双侧散发性肾癌37例手术策略分析  

Surgical Strategies Analysis of Bilateral Sporadic Renal Cell Carcinoma:Report of 37 Cases

作　　者：徐楚潇 何为[1] 肖若陶 刘承[1] 王国良[1] 田晓军[1] 马潞林[1] Xu Chuxiao;He Wei;Xiao Ruotao(Department of Urology, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院泌尿外科,北京100191

出　　处：《中国微创外科杂志》2021年第4期340-345,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：国家自然科学基金面上项目(81972381)。

摘　　要：目的探讨双侧散发性肾癌(bilateral sporadic renal cell carcinoma,BSRCC)的手术治疗策略。方法回顾分析我院2000年6月~2020年6月37例BSRCC的临床资料。全麻下建立腹膜后操作空间,行后腹腔镜保留肾单位手术(nephron-sparing surgery,NSS)或根治性肾切除术(radical nephrectomy,RN)。对肿瘤体积大、与周围组织粘连严重、复杂囊性肿瘤,行后腹腔镜探查、中转开放手术或直接行开放手术切除。结果37例均成功行双侧手术治疗,其中22例行双侧NSS,15例行一侧NSS、对侧RN。1例行同期NSS+RN后出现ClaveinⅣa级肾功能不全,行血液透析治疗,其余36例术后恢复良好,未发生并发症。14枚囊性肿瘤中,除2枚行腹腔镜探查、中转开放NSS外,其余12枚成功行完全后腹腔镜下NSS。82枚肿瘤中,肾透明细胞癌66枚,肾嗜酸/嫌色细胞混合性肿瘤7枚,低度恶性潜能多房囊性肾肿瘤3枚,乳头状肾细胞癌(renal cell carcinoma,RCC)Ⅰ型2枚,RCC未分类型2枚,肾嫌色细胞癌1枚,管状囊性RCC 1枚。术后病理核分级:G17例,G218例,G310例,G42例。35例随访4~194个月,中位时间30个月。30例存活,5例死亡,10例术后发生远处转移。2年总生存率91.3%,2年无进展生存率82.6%。结论BSRCC积极行双侧手术治疗效果良好,双侧腹腔镜NSS是较为理想的选择。对囊性RCC行腹腔镜NSS难度较大,常需手术经验丰富的医师进行操作。BSRCC具有多灶性、易复发的特点,术后应严密随访。Objective To explore the surgical strategies of bilateral sporadic renal cell carcinoma(BSRCC).MethodsThis retrospective study analyzed clinical data of 37 patients with BSRCC from June 2000 to June 2020 in our hospital.Retroperitoneal space was established under general anesthesia for retroperitoneal laparoscopic nephron sparing surgery(NSS)or radical nephrectomy(RN).For cases with tumors of large volume,severe adhesion to adjacent tissues or complex cystic features,laparoscopic exploration converting to open resection or direct open resection were performed.Results All the 37 patients underwent bilateral surgical treatments.There were 22 cases of bilateral NSS and 15 cases of NSS plus contralateral RN.One patient suffered ClaveinⅣa renal dysfunction and he was managed with hemodialysis.The remaining 36 patients recovered uneventfully.Among the 14 cystic renal tumors,12 were managed with totally retroperitoneat laparoscopic NSS while 2 received laparoscopic exploration and open resection.Among the 82 tumors,66 were clear cell carcinoma of the kidney,7 were renal hybrid oncocytic/chromophobe tumors,3 were multilocular cystic renal neoplasms of low malignant potential,2 were papillary renal cell carcinoma typeⅠ,2 were unclassified renal cell carcinoma,1 was chromophobe renal cell carcinoma,and 1 was tubulocystic renal cell carcinoma.In terms of postoperative nuclear grades,7 patients were grade 1(G1),18 patients were grade 2(G2),10 patients were grade 3(G3),and 2 patients were grade 4(G4).A total of 35 cases were followed up for 4-194 months,with a median of 30 months.There were 30 cases survived,5 cases died and 10 cases of distant metastasis.The 2-year cumulative survival rate was 91.3%,and the 2-year cumulative progression free survival rate was 82.6%.Conclusions Bilateral laparoscopic NSS is an ideal choice for BSRCC.Laparoscopic NSS for cystic RCC is difficult,and it often needs experienced surgeons.BSRCC is multifocal and easy to recur,so it should be followed up closely.

关 键 词：双侧散发性肾癌 囊性肾癌 后腹腔镜 保留肾单位手术 根治性肾切除 

分 类 号：R737.11[医药卫生—肿瘤]