邻近受侵器官一并切除的肾癌根治术

Radical nephrectomy with resection of involved adjacent organs (report of 24 cases)

目的探讨肾癌根治术邻近受侵器官一并切除的可行性及临床意义。方法对24例肿物直接侵犯至周围器官的肾癌患者施行邻近受侵器官一并切除的手术，其中左肾连同结肠脾曲、部分降结肠切除7例，部分胰体、胰尾、脾脏切除者5例，单纯连同脾脏切除者3例；右肾连同结肠肝曲切除4例，肝右后叶部分切除者4例，十二指肠降部部分切除1例。24例中部分腰大肌切除5例，合并结肠系膜部分切除者7例。术后9例行免疫治疗。结果本组24例无手术死亡，住院期间无严重并发症出现。术后21例获随访，随访时间3～240个月，1、3、5、8年生存率分别为90．5％（19／21）、42．9％（9／21），33．3％（7／21）及19．0％（4／21）。结论对丁局限于周围器官受侵的肾癌，外科手术切除仍然是首选。患者条件允许时，将邻近受侵器官一并扩大切除，能达到肾癌根治切除的要求，在有一定普通外科经验的条件下，手术较为安全。有可能延长生存时间，并为后续的系统性治疗创造有利条件。

Objective To evaluate the feasibility and clinical significance of radical nephrectomy with en bloc resection of involved adjacent organs. Methods Totally,24 cases of renal cancer invading adjacent structures underwent radical nephrectomy with en bloc resection of involved adjacent organs. Among the 24 cases,left radical nephrectomy with en bloc resection of splenic flexure and descending colon was performed in 7,partial resection of corpus and cauda pancreatis and spleen in 5, solitary splenectomy in 3 ;right radical nephrectomy with en bloc resection of hepatic flexure of the colon in 4, partial hepatectomy of right lobe and end-piece in 4, duodenectomy of pars descendens in 1. Of these cases, partial resection of the psoas muscle was performed in 5 ,and partial resection of mesocolon in 7. Postoperatively,9 cases received immunotherapy. Results There was no intraoperative mortality or severe postoperative complication. Follow-up of 3 -240 months was available in 21 cases. The follow-up showed that 1-,3-,5- and 8-year survival rates were 90.5% （ 19/21 ） ,42.9% （9/21） ,33.3% （7/21） and 19.0% （4/21）, respectively. Conclusions Radical nephrectomy remains the treatment of choice in organ-confined stage of renal carcinoma. With careful selectlon,radlcal nephrectomy with en bloc resection of adjacent structures is technically feasible. It can obtain the radical excisionul effect. Based on our experience,the operation is relatively safe. Complete surgical extirpation can lead to prolonged disease-free survival. It may also offer beneficial foundation for the subsequent systematic therapy.