保留肾单位手术治疗儿童肾细胞癌

目的 探讨保留肾单位手术治疗儿童肾细胞癌的安全性和可行性.方法 对我院1973年1月至2016年12月收治的11例行保留肾单位手术治疗儿童肾细胞癌的临床资料进行回顾性分析.男8例,女3例;年龄4.5～13.5岁,平均7.5岁;左侧5例,右侧6例.临床表现:无痛肉眼血尿4例,腹部包块1例,行B型超声检查偶然发现6例,血尿病史1～7个月,平均3个月.结果 11例患儿均行开放性经腹膜保留肾单位手术,肿瘤直径2.2～6.9 cm,平均3.3 cm.肿瘤位于肾上极4例,肾中极背侧1例、肾中极腹侧1例、肾下极5例.手术时间88～175min,平均107 min,术中阻断肾蒂时间19～25min,平均20.4 min,出血量10～100ml,平均35ml.本组手术均安全进行,无继发出血、漏尿等并发症.术后病理提示9例为Xp 11.2易位/TFE3基因融合相关性肾癌,1例为透明细胞癌,1例为嫌色细胞癌.11例均获随访,随访时间25～129个月,平均53.2个月,无复发及死亡病例.结论 儿童肾癌应用保留肾单位手术的指征应十分严格,在此前提下,保留肾单位手术治疗儿童肾癌安全、可行.

Safety and feasibility of nephron-sparing surgery for pediatric renal cell carcinoma

Objective To explore the safety and feasibility of nephron-sparing surgery (NSS) for pediatric renal cell carcinoma (RCC).Methods The clinical characteristics of 11 RCC children (8 males and 3 females) undergoing NSS between January 1973 and December 2016 were retrospectively analyzed.The mean age was 7.5 (4.5-13.5) years.RCC was involved at left (n=5) and right (n=6).Clinical presentations included painless gross hematuria (n =4),abdominal mass (n =1) and incidental ultrasonic finding (n =6).The mean course of hematuria was 3 (1-7) months.Results All NSS procedures were completed via an open transperitoneal approach.The mean tumor diameter was 3.7 (2.2-6.9) cm.The locations of renal tumors were in upper pole (n =4),mid-dorsal (n =1),midventral (n =1) and lower pole (n =5).The mean operative duration was 107 (88-175) min and estimated volume of blood loss 35 (10-100) ml.And the mean duration of renal pedicle clamping was 20.4 (19-25) min.No such complications as leakage of urine,prolonged drainage or secondary bleeding were noted.The pathological types were RCC associated with Xp1 1.2 translocation/TFE3 gene fusions (n=9),clear cell carcinoma (n =1) and chromophobe carcinoma (n =1).There was no local recurrence during a mean follow-up period of 53.2 (25-129) months.Conclusions The surgical indications of NSS should be strictly grasped for pediatric RCC.And NSS is both safe and feasible for renal cell carcinomas.