双肾多发性肾细胞癌的手术疗效分析

摘要

目的 探讨散发性双肾多发性肾细胞癌的治疗原则,以提高治疗水平. 方法 回顾性分析2000年1月至2011年7月收治的7例散发性双肾多发性肾细胞癌患者的资料.男4例,女3例.年龄40 ～ 73岁,平均57岁.无家族病史.7例均为查体或其他疾病就诊时发现.同时发现双肾癌4例,一侧肾癌术后随访发现对侧肾癌3例,未发现其他脏器及淋巴结转移.肿瘤分布于肾中央及外周,最多者一侧16枚.肿瘤直径0.8～6.0 cm,平均4.1 cm.肿瘤临床分期T1a3例,T1b 3例.结果 1例行单侧肾动脉栓塞者7个月后失访；1例靶向治疗2个疗程后双肾分期行保留肾单位(NSS)手术；3例一侧行根治术,对侧择期行NSS手术；2例双肾择期行NSS手术.7例患者病理报告均为肾透明细胞癌.6例术后随访6 ～ 96个月,平均40个月,肿瘤无复发. 结论 双肾多发肾细胞癌患者应积极实行手术治疗,以切除肿瘤、最大限度地保留肾单位为原则.患者预后不因双肾受累及肿瘤多发而受到明显影响.%Objective To discuss the surgical strategies for bilateral multifocal renal cell carcinoma (BMRCC).Metbods Seven patients of BMRCC were reviewed.The clinical characteristics,surgical procedure,tumor pathology and follow-up results were collected.Of the 7 patients,4 were males; the mean age was 57.Four diagnosed synchronous BMRCC,the other 3 were found contralateral renal carcinoma during follow-up after RCC surgical treatment.One patient was treated with unilateral renal artery embolization.Three cases were had a radical nephrectomy and another side got staged NSS.And the other 3 patients applied staged NSS.Results All the 7 patients were diagnosed as renal cell carcinoma pathologically.The follow-up duration was 6 to 96 months after last operation,and all showed no tumor recurrence.Conclusions For patients with BMRCC,surgical strategies should be performed positively.The prognosis of these patients cannot be obviously affected by bilaterality and multifocality of the lesions.