不同术式治疗多囊性肾癌的比较研究

Multilocular Cystic Renal Cell Carcinoma:Comparison the Safety and Efficacy of Three Different Operations.

目的比较3种手术方式治疗多囊性肾癌(MCRCC)的安全性和有效性,探讨保留肾单位手术(NSS)对多囊性肾癌的最佳适用范围。方法回顾性分析2006～2008年收治的28例多囊性肾癌患者的临床病理资料。根据术式的不同,将此28例患者分为保留肾单位术组(12例),根治性肾切除术组(13例),手助腹腔镜根治性肾切除术组(3例)。收集整理3组患者的手术时间、术中估计失血量、输血情况、术后引流管留置时间、镇痛泵留置时间、术后住院天数、术后并发症情况及术后随访资料并行统计学分析。结果 28例MCRCC患者平均年龄51.9岁,男女比例3:1,肿瘤平均最大直径5.1 cm,T_1N_0M_0者23例,T_2N_0M_0者5例,2例为双肾癌,1例合并甲状腺癌。保留肾单位手术组患者在术中失血量、术后住院天数上多于根治性肾切除术组患者(P<0.05),而在手术时间、输血率、术后引流管留置时间、镇痛泵应用时间方面两组相比没有显著性差异(P>0.05)。手助腹腔镜根治性肾切除术在术中估计失血量、术后引流管留置时间、镇痛泵应用时间、术后住院天数方面在数值上似优于其它两种术式,因例数较少,未纳入统计学分析。三组患者均未发生围手术期严重并发症。术后获得长期随访者21例,术后1月内首次随访的血肌酐和尿素氮水平均正常。平均随访时间18.1个月。21人均健在。结论保留肾单位手术治疗5 cm以下的多囊性肾癌安全有效,近期效果与根治性肾切除术相似,但对位于肾脏中极或凸向肾盂的多囊性肾癌应慎用。手助腹腔镜手术的安全性和微创性为治疗MCRCC提供了又一选择。

Objective To compare the safety and efficacy of three operations for the treatment of multilocular cystic renal cell carcinoma(MCRCC).Methods In this study,28 cases of MCRCC were defined into three groups,the nephron sparing surgery(NSS) group(12 cases),the radical nephrectomy(RN) group(13 cases) and the hand-assisted laparoscopic radical nephrectomy(HALRN) group(3 cases).The operation time,estimated blood loss,blood transfusion rate,patient controlled analgesia(PCA) usage,drainage time,postopera- tive hospital stay and postoperative complications were retrospectively collected and analyzed.Results The mean age was 51.9 yeas old.The gender ratio of these 28 patients was 3:1.23 cases were in T_1N_0M_0 phage and the other 5 cases were in T_2N_0M_0 phage.The mean maximum diameter of the MCRCC was 5.1 cm.There were 2 bilateral cases and one case combined with thyroid carcinoma.Compared with the RN group,the NSS group had more estimated blood loss during the operation and longer postoperative hospital stay(P<0.05).The two groups had no significant different in the operation time,blood transfusion rate,PCA usage and drainage time (P>0.05).HALRN seemed superior to RN on blood loss,drainage time,PCA usage and postoperative hospital stay,but these data were not analyzed statistically because of the sample number were limited.No serious complication occurred postoperatively.21 cases achieved long term follow-up,the mean follow up time was 18.1 months,and all these patients survived.The serum creatinine and urea nitrogen level of all these 21 cases were normal at the first follow up within the first month postoperatively.Conclusions NSS was safe and effective for the MCRCCs.which maximum dimension limited within 5 cm and only for selected cases which located at the middle of the kidney.Because of the safety and minimal invasion,HALRN is another alternative for the treatment of MCRCCs.