岁，平均（4．3±2．5）岁；左侧肾肿瘤4例，右肾3例；肿瘤最大直径4．5～10cm，平均（6．8±2．5）cm，术前CT或MRI检查均未超过中线。Ⅰ期经腹腔途径LRN手术6例，经细针穿刺活检、化疗后6周后LRN手术1例。结果7例均腹腔镜下完成LRN，无中转开腹者；手术时间70-150min，平均97rain；出血量5～30ml，平均13．5ml，均未术中输血。术后住院时间（含术后首次化疗时间）6-11d，平均8．5d。术后病理检查证实FH型肾母细胞瘤5例，肾横纹肌样肉瘤1例，肾癌1例。按COG分期肿瘤Ⅰ期6例，Ⅱ期1例。手术后按照NWTS-4化疗5例。术后随访0．3～2．9年，平均（1．9±1．5）年；术后无瘤生存6例，失访1例。结论经腹腔途径LRN治疗小儿肾脏恶性肿瘤是可行的，对早期和较小的肾脏肿瘤是安全有效的，但要选择适当的病例并由腹腔镜经验丰富的医师进行。其远期效果尚需大样本多中心对照研究和长期随访进一步证实。Objective To review the preliminary experiences of two children＇s hospitals in Shanghai and evaluate the laparoscopic radical nephrectomy （LRN） in children with Wilms＂ tumor and renal cancer. Methods From January 2010 to October 2013, the medical records were reviewed for 7 cases undergoing LRN for renal tumor at Shanghai Children＇s Hospital/Shanghai Jiao Tong University and Children＇s Hospital of Fudan University. There were 5 boys and 2 girls with an average age of （4. 3± 2. 5） （1.5-11） years. There were left （n = 4） and right （n = 3） renal tumors. The greatest average tumoral size was （6. 8 ± 2.5） （4. 5-10） cm without crossing lateral vertebral edge. Six cases underwent LRN and one was operated after 6 weeks preoperative chemotherapy. Results All cases underwent LRN successfully without conversion. The average operative duration was 97 （70-150） min, blood loss volume 13.5 （5-30） ml and median hospital stay 8. 5（6-11） days. The pathologic examinations revealed Wilms＇ tumors （n = 5）, rhabdoid tumor （n = 1） and renal carcinoma （n = 1 ）. Five of them underwent chemotherapy according to the COG （Children＇s Oncological Group） protocol. And 6 cases had a median follow-up period of （1.9 ± 1.5） （0. 3-2. 9） years. Conclusions The children with early and small-sized Wilms＇ tumor or renal cancer may be safely treated with LRN. However, multicenter prospective studies with a longer follow-up period and a larger sample size are necessary for comparing the outcomes of laparoseopic approaches.

关 键 词：肾母细胞瘤 肾肿瘤 腹腔镜检查 肾切除术 

分 类 号：R737.11[医药卫生—肿瘤]