肾癌保留肾单位手术的临床价值(附17例报告)

目的　评价肾癌保留肾单位手术的临床价值。　方法　回顾性研究 17例行保留肾单位手术的肾癌患者临床资料 ,其中单侧 15例 ,双肾异时性肾癌且一侧为多发肿瘤 2例。绝对指征 2例 ,相对指征 6例 ,选择性指征 9例。肿瘤直径 2～ 6cm ,均为T1期 (1997年TNM标准 ) ;行改良肾肿瘤剜除术 (切缘于肾肿瘤外 1cm正常肾实质处 ) 15例 ,肾上极切除术 1例 ,楔形切除术 1例。 2 0例同期肾癌临床及分期相当但行根治性手术的患者资料作随访对照 ,并作生存率时序检验。　结果　 17例患者随访 3～ 6 3个月 ,平均 35 .2个月 ,未见并发症及残肾肿瘤复发。无瘤生存率与根治性手术者相近。　结论　肾癌保留肾单位手术安全、有效 ,适合于对侧肾功能正常、一侧局限的偶发肾肿瘤患者。

Clinical significances of nephron sparing surgery for renal cell carcinoma (report of 17 cases)

Objective To evaluate the role of nephron sparing surgery in patients with renal cell carcinoma. Methods Retrospectively analyzed a total of 17 patients with renal cell carcinoma treated with nephron sparing surgery between September 1997 and September 2002.Among these patients,2 cases were bilateral asynchronous and multicentric tumor,15 cases were unifocal tumor.2 cases were in imperative indications,6 cases in relative indications,and 9 cases in elective indications.The tumor diameter ranged from 2 cm to 6 cm,all tumor were in T 1 (1997 TNM staging system).15 cases underwent tumor enucleation at 1 cm apart from surgical margin,1 case underwent upper polar nephrectomy,1 case underwent wedged resection.Selected 20 patients matched for age, tumor location and stage who underwent radical nephrectomy at same period for comparison with an average follow-up of 36.4 months. Results The patients were followed up for an average period of 35.2 months (range,3 to 63 months),no surgical complication or local recurrence has been observed,and its long-term cancer-free survival was comparable to that after radical nephrectomy. Conclusions Nephron sparing surgery is safe and effective for the treatment of renal cell carcinoma and indicated for patients with small,localized,often incidental tumors and a normal contra-lateral kidney.