肾母细胞瘤切除术中探查对侧肾脏是必须的吗?  

Is it necessary to explore the contralateral kindey during surgery of Wilms' tumor?

作　　者：陈方[1] 刘国华[1] 李衷初[1] 蔡威[1] 徐卯升[1] 薛皓亮[1] 谢华[1] 

机构地区：[1]上海第二医科大学新华医院小儿泌尿外科,200092

出　　处：《中华小儿外科杂志》2002年第1期26-27,共2页Chinese Journal of Pediatric Surgery

摘　　要：目的　探讨肾母细胞瘤切除术中对侧肾脏探查的必要性。方法　 1979年 10月至 1994年 12月 ,共 81例肾母细胞瘤患儿均于术前接受B超、CT和IVU检查。所有患儿均在本院接受手术并化疗和放疗。 15例患儿接受了MRI成像检查。结果　 76例患儿术前诊断为单侧或双侧 (仅 3例 )肾母细胞瘤 ,与手术结果完全一致。 4例患儿术前怀疑为神经母细胞瘤 ,1例疑为畸胎瘤。 3例双侧者均为小肿瘤侧半肾切除和大肿瘤侧全肾切除 ,单侧者均未探查对侧肾脏。术后病理证实为肾母细胞瘤。根据NWTS的分期标准 ,Ⅰ期 3 4例 ,Ⅱ期 2 3例 ,Ⅲ期 15例 ,Ⅳ期 6例 ,Ⅴ期 3例。结果 :78例单侧患儿随访 6～ 2 0年 ,5年生存率为 79.4 9%。患儿死于转移、复发和化疗或放疗并发症 ,无一例患儿发现有对侧肾母细胞瘤。Objective To evaluate the necessity of exploring the contralateral kidney during the surgery of Wilms' tumor.Methods From Oct.1979 to Dec. 1994,81 cases of Wilms' tumors were operated on in combination with chemotherapy or radiotherapy. According to the staging criteria of NWTS, there were 34 in stage I,23 in stage II,15 in stage III,and 6 in stage IV,only 3 patients in stage V. All patients were evaluated by ultrasound,CT scan,and IVU preoperatively, 11 patients also by MRI. Three out of 76 patients were found to have bilateral Wilms' tumor preoperatively. The other five children were suspected of suffering from neuroblastomas (4) and teratoma (1).Results 78 patients were followed up for 6 20 years. The 5 year survival rate was 79.49%. The patients died of metastasis, recurrence and complications from chemo or radiotherapy. Not a single case developed a contralateral Wilms' tumor.Conclusion It is not necessary to explore the contralateral kidney during the surgery of Wilms' tumor in Chinese patients.

关 键 词：肾母细胞瘤 肾切除术 常规诊断试验 B超 CT 诊断 对侧肾 探查 

分 类 号：R737.11[医药卫生—肿瘤]