术前肾动脉栓塞在复杂性右侧肾癌合并下腔静脉瘤栓治疗中的作用

The application of preoperativerenal artery embolization in the right renal cell carcinomawith inferior vena cava tumor thrombus and renalhilum invasion

目的:评估术前肾动脉栓塞(PRAE)在肾门部侵犯的复杂性右侧肾癌合并下腔静脉瘤栓(RCC-IVCTT)治疗中的应用价值。方法:回顾性分析2013年6月-2020年10月中国人民解放军总医院第一医学中心泌尿外科收治的105例右侧RCC-IVCTT患者行机器人手术的临床资料,将术中肿瘤侵犯周围组织、合并肾门肿大淋巴结等导致肾动脉游离困难的情况定义为复杂性RCC-IVCTT。根据是否行PRAE,将瘤栓患者分别记录为栓塞组(17例)与对照组(88例),且栓塞组均为复杂性RCC-IVCTT。利用倾向性得分匹配(PSM),按1∶1进行配对后对比分析两组手术时间、出血量、术后住院时间、输血量及疾病复发、进展情况。结果:实际匹配17例,匹配后组间基线资料具有可比性,差异无统计学意义(P>0.05)。栓塞组中位手术时间190 min,中位术中出血600 mL,8例(47.1%)术中输血,中位术后住院时间7 d,术后病理诊断15例(88.2%)为透明细胞癌,2例(11.8%)为乳头状肾细胞癌;对照组中位手术时间175 min,中位术中出血800 mL,10例(55.6%)术中输血,中位术后住院时间7.5 d,术后病理诊断13例(76.5%)为透明细胞癌,1例(5.9%)为乳头状肾细胞癌,3例(17.6)为高级别浸润性尿路上皮癌,两组差异均无统计学意义(P>0.05)。栓塞组存活率76.5%,疾病进展率47.1%;对照组存活率52.9%,疾病进展率58.8%,差异无统计学意义(P>0.05)。结论:对于复杂性右侧RCCIVCTT,PRAE可预处理右肾动脉,降低手术难度,具备一定技术优势,但其远期疗效仍需长期随访及进一步评估。

Objective:To evaluate the value of preoperative renal artery embolization(PRAE)in the treatment of the right renal cell carcinomawith inferior vena cava tumor thrombus(RCC-IVCTT)andrenalhiluminvasion.Methods:The clinical data of 105 patients with right RCC-IVCTT who underwent robotic surgery in our hospital during June 2013 and October 2020 was analyzed retrospectively.The complicated RCC-IVCTT was defined as difficulty in renal artery dissociation caused by intraoperative tumor invasion of surrounding tissues and hilar enlargement of lymph nodes.It was divided intotherapeutic group(17 patients)and control group(88 patients)according to PRAE and renalhilum invasion.By using propensity score matching method with 1:1 radio,the operative time,estimated blood loss,postoperative hospital stay,blood transfusion and progression of cancer were compared between the two groups,respectively.Results:A total of 17 were matched and baseline data between groups were comparable.Median operative time was 190 min,median estimated blood loss was 600 ml and 8 patients need blood transfusion in the therapeutic group while median operative time was 175 min,median estimated blood loss was 800 ml and 10 patients need blood transfusion in the control group.Median postoperative hospital stay was 7 d and primary tumor type was clear cell carcinoma in 14 patients in the therapeutic group while median postoperative hospital stay was 7.5 d and primary tumor type was clear cell carcinoma in 13 patients in the control group.The overall survival rate and progressionillness rate in the therapeutic group were 76.5%and 47.1%respectively while 52.9%and 58.8%in the control group.For the above data,there was no significant difference between the two groups(P>0.05).Conclusion:PRAE can pretreat right renal artery and reduce the difficulty of surgery in the treatment of right RCC-IVCTT andrenalhilum invasion.However,further large sample studies are needed to evaluate application of PRAE.