早期肾癌保肾手术安全范围的研究

目的：探讨直径≤4cm肾癌保肾手术的安全切除范围。方法：直径≤4cm肾癌根治术标本41例，标本分层切开，观察肾内原发癌及癌旁病变累及范围，并对肾癌切除标本采用免疫组化方法，检测癌和癌旁组织Ki-67和增殖细胞核抗原（PCNA）表达情况。分析肿瘤向周边浸润及周围组织癌变趋向的规律。结果：41例肾癌中，17％（7／41）存在1种以上假包膜外癌灶。距原发癌越远。癌旁组织Ki-67和PCNA阳性的比例越低。结论：直径≤4cm肾癌保肾手术安全切缘须包括假包膜外1cm以内的正常肾实质。同时对癌旁组织瞄．67和PCNA阳性表达者应扩大切除范围，达到切缘阴性。降低局部复发率。

Explotation of safety margin in nephron-sparing surgery in the patients with early renal cell carcinoma

Objective To explore the excision extension in nephron-sparing surgery(NSS) in the patients with early renal cell carcinoma (RCC) including 4 cm or less in diameter. Methods Forty-one kidneys resected by radical nephrectomy were examined using immunohistochemistry to observe the expressions of Ki-67 and PCNA in primary tumor and paracarcinoma tissues. Results Of 41 primary tumors, 17.0%(7/41) existed one or more pseudocapsule cancer focus. Along with the further distance from primary tumor,the proportions of positive expressions of Ki-67 and PCNA in paracarcinoma tissue were decreased gradually. Conclusions It is suggestted that when NSS is performed in RCC 4 cm or less in diameter, a margin of more than 1 cm of adjacent parenchyma should be excised with the tumor. It is necessary to choice individual treatment for RCC with strong expressions of Ki-67 and PCNA.