不同病理类型双侧肾癌5例临床分析  

Clinical analysis of bilateral renal cell carcinoma with different pathological subtypes:a report of 5 cases

作　　者：徐楚潇 孙争辉 陆敏[2] 刘承[1] 王国良[1] 马潞林[1] XU Chuxiao;SUN Zhenghui;LU Min;LIU Cheng;WANG Guoliang;MA Lulin(Department of Urology,Peking University Third Hospital,Beijing 100191,China;Department of Pathology,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 [2]北京大学第三医院病理科,北京100191

出　　处：《现代泌尿外科杂志》2021年第5期410-414,共5页Journal of Modern Urology

摘　　要：目的探讨不同病理类型双侧肾癌(BRCC)的临床病理特点、手术治疗策略和预后。方法回顾性分析2004年6月至2019年6月北京大学第三医院收治的5例不同病理类型BRCC患者的临床资料。5例均为男性,平均年龄53(33~61)岁。同时性BRCC 3例,异时性BRCC 2例。5例均为双侧单发肿瘤。10枚肿瘤中实性肿瘤3枚,囊性肿瘤7枚。肿瘤平均直径2.4(1.4~6.7)cm。平均R.E.N.A.L.评分5(4~8)分。5例患者术前平均血清肌酐79(74~108)μmoI/L。结果5例均成功行双侧手术治疗:其中3例行双侧后腹腔镜下保留肾单位手术(NSS);1例行一侧后腹腔镜下根治性肾切除术(RN),对侧后腹腔镜下NSS;1例因一侧囊性肿瘤体积较大,粘连严重行后腹腔镜探查,中转开放NSS,对侧后腹腔镜下NSS。3例同时性BRCC患者均采用分期手术策略,双侧手术平均间隔时间3(1.5~4)个月。5例平均手术时间126(110~221)min,行NSS者平均热缺血时间24(11~40)min。平均手术失血量20(10~50)mL。5例患者术后平均血清肌酐95(77~121)μmol/L,术后平均住院时间6(3~16)d。术后病理示5例均为一侧肾透明细胞癌,其中对侧低度恶性潜能多房囊性肾肿瘤者3例、肾嫌色细胞癌者1例、管状囊性肾细胞癌者1例。5例平均随访时间26.7(18.6~194.3)个月,均无局部复发或远处转移,肾功能良好。结论不同病理类型BRCC临床较为罕见,治疗以分期双侧NSS为首选。腹腔镜下NSS治疗复杂性肾囊性肿瘤难度较大,需临床经验丰富的医师进行操作。BRCC多灶发病的概率显著高于单侧肾癌,术后应严密随访,不同病理类型BRCC的预后取决于恶性度较高、分期较晚的一侧。同一机体发生不同病理类型的BRCC,为该病的肿瘤起源研究提供新的线索和思路,但BRCC的发生机制尚需基因测序的大样本研究进一步阐明。Objective To investigate the clinicopathological characteristics,surgical strategies and oncological outcomes of bilateral renal cell carcinoma(BRCC)with different pathological subtypes.Methods Clinical data of 5 BRCC patients were analyzed.All cases were male and the median age was 53(33-61)years,including 3 synchronous cases and 2 metachronous cases.All 5 patients had solidary tumor in either side.Of the 10 tumors,3 were solid and 7 were cystic.The median tumor diameter was 2.4(1.4-6.7)cm,R.E.N.A.L.score was 5(4-8),and preoperative serum creatinine was 79(74-108)μmoI/L.Results All surgeries were successful.Bilateral retroperitoneal laparoscopic nephron-sparing surgery(NSS)was performed in 3 cases;retroperitoneal laparoscopic radical nephrectomy(RN)plus contralateral NSS was performed in 1 case;laparoscopic exploration,open NSS and contralateral retroperitoneal laparoscopic NSS were performed in 1 case with large cystic tumor and severe adhesion.The 3 patients with synchronous BRCC received two-stage surgeries with the median interval of 3(1.5-4)months.The median operation time was 126(110-121)min,estimated blood loss 20(10-50)mL,warm ischemia time of NSS 24(11-40)min,postoperative serum creatinine 95(77-121)μmol/L,and hospital stay 6(3-16)d.Postoperative histopathology revealed clear cell renal cell carcinoma(ccRCC)and contralateral multilocular cystic renal cell neoplasm of low malignant potential(MCRCNLMP)in 3 cases;ccRCC and contralateral chromophobe renal cell carcinoma(chRCC)in 1 case;ccRCC and contralateral tubulocystic renal cell carcinoma(tcRCC)in 1 case.Conclusion BRCC with different pathological subtypes is rare in clinical practice and bilateral NSS is the preferred surgical strategy.Laparoscopic surgery for complex cystic renal neoplasm is difficult and should be performed by experienced surgeons.Strict follow-up is necessary for BRCC patients due to the high multifocal rate.The oncological outcome of BRCC mostly depends on the more malignant tumor.BRCC with different pathological subtypes renders

关 键 词：双侧肾癌 病理类型 手术 预后 肿瘤起源 

分 类 号：R737.11[医药卫生—肿瘤]