【作者】 王宗平；

【导师】 李长岭； 张蓉； 李正江；

【作者基本信息】 中国协和医科大学 ， 肿瘤学， 2009， 硕士

【摘要】 目的评价保留肾单位手术治疗局限性肾细胞癌的临床效果。材料和方法回顾性分析自1999年6月至2008年11月因肾细胞癌于中国医学科学院肿瘤医院泌尿外科施行保留肾单位手术治疗的171例患者的临床资料,其中4例患者为双侧肾癌,分别施行了两次肾部分切除术。结果23例患者为保留肾单位手术绝对适应证,50例为相对适应证,102例为选择性适应证。手术方式均为肾部分切除术,159例行术中阻断肾蒂,平均阻断时间15分钟,最短5分钟,最长30分钟。术后病理结果:肾透明细胞癌163例,乳头状肾细胞癌4例,嫌色细胞癌6例,多房囊性肾细胞癌2例。肿瘤平均直径为2.8cm(0.5-7cm),其中T1aNOMO 153例,T1bNOMO 22例。手术切缘距肿瘤0.1-2cm,平均为0.7cm。所有病例手术切缘均为阴性。术后出现并发症8例,围手术期无患者出现急性肾功能衰竭。中位随访时间为33月(3-119月),1例局部复发,1例出现远处转移,5年肿瘤特异性生存率及5年总生存率分别为98.5%和95.9%。结论对于局限性肾细胞癌,保留肾单位手术对肿瘤控制的疗效满意,手术合并症发生率较低,且部分保留了患肾功能,是一种安全可靠的术式。更多还原

【Abstract】 Objective: To evaluate the results of Nephron-sparing surgery for localized renal cell carcinomas.Material & Methods: A retrospective analysis was peroformed for 171 patients who were affected by renal cell carcinoma and treated with nephron-sparing sugery between June 1999 and November 2005.There was 4 patients had bilateral tumors and nephron-sparing surgery was performed twice among those patients.Results: Nephron-sparing sugery was done for absolute indication in 23 patients,for relative indication in 50 patients,and for elective indication in 102 patients. All was treated with partial nephrectomy .The renal vessel was clamped in 159 cases intraoperative, the mean intraoperative renal interrupted time was 15 mins(range 5 to 30).The histological subtype was clear cell carcinoma in 163 cases,papillary renal cell carcinoma in 4 cases,chromophobe in 6 cases,multilocular cystic renal cell carinoma in 2 cases. The mean tumor size was 2.8 cm (range 0.5 to 7cm).The mean size of surgical margin was 7 mm and surgical margin were negative in all cases.Eight patients had postoperative complications and no perioperative acute renal failure occurred. After a median follow-up of 33 months (range 3 to 119), one patient had developed local recurrence, one patient had developed distant progression.5 year cancer specific survival rates and overall survival rates were 98.5% and 95.9%.Conclusions: For patients with localized renal cell carcinomas, nephron-sparing surgery can achieve an effective oncologic outcome and a low local recurrence rate, it is an affective and safe operation and can providing functional advantage by the maximal preservation of unaffected renal parenchyma.更多还原