经后腹腔途径治疗合并肾静脉癌栓型中晚期肾癌的初步临床观察  

Preliminary clinical study on retroperitoneal approach in the treatment of advanced renal carcinoma with renal vein tumor thrombi

作　　者：韩兴涛[1] 杨凌博 李小辉 魏澎涛[1] 吕文伟 张寒[1] 孙建涛[1] HAN Xingtao;YANG Lingbo;LI Xiaohui;WEI Pengtao;LYUWenwei;ZHANG Han;SUN J iantao(Department of Urology, Luoyang Central Hospital, Luoyang, Henan, 471000, China)

机构地区：[1]洛阳市中心医院泌尿外科,河南洛阳471000

出　　处：《临床泌尿外科杂志》2018年第5期365-368,共4页Journal of Clinical Urology

摘　　要：目的:研究经后腹腔途径治疗合并肾静脉癌栓型肾癌的临床疗效,初步探讨其手术安全性及肾周淋巴结转移对此类患者生存预后的影响。方法:回顾性分析2011年7月~2015年2月我院收治的37例肾肿瘤伴肾静脉癌栓的临床资料,其中男25例、女12例,平均年龄(53±9.6)岁。21例患者因血尿就诊时查泌尿系彩超时发现肾肿瘤合并肾静脉癌栓,16例因腰部酸胀不适主诉就诊。肿瘤位于左肾14例,右肾23例。所有患者术前均行CT、MRI检查证实肾脏肿瘤合并肾静脉癌栓形成,同时均未发现远处转移病例。所有患者完善术前检查、排除手术禁忌后于全麻行后腹腔镜下肾癌根治术联合肾静脉癌栓取出术。结果:37例患者均手术成功,无中转开放,手术平均用时(178.0±37.5)min。术中平均出血量(289.0±78.6)ml,4例患者术中给予术中输血治疗。术后1周内无继发出血、感染等手术并发症发生。术后病理结果显示肾透明细胞癌28例;乳头状肾细胞癌5例;嫌色细胞癌3例;未分类癌1例。按照TNM肾癌分期标准均属于Ⅲ期肾癌。其中12例提示癌组织侵及肾周淋巴结。术后平均随访(19.3±4.8)个月,5例患者术后因癌组织肝转移死亡,2例发生肺部转移。结论:后腹腔镜治疗合并静脉癌栓的中晚期肾癌是安全、有效的,同期存在肾门部淋巴结转移较单独肾静脉癌栓患者生存时间明显较短。Objective：To study the clinical efficacy of retroperitoneal approach in the treatment of renal cell carcinoma with renal vein tumor thrombi,and to explore the safety of surgery and the influence of perirenal lymph node metastasis on the prognosis of these patients.Method：We retrospectively analyzed the clinical data of 37 cases of renal tumor with renal vein tumor thrombi from July 2011 to February 2015,including 25 males and 12 females with an average age of（53.0±9.6）years old.Twenty-one patients were diagnosed with renal tumor thrombus due to hematuria and 16 cases complained of lumbar soreness.The tumors were located in 14 cases of left kidney and 23 cases of right kidney.All patients were confirmed kidney tumor with renal vein tumor thrombus formation by preoperative CT and MRI examination,while no other cases of distant metastasis was found.After all patients with completion of preoperative examination and surgical contraindications exclusion,the retroperitoneal laparoscopic radical nephrectomy combined with renal vein thrombectomy were implemented.Result：All patients were successfully operated without open surgery.the average operation time was（178.0±37.5）min,and the average blood loss during operation was（289.0±78.6）ml.Four patients received intraoperative blood transfusion.Within 1 week after operation,there was no complication such as secondary hemorrhage or infection.Pathological results showed clear renal cell carcinoma in 28 cases;papillary renal cell carcinoma in 5 cases;chromophobe cell carcinoma in 3 cases;unclassified cancer in 1 case,which was classified as stageⅢrenal cell carcinoma according to TNM staging criteria.Of which 12 cases prompted tumor invasion to perirenal lymph nodes.The average follow-up period was（19.3±4.8）months.Five patients died of postoperative liver metastasis and two patients had lung metastasis.Conclusion：Retroperitoneal laparoscopic treatment of advanced renal cancer with venous tumor thrombus is safe and effective,the survival time of patie

关 键 词：肾癌 肾静脉癌栓 后腹腔镜治疗 预后 

分 类 号：R737.11[医药卫生—肿瘤]