T1b期肾癌行保留肾单位手术最佳切缘的探讨  

The Optimal Surgical Margins of Nephron-sparing Surgery for Stage T1b Renal Tumors

作　　者：赵国斌[1] 王宇[1] 唐玉红[2] 李建龙 冯超 李向东[1] ZHAO Guo-bin;WANG Yu;TANG Yu-hong;LI Jian-long;FENG Chao;LI Xiang-dong(Department of Urology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000;College of Laboratory Medicine,Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院泌尿外科,张家口075000 [2]河北北方学院医学检验学院,张家口075000

出　　处：《四川大学学报（医学版）》2020年第4期552-555,共4页Journal of Sichuan University(Medical Sciences)

摘　　要：目的分析T1b期肾癌病理学特点,同时探讨该期肾癌行保留肾单位手术的最佳手术切缘。方法回顾性分析2013年9月.2017年12月于我院行手术治疗的245例T1b期肾癌患者的临床及病理资料。结果245例患者中男158例,女87例,平均年龄59.6岁,平均肿瘤大小5.3 cm。行根治性肾切除术者174例,保留肾单位手术者71例。术后病理学检查为肾透明细胞癌209例(85.3%),219例(89.4%)患者瘤体周围可见明显假包膜,其中26例(10.6%)患者肿瘤细胞穿透假包膜并侵入周围肾实质,浸润深度在1 mm、1~2 mm和2~3 mm的肿瘤分别为7例(26.9%)、16例(61.5%)和3例(11.5%)。24例(9.8%)患者可见多发性肿瘤。肾部分切除术的平均切缘为5 mm(3~7 mm)。结论保留肾单位手术可用于T1b期肾癌,为避免切缘阳性,切缘距肿瘤表面应至少3 mm。Objective To analyze the pathological characteristics and explore the optimal surgical margins(SM)of nephron-sparing surgery(NSS)for stage T1 b renal carcinoma(4–7 cm)on preoperative imaging.Methods The clinical and pathological data of 245 cases of stage T1 b kidney cancer from September 2013 to December 2017 were collected and reviewed retrospectively.The radical nephrectomy(RN)was performed on 174 cases and other 71 cases accepted NSS.There were 158 males and 87 females,with a mean age of 59.6 years and mean tumor size of 5.3 cm.Results Through postoperative pathological examination,209(85.3%)cases were confirmed renal clear cell carcinoma and 219(89.4%)cases were surrounded with visible peritumoralpseudocapsule(PC).26(10.6%)cases of cancerous cells invaded beyond peritumoral PC and into renal parenchyma.The infiltrative depth into renal parenchyma beyond PC was all limited in 3 mm and the cases of≤1,1-2 and 2-3 mm were 7(26.9%),16(61.5%)and 3(11.5%),respectively.Multifocal tumors were discovered in 24(9.8%)cases.The average resection margin for partial nephrectomy was 5 mm(3-7 mm).Conclusion For stage T1 b renal tumors,NSS is acceptable and a 3 mm of surgical margin is safe and suitable to avoid positive SM.

关 键 词：肾癌 保留肾单位手术 手术切缘 假包膜 

分 类 号：R737.11[医药卫生—肿瘤]