目的 探讨肾单位保留术治疗解剖性孤立肾肾癌的临床疗效。方法 回顾性分析武警湖北总队医院2010-04至2019-11收治的12例解剖性孤立肾肾癌患者的临床资料,其中男8例,女4例,平均年龄(48.67±2.34)岁。肿瘤直径为4.62 cm(2.2~8.2 cm)。临床分期4例为T1aN0M0,6例为T1bN0M0,2例为T2N0M0。12例均行手术治疗,其中开放肾单位保留术9例,后腹腔镜下肾单位保留术3例。对两种不同术式,术后当天和术后1周复查肾功能结果进行分析,并对手术时间、失血量及热缺血时间进行分析。术后随访12~36个月,分析患者预后情况。结果 12例均顺利完成手术,9例开放手术时间为142 min(115~172 min),失血量为253 ml(175~420 ml),热缺血时间为34 min(25~41 min);3例腹腔镜手术时间为112 min(96~131 min),失血量为197 ml(120~270 ml),热缺血时间为25 min(23~27 min)。术后当天和术后1周平均血肌酐值分别为239 μmol/L(136~302 μmol/L)、186 μmol/L(92~287 μmol/L)。12例围手术期均未输血,腹腔镜手术均未中转开放,围手术期均无出血、尿漏、肠梗阻、急性肾损伤等严重并发症,无需暂时血液透析。术后病理检查肾透明细胞癌7例,乳头状肾细胞癌4例,肾嫌色细胞癌1例。术后随访12例,失访1例,1例术后10个月死于肺炎,1例术后21个月死于心血管意外,余9例均无瘤存活。结论 肾单位保留术治疗解剖性孤立肾肾癌临床疗效显著。
Abstract
Objective To investigate the clinical effect of nephron sparing surgery in the treatment of anatomic solitary renal tumor. Methods A retrospective analysis was conducted on 12 patients with anatomic solitary renal tumor admitted to Hubei Provincial Corps Hospital of Chinese People's Armed Police Force from April 2010 to November 2019, including 8 males and 4 females, with an average age of (48.67±2.34) years. The tumor was 4.62 cm (2.2-8.2 cm). The clinical stage was T1aN0M0 in 4 patients, T1bN0M0 in 6 cases and T2N0M0 in 2 cases. All the 12 patients underwent surgical treatment, including open nephron sparing surgery in 9 cases and laparoscopic nephron sparing surgery in 3 cases. The results of renal function reexamination on the day and 1 week after operation of the two different operation methods were analyzed, and the operation time, blood loss and hot ischemia time were analyzed. The patients were followed up for 12 to 36 months and the prognosis was analyzed. Results All the 12 patients completed the operation successfully. The open operation time of 9 cases was 142 min (115-172 min), the blood loss was 253 ml (175-420 ml), and the warm ischemia time was 34 min (25-41 min). The laparoscopic operation time of 3 cases was 112 min (96-131 min), the blood loss was 197 ml (120-270 ml) and the warm ischemia time was 25 min (23-27 min). The mean serum creatinine values were 239 μmol/L (136-302 μmol/L) and 186 μmol/L (92-287 μmol/L) on the day and 1 week after surgery respectively. None of the 12 patients underwent perioperative blood transfusion, and laparoscopic surgery was not converted to open one. There were no serious complications such as bleeding, urine leakage, intestinal obstruction or acute kidney injury during the perioperative period, and no need for temporary blood dialysis. After operation, there were 7 cases of renal clear cell carcinoma, 4 cases of renal papillary cell carcinoma and 1 case of renal chromophobe cell carcinoma. All the 12 cases were followed up after surgery, and 1 case was lost to follow-up. One patient died of pneumonia 10 months after surgery, one patient died of cardiovascular accident 21 months after surgery, and the remaining 9 patients survived with no tumor. Conclusions Nephron sparing surgery is effective in the treatment of anatomic solitary renal carcinoma.
关键词
孤立肾 /
肾癌 /
肾单位保留术 /
肾部分切除术
Key words
solitary kidney /
renal carcinoma /
nephron sparing surgery /
partial nephrectomy
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