保留肾单位手术治疗偶发性肾癌11例临床分析  

Clinical analysis of 11 cases of incidental renal carcinoma treated by nephron-sparing surgery

作　　者：吴佳成 姜力[1,2] Wu Jiacheng;Jiang Li(China Medical University,Liaoning Shenyang 110000,China;Department of Urology,No.202 Hospital of the PLA,Liaoning Shenyang 110000,China.)

机构地区：[1]中国医科大学,辽宁沈阳110000 [2]中国人民解放军第二0二医院泌尿外科,辽宁沈阳110000

出　　处：《现代肿瘤医学》2018年第11期1744-1748,共5页Journal of Modern Oncology

摘　　要：目的:探讨保留肾单位手术(NSS)治疗偶发性肾细胞癌的临床效果。方法:回顾性分析我院2012年至2014年1月收治并采用保留肾单位手术治疗的11例偶发性肾癌患者的临床资料,并分别与同期9例行肾癌根治术(RN)、8例行保守治疗的偶发性肾癌患者进行对比。结果:保留肾单位手术组与肾癌根治组、保守治疗组患者年龄、性别比较差异无显著性。NSS组肿瘤平均直径为(3.1±1.0)cm,RN组平均直径为(7.5±2.6)cm,保守治疗组平均直径为(5.1±1.4)cm,三者差异有显著意义(t1=7.2,t2=5.6,P<0.01)。同时三组在肿瘤所处位置、术后病理类型、是否有腹膜后淋巴结肿大以及是否有腔静脉系统的癌栓形成等方面都有着显著的差异性。NSS组和RN组在术前肌酐值比较方面无显著性差异,但是在术后差异有显著性(t=6.21,P<0.01)。NSS组和RN组在术中出血量、引流量以及手术时间方面差异无显著性(P>0.05)。NSS组肿瘤分期明显低于其他两组(P<0.01)。术后3年、5年随访生存率分别为88.6%、79.5%,明显高于其他两组。在同等情况下,NSS治疗偶发性肾癌手术治疗效果要明显高于RN组和保守治疗组(P<0.01)。结论:在适应证选择合适情况下,保留肾单位手术是应用于偶发性肾癌的一种有效治疗方式,在保留患肾大部分功能的同时其术后并发症也相对较小,预后相对也较好。Objective：To explore the clinical effect of nephron-sparing surgery（ NSS） for incidental renal cell carcinoma in order to improve its treatment effect.Methods：The clinical data of 11 cases of incidental RCC treated with NSS from 2012 to 2014 was reviewed retrospectively and compared with 9 cases of radical nephrectomy（ RN） and8 cases of conservative treatment of patients with incidental renal cell carcinoma at corresponding time period.Results：There was no significant difference in age,gender between the NSS group and RN group and the conservative treatment group（ P〈0.05）.Compared to the RN group and the conservative treatment group,the diameter of NSS group[（ 3.1 ± 1.0） cm] was smaller（ t1 = 7.2,t2 = 5.6,P〈0.01）,as well as the pathological stage（ P〈0.01）.There were also great quantity differences found in position of tumor,pathological type,lymph node enlargement and thrombus of vena cava system between the three groups.The creatinine value 24 hours after operation of the NSS group was significantly better than that of RN group,the difference was significant（ t = 6.21,P〈0.01）.The intraoperative blood loss,drainage volume and operation time of NSS group and RN group,the difference was not significant（ P〈0.05）.The 3-and 5-year cancer specific survival rates in patients with incidental RCC which treated with NSS were higher than other two groups（ P〈0.01）.In the same case,the effect of surgical treatment of NSS group was significantly higher than other two groups（ P〈0.01）.Conclusion：NSS is an effective method to treat carefully selected incidental RCC patients.While retaining most of the functions of the kidney,its postoperative complications are relatively small and the prognosis is relatively good.

关 键 词：肾癌 偶发性 保留肾单位手术 

分 类 号：R737.11[医药卫生—肿瘤]