保留肾单位手术治疗早期小肾癌21例临床分析

Nephron-sparing surgery for small renal cell carcinoma: clinical analysis of 21 cases

目的探讨保留肾单位手术治疗早期小肾癌的临床效果.方法1999年4月～2004年3月,行保留肾单位手术治疗小肾癌21例,其中孤立肾1例,对侧肾有病变或肾功能受损3例,对侧肾正常17例.肿瘤直径1.5～6.0 cm,平均直径 2.8 cm;其中对侧肾正常者直径均＜4 cm,平均2.5 cm;对侧肾有病变或受损者平均直径为4.2 cm.TNM分期:T1期16 例,T2期4例,T3期1例.4例行肿瘤剜除术,10例行肾极切除术,7例行肿瘤楔形切除术.结果21例随访7～66个月,平均随访40.8个月.1例3年后发现右肺及纵隔转移,1例术后27月因慢性肾小球肾炎接受透析治疗.其余19例未发症及肿瘤局部复发.结论保留肾单位手术是早期局限性肾癌的安全有效治疗方法,可作为治疗对侧肾正常直径<4cm T1～T2期局限性肾癌的金标准.

Objective To evaluate the clinical effects of nephron-sparing surgery in patients with early-stage small renal cell carcinoma. Methods Nephron-sparing surgery was performed in 21 patients with renal cell carcinoma including 1 with solitary kidney, 3 with unilateral tumor and contralateral renal compromise, and 17 with unilateral tumor and normal contralateral kidney. The diameter of the tumors ranged from 1.5 to 6.0 cm, with a mean of 2.8 cm. The tumor diameter in 17 patients with normal contralateral kidney was less than 4 cm (mean 2.5 cm) and the average diameter in 4 patients with contralateral renal compromise was 4.2 cm. Sixteen cases were in stage T1, 4 in stage T2, and 1 in stage T3. Of the 21 patients, 4 underwent tumor enucleation, 10 polar nephrectomy and 7 wedge resection. Results All patients were followed up for an average of 40.8 months (7 to 66 months). One patient suffered a right lung and mediastinum metastasis 3 years after the surgery later and 1 with chronic glomerulonephritis required dialysis 27 months after the operation. No surgical complication or local recurrence were found in other patients. Conclusion As a safe and effective therapy for early-stage small renal cell carcinoma, nephron-sparing surgery can be considered as the gold-standard therapy for patients with lesions less than 4 cm in T1 and T2 stages of localized unilateral tumor with normal contralateral kidney.