术前超选择性肾动脉化疗栓塞对小肾癌保肾手术的价值

The value of superselective chemotherapy and embolization of renal artery in the nephron sparing surgery of small renal carcinoma

背景与目的肾癌生存期统计结果表明小肿瘤、周围性、分界明确的肿瘤可行保留肾单位手术,其结果与根治性肾切除术一样有效。到目前为止,保肾手术适应证已扩展到对侧肾脏正常或没有出现肾功能不良的患者。然而,保肾手术比根治性肾切除术有更多的技术挑战,如术后出血、尿漏、急性肾功能衰竭、动静脉血栓等等。在保肾手术前行超选择性肾动脉化疗栓塞是否会降低术后并发症及肿瘤复发率,尚无结论。本研究旨在探讨术前超选择性肾动脉化疗栓塞对小肾癌保肾手术的影响及价值。方法29例直径小于等于3cm的肾癌患者,按随机原则将其中13例先行超选择性肾动脉化疗栓塞,后行保肾手术;另16例直接行保肾手术作为对照组分析。结果研究组1/3肾脏手术切除率92%、术中平均出血量110ml、术后出血0、尿漏并发症率8%、3年复发率0和3年生存率100%,对照组分别为37%、235ml、25%、31%、18.9%、93.8%。结论术前超选择性肾动脉化疗栓塞可以提高小肾癌保肾手术切除率,降低并发症和复发率。

Background and Purpose： The statstics of survival time indicates that the value of the nephron sparing surgery of small renal carcinoma is similar to radical nephrectomy. However, there are more difficulties in the nephron sparing surgery such as bleeding during or after operation, urine leakage, postoperative renal failure. This work aimed at studying the influence and value of superselective chemotherapy and embolization of renal artery in the treatment of small renal carcinoma before nephron sparing surgery Methods： 29 cases of small renal carcinoma were randomized into two groups. The experimental group （13 cases） were treated by superselective chemotherapy and embolization of renal artery before nephron sparing surgery, and the control group （16 cases） were treated with nephron sparing surgery alone. Results： There were significant differences between the two groups in 5 respects： one third of renal resection （92% vs 37%）, mean blood volume in operation （110 ml vs 235 ml）, postoperative bleeding （0 vs 25%）, urine leakage （8% vs 31%） and 3-year recurrence rate （0 vs 18.9）. Conclusions： Superseleetive chemotherapy and embolization of renal artery before nephron sparing surgery would increase the renal conservation rate, decrease to complications and 3-year recurrence rate.