手术治疗散发性、无转移双侧肾细胞癌22例报道  

Surgical treatment of sporadic M0 bilateral renal cell carcinoma:a report of 22 cases

作　　者：韩苏军[1] 鲁力[1] 王栋[1] 肖泽均[1] 寿建忠[1] 李长岭[1] 

机构地区：[1]中国医学科学院肿瘤医院肿瘤研究所泌尿外科,北京100021

出　　处：《现代泌尿外科杂志》2015年第11期801-804,共4页Journal of Modern Urology

摘　　要：目的评估外科治疗散发性、无转移双侧肾细胞癌的效果。方法回顾性研究2000年1月至2010年1月中国医学科学院肿瘤医院收治的经病理证实的散发性、无转移、双侧肾细胞癌患者的临床、病理及随访资料,评估患者5年无瘤生存率及肾功能结果。结果共入组22例散发性、无转移双肾癌患者,占我院同期收治原发肾细胞癌(1 696例)的1.3%。同时性发病16例(72.7%),异时性发病6例(27.3%)。同时性双肾癌发病年龄为(54.2±15.6)岁。异时性双肾癌第1与第2肿瘤发病年龄分别为(50.8±10.4)岁和(57.5±12.1)岁。22例患者共发现47枚肾肿瘤,左肾22枚、右肾25(有2例患者右肾发生多灶肿瘤,分别为2、3枚肿瘤)枚。肿瘤直径为(4.3±3.9)cm。47枚肿瘤中,46枚(97.9%)为透明细胞癌,1枚(2.1%)为乳头状肾细胞癌。所有患者均接受分期手术治疗:先行一侧根治性肾切除再行对侧保留肾单位手术(RN+NSS)10例,先行一侧保留肾单位手术再行对侧根治性肾切除(NSS+RN)8例,双侧保留肾单位手术(NSS+NSS)4例。第2次手术后RN+NSS组、NSS+RN组及NSS+NSS组中患者出现急性肾功能不全的风险分别为60%、25%和0。患者术后平均随访(72±63)个月。同时性双肾癌与异时性双肾癌的5年无瘤生存率分别为81.8%和50%(P=0.025)。结论保留肾单位手术治疗是散发性、无转移性双肾癌患者的安全有效的治疗手段,可获得良好的肾功能及肿瘤学结果。虽然多数双肾癌表现为同时性发病,但部分患者可在一侧肾脏手术多年后发生对侧肾脏的异时性肿瘤。并且,异时性双肾癌的无瘤生存率低于同时性双肾癌,这些患者应给予更严密随诊。Objective To evaluate the efficacy of surgical treatment of sporadic M0 bilateral renal cell carcinoma （BRCC）. Methods The clinical data of cases identified by pathology as sporadic M0 BRCC during 2000 and 2010 in Cancer Institute ＆ Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The 5-year disease-free survival and renal function outcomes were reviewed. Results A total of 1 696（1.3%） patients surgically treated for RCC had sporadic M0 bilateral disease. Synchronous tumors were found in 16 patients （72.7%） and metachronous tumors in 6 （27.3%）. Mean age at diagnosis of the synchronous BRCC was 54.2± 15.6. Mean age of the metachronous BRCC at diagnosis of the first and second renal cell carcinomas was 50.8±10.4 and 57.5± 12.1 years, respectively. A total of 47 renal tumors were found in the 22 patients, 22 tumors were on the left kidney, and 25 on the right. The mean tumor size was 4.3 cm in diameter （range： 1.0-12.0 cm）. Of the 47 tumors, histology was conventional （clear cell） in 46 （97.9%） tumors, papillary in 1 （2.1%）. All of these patients underwent staged surgical procedures （two operations）. The treatment included unilateral radical nephrectomy followed by contralateral nephron sparing surgery （RN plus NSS group, 10 cases）, unilateral nephron sparing surgery followed by contralateral radical nephrectomy （NSS plus RN group, 8 cases）, bilateral nephron sparing surgery （NSS plus NSS group, 4 cases）. The risk of acute renal failure in RN plus NSS group, NSS plus RN group and NSS plus NSS group was 60%, 25% and 0, respectively, after the second surgery. Mean follow-up time was 72 months （range： 25-150 months）. The 5-year disease-free survival rate in synchronous BRCC and metachronous BRCC was 81.8% and 50% respectively （P = 0. 025）. Conclusions Nephron sparing surgery is a safe and effective procedure for the treatment of sporadic M0 bilateral renal cell carcinoma, resulting in the preservation of renal function and long

关 键 词：肾细胞癌 双侧 诊断 治疗 预后 无瘤生存率 

分 类 号：R737.14[医药卫生—肿瘤]