双侧肾细胞癌21例报告

目的 探讨双侧肾细胞癌手术治疗的疗效。方法 1990年1月至2005年1月收治双侧肾细胞癌患者21例。其中同时性10例，异时性11例。肿瘤位于肾上极15枚，中极19枚，下极20枚；左肾28枚，右肾26枚。肿瘤直径0．5～16．0cm，平均4．5cm。2例伴下腔静脉癌栓。17例经手术治疗。6例同时性肾癌中，5例行双侧一期手术，1例行分期手术。其中1例行双肾部分切除术；1例行双肾部分切除及左肾上腺切除术；3例行一侧肾癌根治术及对侧肾部分切除术；1例行一侧肾癌根治术，对侧肾部分切除术及下腔静脉切开取癌栓术。11例异时性肾癌均分期手术。其中3例行双肾部分切除术；1例行一侧肾癌根治术，对侧肾肿瘤剜出术；1例行一侧肾癌根治术，对侧肾部分切除术加下腔静脉切开取癌栓术；6例行一侧肾癌根治术，对侧肾部分切除术。未行手术治疗4例．其中行介入治疗1例，生物学治疗1例，保守治疗2例。结果 21例随访3个月～24年，平均3．4年。17例手术治疗者中，13例未见肿瘤复发和转移，术后肾功能均可；1例术后10个月出现左上肺转移，已带瘤存活9个月；1例术后1年出现残肾肿瘤复发，经生物学和中药治疗，已带瘤存活5个月；2例死于肿瘤转移。4例未手术者中，1例10个月后死于胰腺转移，1例4个月后死于肾衰竭，1例6个月后死于脑血管意外，1例伴腹膜后淋巴结转移者经化疗和生物学治疗，病情稳定，已带瘤存活7个月。异时性肾癌者的先发一侧行肾癌根治术，对侧肾出现肿瘤的时间为7个月～18年。结论 双侧肾癌并非手术禁忌，如果采取积极的治疗措施，仍可获得满意的手术效果。保肾手术是目前较为理想的治疗方法，如果保留足够的肾实质，患者仍可获得良好的生存状态。     

同时性散发性双肾癌的手术治疗策略研究

目的:探讨同时性散发性双侧肾癌的手术治疗策略。方法:回顾性分析64例同时性散发性双肾癌患者的临床及病理资料。男47例,女17例,年龄25~69岁,平均51岁。59例患者无任何临床症状为体检时发现,2例以血尿就诊,3例以腰痛就诊,均未伴淋巴结及远处转移。肿瘤临床分期为T1a38例,T1b17例,T2a9例。结果:64例患者均行后腹腔镜手术治疗。4例患者行双侧肿瘤的同期手术切除,2例发生术后急性肾功能衰竭,行短期透析治疗。60例行双侧肿瘤分期手术切除,其中33例行双侧保留肾单位手术(NSS-NSS组),19例先行一侧根治性肾切除术后行另一侧保留肾单位手术(RN-NSS组),7例先行保留肾单位手术后行另一侧根治性肾切除术(NSS-RN组)。双侧肿瘤切除术后各组肌酐分别为89、110、102μmol/L。1例行双侧根治性肾切除,术后行常规透析治疗。术后随访7~99个月,中位随访时间49个月,50例患者无瘤生存,2例局部复发,5例发生转移,7例死亡。结论:后腹腔镜分期保留肾单位手术是同时散发性双肾癌的首选治疗策略,在完整切除肿瘤的同时最大限度的保留肾功能。患者预后不因双侧肾脏受累而受到明显影响。     

肾癌并肝下型下腔静脉癌栓的手术治疗并文献复习

目的 探讨肾细胞癌并下腔静脉癌栓的手术治疗方法.方法 回顾性分析6例经手术及病理证实的肾细胞癌并肝下型下腔静脉癌栓患者的临床资料,所有病例均行根治性肾切除并癌栓切除术,分别采用下腔静脉切开、下腔静脉部分切除和节段性下腔静脉切除三种方法 取出癌栓.结果 6例手术均获成功,无大出血、肺梗塞等并发症,术后患者恢复良好.其中2例分别于术后38个月和76个月死亡,3例仍健在,平均存活时间为54个月,1例术后18个月后失访.结论 右肾癌并下腔静脉癌栓患者下腔静脉节段性切除能够安全地进行,根治性肾切除并癌栓切除术能够使患者获得长期存活.     

