散发、无转移、同时性双侧肾细胞癌外科治疗的疗效观察  

Long-term outcomes of surgical treatment on patients with synchronous sporadic and non-metastatic bilateral renal cell carcinoma: a report of 16 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泌尿外科,北京100021

出　　处：《临床肿瘤学杂志》2016年第2期175-178,共4页Chinese Clinical Oncology

摘　　要：目的探讨外科手术治疗散发、无转移、同时性双侧肾细胞癌(BRCC)的疗效。方法回顾性分析2000年至2010年本院收治的16例散发、无转移、同时性BRCC患者的资料。患者均接受分期手术,治疗方案包括先行一侧根治性肾切除再行对侧保留肾单位手术(RN+NSS)5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)3例。评估各组患者长期疗效及肾功能情况。结果 16例同时性BRCC患者共发现33枚肿瘤,其中T1a期19枚(57.6%),T_(1b)期10枚(30.3%),T_(2a)期3枚(9.0%)和T_(3a)期1枚(3.0%)。RN+NSS组、NSS+RN组及NSS+NSS组急性肾功能不全失代偿的发生率分别为80.0%、25.0%和0,差异具有统计学意义(P=0.028),但均无需临时或长期透析。16例患者3、5年无瘤生存率分别为93.8%和87.5%,3年、5年总生存率均为100.0%。结论分期手术是治疗散发性、无转移、同时性双肾癌患者的有效手段,可获得良好的肾功能状况和疗效,通常可选择一期对条件较好的一侧肾脏肿瘤先行NSS,待肾功能恢复后二期针对手术难度相对较大的对侧肾脏肿瘤施行NSS或RN治疗,以降低术后出现急性肾功能不全的风险。Objective To evaluate the long-term outcomes of surgical treatment on patients with synchronous sporadic and non-metastatic bilateral renal cell carcinoma （BRCC）. Methods In this retrospective study, 16 patients with synchronous sporadic and non-metastatic BBRC were enrolled from 2000 to 2010. All patients underwent staged surgical procedures, including nephron-spar- ing surgery（NSS） and radical nephreetomy（RN）. According to the treatment protocol, 16 patients were assigned into unilateral RN fol- lowed by contralateral NSS （RN＋NSS group, n = 5）, unilateral NSS followed by contralateral RN （NSS＋RN group, n = 8） or bilateral NSS（ NSS＋ NSS group, n = 3）. The long-term oncological outcome and renal function were analyzed. Results A total of 33 renal tumors were found in the 16 patients, including Tlal9 tumors（57.6%）, T^b 10 tumors（30. 3%）, T2, 3 tumors（9. 0%） and T3a 1 tumor（ 3.0% ）. The incidence of acute renal failure in RN＋NSS group, NSS＋RN group and NSS＋NSS group were 80.0%, 25.0% and 0（ P= 0. 028） , respectively. None of the patients required temporary or permanent dialysis. The 3-, 5-year disease-free survival rates were 93.8% and 87.5%, and the corresponding overall survival rates were 100% and 100%, respectively. Conclusion Staged surgi- cal procedures are safe and efficient in the treatment of patients with synchronous sporadic and non-metastatic BBRC, resuhing in the preservation of renal function and long-term cancer control. Our strategy was in general to first attempt NSS of the more favorable tumor, followed by NSS or RN of the less favorable contralateral tumor within 6 weeks. This approach allows the patient to recover from possible acute renal failure after NSS.

关 键 词：肾细胞癌 双侧 手术 预后 

分 类 号：R737.11[医药卫生—肿瘤]