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。

Treatment in bilateral renal cell carcinoma( report of 21 cases)

Objective To evaluate the efficacy of surgery treatment in bilateral renal cell carcinoma. Methods From 1990 to 2005, 21 patients with bilateral renal cell carcinoma(BRCC) admitted to our hospital. Among the 21 cases, 10 had synchronous BRCC and 11 had asynchronous BRCC. Fifteen tumors were at the upper pole of kidney, 19 at the middle, 20 at the inferior pole. And 28 tumors were on the left kidney, 26 on the right. The mean tumor size was 4. 5 cm in diameter (range, 0. 5 - 16. 0 cm). Cancer embolus in the inferior caval vein was found in 2 patients. Seventeen patients underwent open operation. Of 6 synchronous BRCC, 5 cases underwent first-stage operation, 1 underwent two-stage operation. The treatment included bilateral partial nephrectomy (1 case) , bilateral partial nephrectomy plus left adrena-lectomy( 1 case) , unilateral radical nephrectomy plus contralateral partial nephrectomy(3 cases) , unilateral radical nephrectomy plus contralateral partial nephrectomy and thrombectomy(1 case). Eleven patients with asynchronous BRCC underwent two-stage operation. The treatment included bilateral partial nephrectomy (3 cases) , unilateral radical nephrectomy plus contralateral simple enucleation (1 case) , unilateral radical nephrectomy plus contralateral partial nephrectomy and thrombectomy (1 case) , unilateral radical nephrectomy plus contralateral partial nephrectomy (6 case). Four patients hadn't undergone open operation. Of them, 1 case received interventional therapys, 1 received biological therapy, 2 received conservative treat- ment. Results All patients were followed up of 3 months to 24 years. Within the 17 patients who underwent operation, 13 were alive without tumor recurrence or metastasis, 1 had lung metastasis at 10 months after surgery but was still alive for 9 months, 1 had local recurrence 1 year after operation but was still alive for 5 months after the biological therapy and Chinese medicine therapy, 2 died of tumor metastasis. Among the 4 patients who had not undergone operation, 1 died of pancreas metastasis, 1 died of renal function failure, 1 died of cerebrovascular accident, 1 was alive for 7 months after chemotherapy and biological therapy. After 7 months to 18 years, tumor on contralateral kidney appeared in patients who had undergone radical resection of asynchronous BRCC. Conclusions BRCC isn't contraindication of surgery. The nephron sparing surgery is a safe and reasonable method at present to gain satisfying life quality with sufficient nephridial tissue reserved.