肾部分切除术治疗cT2期肾癌疗效分析  

Partial nephrectomy for cT2 renal cell carcinoma

作　　者：汪月明 蔡文[1] 陈勇辉[1] 张进[1] 刘东明[1] 薛蔚[1] 黄翼然[1] 黄吉炜[1] WANG Yue-ming;CAI Wen;CHEN Yong-hui;ZHANG Jin;LIU Dong-ming;XUE Wei;HUANG Yi-ran;HUANG Ji-wei(Department of Urology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院泌尿科,上海200127

出　　处：《现代泌尿外科杂志》2020年第8期693-696,701,共5页Journal of Modern Urology

基　　金：上海市科学技术委员会科研计划项目(No.18ZR1423200);上海交通大学医学院附属仁济医院临床科研创新培育基金延续支持项目(No.PYXJS16-008);上海市申康-三年行动计划专科疾病临床五新转化项目(No.16CR3062B)。

摘　　要：目的探讨肾部分切除术治疗cT2期肾癌的疗效。方法回顾性分析2007年1月至2018年10月在仁济医院接受肾部分切除术的60例cT2期肾癌患者的临床资料,其中男性46例,女性14例;年龄26~79岁,中位年龄58岁;左侧35例,右侧25例;肿瘤最大直径7.1~11.2 cm,中位数为7.9 cm。25例患者接受开放肾部分切除术,33例患者接受腹腔镜肾部分切除术,2例患者接受机器人辅助肾部分切除术。观察肾功能结果、并发症发生率及癌症控制效果等指标。结果59例术后病理切缘阴性,1例阳性。术前的肾小球滤过率估值(eGFR)的中位数为96.07(40.40~181.44)mL/(min·1.73 m^2),最后一次肾功能评估的eGFR中位数为79.40(6.03~182.81)mL/(min·1.73 m^2)。共有22例患者术后出现并发症,严重并发症(CCS分级Ⅲ级及以上)的发生率为10%。2年总生存率为97.4%,2年肿瘤特异性生存率为97.4%,2年无进展生存率为93.0%。结论肾部分切除术可以安全地用于合适选择的cT2期肾癌,具有良好的肾功能保护效果、可接受的并发症发生率和癌症控制效果。Objective To investigate the efficacy of partial nephrectomy in the treatment of cT2 renal cell carcinoma.Methods Clinical data of 60 patients with cT2 renal cell carcinoma who received partial nephrectomy during Jan.2007 and Oct.2018 in our hospital were retrospectively analyzed.The patients included 46 males and 14 females,median age 58 years,ranging from 26 to 79 years.The carcinoma was located in the left side in 35 cases,and in the right side in 25 cases.The median diameter of carcinoma was 7.9 cm,ranging from 7.1 to 11.2 cm.Open partial nephrectomy(OPN)was performed in 25 cases,laparoscopic partial nephrectomy(LPN)in 33 cases,and robot-assisted partial nephrectomy(RAPN)in 2 cases.The functional outcomes,incidence of complications,overall survival(OS),cancer-specific survival(CSS)and progression-free survival(PFS)were observed.Results Negative surgical margin was detected in 59 cases,and positive surgical margin was observed in 1 case.The preoperative estimate glomerular filtration rate(eGFR)was 96.07 mL/min per 1.73 m^2(ranging from 40.40 to 110.44).In the last follow-up,the eGFR was 79.40 mL/min per 1.73 m^2(ranging from 6.03 to 182.81).Complications were observed in 22 cases,and the incidence of severe complications(CCS≥3)was 10%.The 2-year OS,CSS and PFS were 97.4%,97.4%and 93.0%,respectively.Conclusion Partial nephrectomy is safe and effective for selected cT2 renal cell carcinoma cases.It has good effects on renal function preservation and tumor control,and acceptable incidence of complications.

关 键 词：肾癌 肾部分切除术 肾功能 生存 

分 类 号：R737.11[医药卫生—肿瘤]