双侧肾癌的诊治与预后4例报告

目的:探讨双侧肾癌(bilateral renal cell carcinoma,BRCC)的诊治与预后。方法:双侧同时性BRCC4例,肿瘤大小2.5～7.0cm,皆行双侧间期腹腔镜手术。其中1例先行一侧腹腔镜根治性肾切除术(retroperito-neal laparoscopic radical nephrectomy,RLRN),2周后再行对侧腹腔镜肾部分切除术(retroperitoneoscopic partialnephrectomy,RPN);3例先行一侧RPN,2周后再行对侧RLRN。结果:4例随访3～45个月,平均18个月,总肾功能情况良好,目前未发现肿瘤转移及复发。结论:BRCC的治疗原则为尽可能切除肿瘤和最大限度保存总肾功能,RLRN结合RPN的方法治疗双侧肾癌,安全有效,预后较好。     

下腔静脉整段切除术治疗肾肿瘤伴下腔静脉癌栓完全性梗阻

目的提高肾肿瘤根治术的治疗效果。方法报告应用下腔静脉整段切除术和右肾癌根治性切除术,治疗４例右肾肿瘤并下腔静脉癌栓完全性梗阻病人。４例下腔静脉癌栓均位于肝静脉平面以下。结果所有病人术后血尿素氮、肌酐水平无明显上升。１例因肿瘤肺转移于术后１年零３个月死亡,１例随访３年后失访,２例健在（分别为术后１年及１０个月）。结论无远处重要器官转移的伴有下腔静脉癌栓完全梗阻的肾肿瘤病人仍是积极手术治疗的指征。整段切除癌栓完全梗阻的下腔静脉,因包括左肾在内的血液回流已建立了良好的侧支循环,因而无需再行血管重建手术。     

双侧上尿路肿瘤的治疗方法分析与评估(附2例报告)

目的 探讨双侧上尿路同时发生恶性肿瘤的治疗方法及有效性评价.方法 报告2013年1月～2013年2月本院收治的2例双侧上尿路同时发生肿瘤患者的临床资料,2例均行一侧肾输尿管全长切除术,对侧保留肾脏的手术.其中1例为输尿管膀胱再吻合术,1例为输尿管镜下肿瘤切除术.结果 术后病理结果均提示移行细胞癌.目前2例患者均在随访中,其中1例术后6个月及8个月分别出现膀胱肿瘤复发,后于2013年10月行膀胱根治性切除术;1例未见肿瘤复发.结论 对于双侧同时存在尿路上皮肿瘤的患者,可根据实际情况选择一侧肾输尿管全长切除+对侧保留肾脏的手术方法,此种治疗方式术后花费低、患者主观生存质量较高,值得临床推荐.当然术后有效的随访必不可少.     

腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术

目的 探讨腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术的可行性. 方法 右肾占位病变患者2例.增强CT显示1例肿物部分延伸至肾静脉及腔静脉内,1例右肾静脉内可见充盈缺损并突入腔静脉内.均在全麻下行经后腹腔镜下根治性右肾切除及肾静脉、腔静脉取栓术.术中放置4个穿刺套管针,切断肾动脉后游离腔静脉及肾静脉,腔镜血管阻断钳部分阻断腔静脉,切开腔静脉取出瘤栓,缝合腔静脉,完整切除肾脏及瘤栓. 结果 2例患者的腔静脉瘤栓长度分别为0.3和1.0 cm,均安全取出,术后恢复良好,5 d出院.病理诊断分别为上皮样肾血管平滑肌脂肪瘤和肾透明细胞癌1～2级.术后随访5个月未见肿瘤复发和转移. 结论 对选择性肾肿瘤并肾静脉及腔静脉瘤栓患者行腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术安全可行.     

肾癌并肾静脉、下腔静脉、右心房癌栓的外科治疗(附3例报告)

目的评价肾肿瘤并肾静脉、下腔静脉、右心房癌栓患者行根治性肾切除术及取栓术后的早期和远期疗效。方法对本院2011年3月至2013年5月手术治疗的3例肾肿瘤并肾静脉、下腔静脉、右心房癌栓的患者进行回顾性分析。本单位泌尿外科团队联合心外科团队对这3例患者施行了根治性肾切除术及低温体外循环下右心房和腔静脉癌栓取栓术,手术过程顺利。术后规律随访,第1年患者每3个月复查评估1次,第2年及第3年每6个月1次,此后1年1次。结果所有患者术中无栓塞,无院内死亡。1例患者术后6个月发生肺转移,2年后死亡。另外2例患者健在(分别随访90个月、64个月),在未给予其他的辅助治疗情况下没有发现肿瘤复发或转移。结论肾肿瘤并肾静脉、下腔静脉、右心房癌栓患者手术治疗需要多学科参与。根治性肾切除术及低温体外循环下能安全有效地进行右心房和腔静脉癌栓取栓术,并发症发生率低。准确的诊断及合理的治疗措施能减少相关的并发率和死亡率。长期随访结果是可喜的。但需要更多更大样本量的研究结果来进一步验证。     

