肾部分切除术治疗孤立肾肾癌15例经验总结

摘要

目的：通过分析接受肾部分切除术的孤立肾肾细胞癌患者的临床资料,总结孤立肾肾部分切除术的临床应用经验.方法：从1999年1月~2012年11月,共有15例孤立肾肾癌患者接受了肾部分切除术.统计分析所有患者的临床资料,包括术前基本情况、手术情况、术后肾功能、术后病理以及随访情况等,总结临床经验.结果：患者中位年龄50(39~71)岁,男女比例4∶1.平均手术时间150 min .15例患者中有10例在手术中阻断肾动脉,平均热缺血时间为24 min ,另外5例采用手指轻压止血.中位失血量300 ml .肿瘤中位大小2.5(1.5~7.0)c m.14例患者病理类型为透明细胞癌,1例为乳头状肾细胞癌.所有患者肿瘤切缘均为阴性.所有患者术后血肌酐水平都有不同程度升高,但在手术后1个月内都降至术前基线水平,无患者需要血液透析.2例患者出现血尿或者急性肾功能不全等围手术期并发症,经保守治疗缓解.患者中位随访时间51(10~167)个月,无远期手术并发症.随访过程中,有1例患者在术后14个月发现骨转移,在术后32个月死亡；2例患者出现患肾新发病灶,目前持续应用靶向药物治疗.结论：肾部分切除术对于孤立肾肾癌患者是一种安全有效的治疗方法,肿瘤治疗效果满意,肾功能得到最大限度保留.%Objective:To report the experience of partial nephrectomy for renal cell carcinoma in patients with a solitary kidney at our institution,with analysis of renal function,complications ,oncological efficacy and survival . Methods:We identified 15 consecutive patients with a solitary kidney who underwent partial nephrectomy between Jan .1999 and May 2013 .Variables exa mined included patient age and gender ,renal function ,renal ische mia ti me , surgical marginstatusandcomplications.Tumorsize,histologicalsubtypeandtumorstage werealsoassessed.Re-sults:The median age was 50 years (range:39 to 71 ).The male/fe male ratio was 4 :1 .The mean operative ti me was 150 min .The renal artery was occluded in 10 of 15 patients and the mean war mische mia ti me was 24 min .Gentle manual compressiontothekidney wasappliedintheother5 patients.The medianbloodloss was300 mL.The medi-ansizeofthetumor was2.5cm(range:1.5to7.0).Thehistologicalsubtype wasclearcellcarcinomain14cases andpapillarycellcarcinomainonecase.Allsurgical margins werenegative.The mediancreatininelevelincreasedaf-tertheoperationbutthatin11 ofthemhadreturnedtothebaselineone monthaftertheoperationduringthefollow-upperiod.Nopatientrequiredhemodialysis.Perioperativecomplicationsincludedacuterenalfailureandhematuria. The median follow-up was 51 months (range:10 to 167 ).Bone metastasis was found in one patient ,who was dead 32 months after the surgery .Local recurrence was found in 2 patients ,who were treated by target therapy .Conclu-sions:Partial nephrectomyforrenalcellcarcinomainpatients withasolitarykidneycansafelypreserverenalfunction and effecti vel y treat mali gnancy .