T1b期肾细胞癌保留肾单位手术的临床价值

 目的   探讨T1b期肾细胞癌 (renal cell carcinoma,RCC) 行各种保留肾单位手术 (nephron sparing surgery,NSS)的安全性与可行性。方法   回顾性分析2011年1月至2013年12月复旦大学附属中山医院 50 例行开放、腹腔镜及机器人辅助下NSS的T1b期RCC患者临床资料及随访情况。结果   50例患者均成功行NSS,手术时间 (70～210) min,平均 (122.8±44.1) min。阻断肾血流38例,热缺血时间 (20~47) min,平均 (29.0±8.5) min。术中出血量 30～1 100 mL,平均 (196.6±212.8) mL,肿瘤RENAL评分4～10,平均7.3±1.6,术前血肌酐42～150 μmol/L,平均 (77.4±22.0) μmol/L;术后住院5～46天,平均 (8.4±6.5)天。术后病理示:透明细胞癌45例,嫌色细胞癌3例,乳头状癌2例。50例患者术后1周、3个月和6个月肾功能复查,肌酐分别为 (87.3±11.6)μmol/L、 (82.5±10.8)μmol/L和(79.7±12.1)μmol/L,血尿素氮分别为 (5.7±1.6) mmol/L、 (5.2±1.3) mmol/L和(5.1±1.2) mmol/L,与术前比较差异无统计学意义。结论   NSS既能有效切除肿瘤,又能保留部分肾单位,是一种有效的治疗T1b期RCC可行的选择,尤其对双侧肾肿瘤或者孤立性肾脏肾肿瘤。

The clinical value of nephron sparing surgery for T1b stage renal cell carcinoma

Objective  To investigate the safety and feasibility of T1b stage renal cell carcinoma (RCC) underwent nephron sparing surgery (NSS).Methods  Fifty cases of T1b stage RCC treated with NSS through open、laparoscopic and robotic assisted laparoscopic resection in Zhongshan hospital from Jan.,2011 to Dec., 2013 were included and retrospectively analysized.Results  Fifty patients were successfully performed through NSS with meas operation time of (122.8±44.1) min (70-210 min). Mean intra-operative blood loss of (196.6±212.8) mL (30-1 100 mL), mean preoperative serum creatinine of (77.4±22.0) μmol/L (42-150 μmol/L),and mean postoperative hospital stay of (8.4±6.5) days (5-46 days). In 38 cases with interruption of renal blood flow during operation, mean warm ischemia time was (29.0±8.5) min (20-47 min). The postoperative pathology indicated that 45 cases were clear cell carcinoma,3 cases were chromophobe renal cell carcinoma, 2 cases were papillary carcinoma.The 50 cases post-operation follow-up renal function, one week, three months  and six months,the serum creatinine were (87.3±11.6) μmol/L, (82.5±10.8) μmol/L, (79.7±12.1) μmol/L; blood urea nitrogen were (5.7±1.6) mmol/L,(5.2±1.3) mmol/L and (5.1±1.2) mmol / L,respectively.It has no significant difference with the pre-operation. Conclusions   Tumor resection and renal function blood urea nitrogen levels. partial preservation can be both achieved by NSS. Therefore it is an alternative treatment for T1b RCC, especially for those cases with solitary kidney or bilateral RCC.