肾肿瘤伴下腔静脉癌栓完全梗阻的手术治疗

目的：提高肾肿瘤根治术的治疗效果。方法：回顾性分析7例肾肿瘤伴下腔静脉癌栓完全梗阻患者的治疗，6例行下腔静脉整段切除术加右肾根治性切除术．1例行右肾肿瘤根治术加腔静脉切开取栓术。结果：全组患者术后血尿素氮、肌酐水平无明显上升。2例因肿瘤转移分别于术后1年3个月及1年6个月死亡。1例3年后失访，4例健在。结论：无远处重要器官转移的伴有下腔静脉癌栓完全梗阻的肾肿瘤患者仍是积极手术治疗的指征。     

双侧同时性上尿路移行细胞癌诊治研究

目的：提高双侧上尿路移行细胞癌的诊断率并探讨双侧上尿路同时发生移行细胞癌患者的治疗策略。方法：报告5例双侧上尿路同时发生移行细胞癌患者的临床资料,均有无痛性全程肉眼血尿,有2例肾功不全,4例术前行B超、IVP、CTU及逆行造影检查,2例术前获得诊断,2例一侧仅表现异常,术中获得确诊。4例均行保肾手术。1例在外院仅诊断一侧肿瘤,并行根治性切除术,20天后又在我院确诊对侧也存在肿瘤并行保肾手术。结果：随访14～40个月,平均26个月。随访期间1例死亡,2例术后发生膀胱肿瘤。2例未见肿瘤复发。结论：双侧上尿路同时发生移行细胞癌易漏诊一侧,保肾手术是治疗的最优选择。     

Surgical management in synchronous bilateral renal cell carcinoma

Six patients with synchronous bilateral renal cell carcinoma were treated surgically over a 7-year period in our department. They were all males and the mean age was 60.3 years. They comprised 7.1% of all patients with renal cell carcinoma encountered during the same period. In four out of the six cases, radical nephrectomy for the larger tumor plus partial nephrectomy for contralateral kidney was performed simultaneously. In the remaining two cases, bilateral partial nephrectomy was performed simultaneously or as separate procedures. Two patients required chronic hemodialysis and died of cardio-pulmonary insufficiency on the 70th and 75th day. One patient, who underwent bilateral partial nephrectomy with incomplete tumor removal, subsequently died of metastatic disease at 27 months. Although one of them required transient hemodialysis, the remaining three patients were alive and disease-free 84, 42, and 17 months after operation, without evidence of tumor. This series suggests that partial nephrectomy is an appropriate option in the management of selected cases of bilateral renal cell carcinoma.     

Bilateral synchronous renal cell carcinoma: report of three cases

We report here three cases of bilateral synchronous renal cell carcinoma. One of the 3 patients underwent bilateral partial nephrectomy, while the other 2 underwent combined partial nephrectomy and radical nephrectomy. All patients received adjuvant therapy of interferon-alpha and tegafur uracil. In the management of synchronous bilateral renal cell carcinoma, we discussed the selection of surgical procedure for primary lesions, i.e., based on the renal function of both sides, and the necessity of adjuvant therapy in such cases.     

肾癌合并静脉瘤栓的外科治疗效果观察

目的 观察肾癌根治性切除加瘤栓取出术治疗肾癌合并静脉瘤栓的效果。方法 总结8例肾脏恶性肿瘤合并静脉瘤栓患者的临床及病理资料。男7例，女1例。平均年龄58岁。右侧7例，左侧1例。Robson分期Ⅲ期5例，Ⅳ期3例。瘤栓类型：肾静脉型1例，肝下型4例，肝上型3例。结果 7例患者行肾肿瘤根治性切除加瘤栓取出术，1例行右肾肿瘤及右肾上腺根治性切除术，腔静脉瘤栓放射治疗。1例瘤栓达右心房者术中死亡。随访7例，3例分别存活2、4和22个月，均死于远隔转移。4例术后已随访12、14、25和47个月者现仍无瘤存活。结论 肾肿瘤根治性切除加瘤栓取出术是治疗肾癌合并静脉瘤栓的有效方法。     

