肾癌局部复发的手术治疗

目的 提高肾癌局部复发的治疗水平.方法肾癌术后局部肿瘤复发患者7例.根治性肾切除术5例,原发肿瘤直径5.6～9.6 cm,平均6.5 cm;保留肾单位手术2例,原发肿瘤直径均<3.0 am.年龄19～64岁,平均42岁.肿瘤局部复发时间为术后12～54个月,平均23个月.复发肿瘤直径2.5～10.5 cm,平均5.2 cm.结果 行复发肿瘤切除术5例,复发肿瘤及肾切除术2例.7例手术均成功.术中出血150～3000 ml.患者术后恢复顺利.1例复发肿瘤压迫髂腹下神经,分离过程中因过度牵拉神经束,术后出现短暂的术侧下肢皮肤疼痛.1例术中分离损伤小肠,破孔1 cm,给予修补,术后恢复良好.余5例无明显术中和术后并发症.6例随访8～27个月,平均13个月.局部再次复发2例;出现远处转移2例,其中行免疫治疗1例,复发肿瘤切除术后22个月死亡1例.结论肾癌局部复发后再手术难度较大、出血较多,但大部分复发可以手术切除,延长患者的生存期.

Surgical excision of isolated local recurrence for renal cell carcinoma

Objective To sum up experience with surgical excision of isolated local recurrence for renal cell carcinoma. Methods From March 2004 to November 2007, 7 patients (five cases un-derwent radical nephrectomy and two nephron-sparing surgery) with isolated local recurrence of renal cell carcinoma were treated at our department. All patients underwent extensive surgery for local re-currence. Results The mean patient age was 42 years (range 19 to 6). The mean time to local re-currence was 23.3 months (range 12 to 54). The Mean size of the recurrent tumor was 5.2 cm(range 2.5 to 10.5). Peritoneal exploration was performed in 7 patients and 5 had complete en bloc excision of the renal cell carcinoma mass. 2 patients gross disease was excised. The mean blood loss was 1050 (150-3000) ml. Surgical complications occurred in 2 patients, iliohypogastric nerve injure in one and ileus performation in another one. All patients recovered finally. Six patients were followed and one lost follow-up. Mean follow-up time was 13(8-27) months. One patient died of metastatic disease at 22 months after excision of the renal cell carcinoma mass. Conelusion En bloc excision of isolated locally recurrent renal cell carcinoma is possible, and complete surgical resection could lead to pro-longed disease-free survival.