同侧小体积肾及肾上腺肿瘤一期手术16例体会  

One-stage surgery for small renal mass with ipsilateral adrenal mass in 16 Patients

作　　者：高翔[1] 刘佳文 冯登元 谭若芸 易小敏 GAO Xiang;LIU Jiawen;FENG Dengyuan;TAN Ruoyun;YI Xiaomin(Department of Urology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院泌尿外科,江苏南京210029

出　　处：《中国肿瘤外科杂志》2022年第1期39-43,共5页Chinese Journal of Surgical Oncology

基　　金：国家自然科学基金面上项目(82070769)

摘　　要：目的总结同侧小体积肾及肾上腺肿瘤患者一期行后腹腔镜肾部分及肾上腺部分切除术的临床经验。方法回顾性分析2010年9月至2021年11月南京医科大学第一附属医院收治的16例同侧小体积肾及肾上腺肿瘤一期后腹腔镜手术患者的临床资料。结果所有患者均在后腹腔镜下完成肾部分及肾上腺部分切除手术,其中机器人辅助手术3例,无中转开放手术者。肾肿瘤直径0.9~4.0(2.4±1.0)cm;肾上极肿瘤7例,肾中极4例,肾下极4例,1例多发;肾上腺肿瘤直径1.0~4.0(2.0±1.0)cm。术后病理示肾透明细胞癌12例,嫌色细胞癌1例,极性倒置的乳头状肾肿瘤1例,肾错构瘤2例;肾上腺皮质腺瘤15例,嗜铬细胞瘤1例。肾透明细胞癌合并肾上腺皮质腺瘤最常见,占比68.75%。术后随访1~90个月(中位随访时间24个月),均无复发或转移。结论小体积肾肿瘤合并的同侧肾上腺肿瘤多为良性,此类患者一期行后腹腔镜肾部分及肾上腺部分切除术安全有效,术后需长期随访。Objective To evaluate the safety and clinical efficacy of simultaneous laparoscopic partial nephrectomy and adrenalectomy in patients with small renal mass and ipsilateral adrenal mass.Methods The clinical data of patients with small renal mass and ipsilateral adrenal mass in the First Affiliated Hospital of Nanjing Medical University from September 2010 to November 2021 was collected.Results All patients underwent simultaneously retroperitoneal laparoscopic partial nephrectomy and partial adrenalectomy successfully without conversion to open surgery.Three cases received robot-assisted surgery.The renal tumor diameter ranged from 0.9 cm to 4.0 cm,with the average diameter of(2.4±1.0)cm.There were 7 cases in upper pole,4 cases in medium pole,4 cases in lower pole,and 1 case with multiple tumors.The diameter of adrenal tumor ranged from 1.0 cm to4.0 cm,with the average diameter of(2.0±1.0)cm.Postoperative pathological results revealed that there were 12 cases of clear cell carcinoma(RCC),1 case of chromophobe RCC,1 case of papillary RCC and 2 cases of angiomyolipoma as well as 15 cases of adrenocortical adenoma and 1pheochromocytoma.Most common type was clear cell RCC combined with adrenocortical adenoma(68.75%).No recurrence or metastasis was found during 1 to 90 months(median 24)outpatient follow-up.Conclusions Benign adrenal mass is a common combination with small renal mass.One-stage retroperitoneal laparoscopic surgery is safe and effective.Long-term postoperative follow-up is necessary.

关 键 词：肾肿瘤 肾上腺肿瘤 腹腔镜肾部分切除术 腹腔镜肾上腺部分切除术 机器人辅助腹腔镜手术 

分 类 号：R737.11[医药卫生—肿瘤] R736.6[医药卫生—临床医学]