局限性肾癌保留肾单位手术20例分析

目的探讨保留肾单位手术（nephrom-sparing surgery,NSS）治疗局限性肾癌的安全性和疗效。方法回顾性分析20例行NSS肾癌患者的临床资料,其中双侧肾癌1例,孤立肾肾癌1例,对侧肾有病变或潜在功能损害的肾癌3例,对侧肾正常的肾癌15例。肿瘤直径平均3.9（1.3-7.4）cm。行肿瘤剜除术13例,肾部分切除术4例,肾楔形切除术3例。结果 20例患者手术均成功。术后平均随访29（15-37）个月,1例双侧肾癌患者术后14月出现远处转移死亡,1例术后12个月因局部复发改行根治性肾切除术,2例术后出现暂时性肾功能不全。结论 NSS治疗肾癌安全有效,尤其适用于局限性肾癌患者。     

A case of bilateral synchronous renal cell carcinoma treated with left partial nephrectomy and laparoscopic right nephrectomy]

We describe a case of bilateral synchronous renal cell carcinoma. A 70-year-old female was admitted to our department because of further examination for bilateral renal masses. Computed tomographic scanning and ultrasound examinations revealed bilateral solid enhanced renal masses, and bilateral renal cell carcinomas were suspected. First, partial left nephrectomy was performed. On the 21th day after the first operation, we confirmed the recovery of the left kidney, and performed right nephrectomy laparoscopically. The histopathological diagnosis revealed bilateral renal cell carcinomas. The patient is alive with no metastatic lesions and no recurrence at 16 months after the operations.     

Bilateral partial nephrectomy in a case of bilateral synchronous renal cell carcinoma

We report a case of bilateral synchronous renal cell carcinoma in a 66-year-old-man, who underwent bilateral partial nephrectomy. He visited our hospital, complaining of left flank pain. Drip infusion pyelography showed a left ureteral stone and left hydroureteronephrosis. Computerized tomography revealed bilateral renal tumors. These tumors were small (< 2 cm), so bilateral partial nephrectomy and left ureterolithotomy were performed. The pathological examination showed that all tumors were renal cell carcinoma. No recurrence has been seen nine months after the operation. This is the 12th case in the Japanese literature reported as bilateral partial nephrectomy for bilateral synchronous renal cell carcinoma.     

Bilateral Wilms' tumors: changing concepts in management

Bilaterality is uncommon in Wilms' tumor, being present in 4% to 8% of the cases. We report the combined experience of two children's hospitals in one city over a 20-year period. We encountered nine cases of synchronous bilateral nephroblastoma (National Wilms' Tumor Study 3, stage V). Age at diagnosis ranged from 9 to 41 months (mean 23 months). There were five girls and four boys. Associated findings include nephroblastomatosis in three cases (33%), one of which also had a familial history; undescended testis in two cases; and minor anomalies in two other cases. Surgical treatment consisted of unilateral nephrectomy with contralateral partial nephrectomy or tumorectomy in six cases, nephrectomy with contralateral biopsy only in two cases, and the other patient had bilateral biopsies initially, followed at a later date by partial nephrectomy on one side. All patients received chemotherapy; actinomycin D (AMD) only was used in the oldest case, vincristine and AMD in five cases, to which was added cyclophosphamide in one case and adriamycin in two. Seven patients received radiation therapy. Seven out of the nine patients survived more than 2 years (77%); five are well, off chemotherapy, with no evidence of disease from 4 to 11 years after diagnosis. Two patients suffered from chronic renal failure and one died from complications after renal transplantation more than 19 years after diagnosis. The two patients who died from their disease presented with more advanced tumor. Therefore, the agressiveness of multimodal therapy can be tailored according to stage and histology, and effective chemotherapy allows maximal preservation of renal parenchyma in patients with stage I and II tumors.     

双肾癌诊断和治疗策略

目的探讨双肾癌诊断和治疗策略。方法回顾分析22例双肾癌患者的临床资料。男15例，女7例；年龄32-69岁；同时性12例，异时性10例。3例有家族史。结果22例患者行保留肾单位的手术或肾癌根治术。随访18-91个月，5例肿瘤复发，1例死于尿毒症，1例死于肿瘤转移，10例无瘤生存，3例非癌死亡，2例失访。结论双肾癌多见于遗传性肾癌，保留肾单位手术是治疗双肾癌的首选方法，CT血管造影及三维重建有助于制定手术方案，异时性双肾癌预后较同时性双肾癌差。