保留肾单位手术治疗儿童肾细胞癌  

Safety and feasibility of nephron-sparing surgery for pediatric renal cell carcinoma

作　　者：刘超[1] 宋宏程[1] 张潍平[1] 孙宁[1] 黄澄如[1] 

机构地区：[1]首都医科大学附属北京儿童医院泌尿外科,100045

出　　处：《中华小儿外科杂志》2017年第10期740-743,共4页Chinese Journal of Pediatric Surgery

基　　金：北京市医院管理局“登峰”人才培养计划（DFL20151102）;北京市医院管理局“扬帆计划”：小儿泌尿外科（ZYLX201709）;北京市卫生系统高层次卫生技术人才培养计划（2015-3-078）

摘　　要：目的探讨保留肾单位手术治疗儿童肾细胞癌的安全性和可行性。方法对我院1973年1月至2016年12月收治的11例行保留肾单位手术治疗儿童肾细胞癌的临床资料进行回顾性分析。男8例，女3例；年龄4．5-13．5岁，平均7．5岁；左侧5例，右侧6例。临床表现：无痛肉眼血尿4例，腹部包块1例，行B型超声检查偶然发现6例，血尿病史1-7个月，平均3个月。结果11例患儿均行开放性经腹膜保留肾单位手术，肿瘤直径2．2-6．9cm，平均3．3cm。肿瘤位于肾上极4例，肾中极背侧1例、肾中极腹侧1例、肾下极5例。手术时间88-175min，平均107min，术中阻断肾蒂时间19-25min，平均20．4min，出血量10-100ml，平均35ml。本组手术均安全进行，无继发出血、漏尿等并发症。术后病理提示9例为Xp11．2易位／TFE3基因融合相关性肾癌，1例为透明细胞癌，1例为嫌色细胞癌。11例均获随访，随访时间25-129个月，平均53．2个月，无复发及死亡病例。结论儿童肾癌应用保留肾单位手术的指征应十分严格，在此前提下，保留肾单位手术治疗儿童肾癌安全、可行。Objective To explore the safety and feasibility of nephron-sparing surgery （NSS） for pediatric renal cell carcinoma （RCC）. Methods The clinical characteristics of 11 RCC children （8 males and 3 females） undergoing NSS between January 1973 and December 2016 were retrospectively analyzed. The mean age was 7. 5 （4. 5-13. 5） years. RCC was involved at left （n = 5） and right （n = 6）. Clinical presentations included painless gross hematuria （n = 4）, abdominal mass （n = 1） and incidental ultrasonic finding （n = 6）. The mean course of hematuria was 3 （1-7） months. Results All NSS procedures were completed via an open transperitoneal approach. The mean tumor diameter was 3. 7 （2. 2-6. 9） cm. The locations of renal tumors were in upper pole （n = 4）, mid-dorsal （n = 1）, mid- ventral （n = 1） and lower pole （n = 5）. The mean operative duration was 107 （88-175） rain and estimated volume of blood loss 35 （10-100） ml. And the mean duration of renal pedicle clamping was 20. 4 （19-25） miru No such complications as leakage of urine, prolonged drainage or secondary bleeding were noted. The pathological types were RCC associated with Xpl 1.2 translocation/TFE3 gene fusions （n= 9）, clear cell carcinoma （n = 1） and chromophobe carcinoma （n = 1）. There was no local recurrence during a mean follow-up period of 53. 2 （25-129） months. Conclusions The surgical indications of NSS should be strictly grasped for pediatric RCC. And NSS is both safe and feasible for renal cell carcinomas.

关 键 词：肾细胞癌 保留肾单位手术 随访 

分 类 号：R737.11[医药卫生—肿瘤]