原发性腹膜后软组织肉瘤联合肾切除27例临床分析  

Primary retroperitoneal soft tissue sarcoma resection combined with nephrectomy:a report 27 cases

作　　者：林佳鑫 刁德昌[2] 廖伟林 汪佳豪 唐新 李文娟[1] 李洪明[2] 易小江 卢新泉 冯晓创 陈昭宇 Lin Jiaxin;Diao Dechang;Liao Weilin;Wang Jiahao;Tang Xin;Li Wenjuan;Li Hongming;Yi Xiaojiang;Lu Xinquan;Feng Xiaochuang;Chen Zhaoyu(The Second Clinical Medical School,Guangzhou University of Chinese Medicine,Guangzhou 510405,China;Department of Colorectal Surgery,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第二临床医学院,广州510405 [2]广东省中医院胃肠外科,广州510120

出　　处：《中华普通外科杂志》2023年第12期905-908,共4页Chinese Journal of General Surgery

摘　　要：目的探讨腹膜后软组织肉瘤联合肾切除的疗效与安全性。方法回顾性分析2017年6月至2022年8月广东省中医院胃肠肿瘤中心诊治的27例联合肾切除的腹膜后软组织肉瘤的临床资料,分析肾切除术的原因、肾功能不全进展情况及生存率。结果26例(96%)肿瘤实现R 0/R 1切除,1例行R_(2)切除。6例接受了联合单侧肾脏切除,21例患者接受了联合多器官切除,中位切除器官数量为4(2,5)个。术后病理提示合并切除的肾脏肿瘤浸润阳性17例。5例出现Clavien-Dindo3级及以上并发症,术后无30 d内死亡病例。在术后第90天时,19例(70%)患者肾功能下降(Z=2.88,P=0.04),估算肾小球滤过率(eGFR)中位数为60.4(40.9,70.8)ml·(min·1.73 m^(2))^(-1),中位下降-3.96(-30.36,0.31)ml·(min·1.73 m^(2))^(-1)。11例患者出现了肾功能损害的进展,其中8例术前慢性肾脏疾病(CKD)分期1期的患者出现进展(6例进展到CKD 2期,2例进展到CKD 3期),2例CKD 2期的患者进展为CKD 3期,1例术前CKD 3期的患者进展至CKD 4期。随访时间为3~38个月,随访期间无患者进展为CKD 5期,无1例患者需要透析治疗。结论腹膜后软组织肉瘤联合肾切除安全可行,并且可提高肿瘤的根治性。Objective To investigate the efficacy and safety of retroperitoneal soft tissue sarcoma resection combined with nephrectomy.Methods The clinical data of 27 cases undergoing retroperitoneal soft tissue sarcoma resection combined with nephrectomy at the Gastrointestinal Tumor Center,Guangdong Provincial Hospital,Traditional Chinese Medicine from Jun 2017 to Aug 2022 were retrospectively analyzed for the indication of nephrectomy,postoperative progression of renal insufficiency and survival rate.Results Twenty-six cases(96%)achieved R_(0)/R_(1) resection and 1 case nderwent R_(2)resection.Six cases underwent combined unilateral nephrectomy and 21 patients underwent combined multi-organ resection with a median number of resections of 4(2,5).Postoperative pathology suggested that the combined resected kidney was positive for tumor infiltration in 17 cases.Five cases had Clavien-Dindo grade 3 or higher complications and no deaths occurred within 30 days after surgery.At the 90th day after surgery,19 cases(70%)had decreased renal function(Z=2.88,P=0.04),with a median decrease of-3.96(-30.36,0.31)ml·(min·1.73 m^(2))^(-1),including 8 cases of preoperative Chronic Kidney Disease(CKD)1 stage progression(6 cases of CKD 2 stage,2 cases of CKD 3 stage);2 cases of CKD 2 stage progressed to CKD 3 stage;1 case of preoperative CKD 3 stage progressed to CKD 4 stage.During the follow-up period of 3-38 months,no patient progressed to CKD 5 stage and no patient required dialysis treatment.Conclusion Retroperitoneal soft tissue sarcoma resection combined with nephrectomy is safe and feasible while improving tumor radicality.

关 键 词：腹膜后肿瘤 肾切除术 肾功能不全 预后 

分 类 号：R735.4[医药卫生—肿瘤] R699.2[医药卫生—临床医学]