小肾癌保留肾单位手术体会(附26例报告)

Nephron Sparing Surgery for Small Renal Cell Carcinoma

目的探讨NSS的适应症、术中方法以及预后。方法采用NSS治疗小肾癌26例,T1a期19例、T1b期7例。深部肿瘤辅助术中超声定位。术中常规冰冻切片检查。结果15例行单纯肿瘤剜除术,11例行肾楔行切除或肾部分切除术。4例冰冻切片曾考虑肾腺瘤或细胞不典型分化,但术后石蜡切片确诊为肾细胞癌。本组石蜡病理显示:透明细胞癌21例,乳头状肾细胞癌5例。冰冻与石蜡病理诊断符合率为85%。术中和术后病理均未发现切缘阳性。所有患者恢复顺利,无严重并发症。平均随访46.2个月。无肿瘤局部复发。1例术后61个月死于对侧肾癌合并脑脊柱转移。1例术后28个月死于心梗。结论T1期肾癌采用NSS可获得满意疗效。术中冰冻切片检查有助确保切缘无瘤化,术前逆行插管、术中超声定位以及肾脏局部低温等是提高NSS疗效的重要措施。

OBJECTIVE To evaluate the indication, surgical techniques, and prognosis of NSS. METHODS Image examination showed Tla 19 cases, Tlb 7 cases. The operations were performed via retroperitioneal approach. Frozen section was routinely performed. RESULTS 15 patients underwent simple enucleation. Another 11 patients underwent wedge or partial nephrectomy.In forzen section, 4 cases was considered as adenoma or atypical cells, but subsequently verified as RCC by Paraffin section.In all cases final pathology showed clear cell carcionma in 21 cases, papillary renal neoplasm 5 cases. The consistency between frozen and paraffin pathology was 85%. No positive tumor margins had been found in both forzen or paraffin pathology. All patients recovered normally without major complications. Average follow-up was 46.2 months. No evidence of local recurrence was found. 1 cases died of contralateral RCC with metastasis of brain and spinal bone at 61 months. 1 case died of heart attack at 28 months. CONCLUSIONS NSS was suitable for T1 RCC with good prognosis. Frozen section was helpful to verify tumor free in resection margin. For some cases it could be important measure to improve NSS results with retrograde ureteric catheterization, intraoperative ultrasound scan or hypothermia.