经腹腔肾癌根治术治疗肾细胞癌155例经验总结

Transabdominal Radical Nephrectomy for Renal Cell Carcinoma: an Experience on 155 Patients

背景与目的:肾细胞癌是泌尿系统常见恶性肿瘤,手术切除为主要治疗。但手术是经腹腔还是经腰部切口、是否同时作淋巴结清扫以及淋巴结清扫是扩大淋巴结清扫还是区域淋巴结清扫,均存在争议。本研究回顾性分析经腹腔肾癌手术的手术时间、出血量、术后住院日、并发症和患者的生存率,总结经腹腔肾癌手术的经验。方法:1999年10月至2005年12月对155例肾癌患者采用经腹腔根治性肾切除和区域淋巴结清扫术。对155例患者的手术时间、出血量、术后住院日、并发症和生存率进行回顾性统计和分析。结果:本组手术时间为60～360min(中位时间155min);术中出血量为50～10000ml)(中位出血量为200ml),输血16例,平均输血量为11.5个单位红细胞(1个单位红细胞由200ml全血制备)。术中出血量>500ml有23例(14.8%),其中5例同时取腔静脉癌栓,出血量为600～6000ml(中位出血量为1100ml)。术后住院日6～46天(中位术后住院15天)。术中并发症有脾脏损伤2例,腔静脉撕裂并十二指肠损伤1例,血管损伤2例,均于术中处理无后遗症。术后并发症有心衰1例,不完全性肠梗阻2例,经保守治疗治愈,无手术死亡。随访1～78.6个月,中位随访时间20.0个月。1年、3年和5年总生存率分别为93.2%(145/155)、84.1%(131/155)、74.8%(116/155);病理分期为Ⅰ、Ⅱ、Ⅲ和Ⅳ期的患者1年生存率分别为100%(78/78)、100%(34/34)、88.2%(25/28)、53.8%(8/15),3年生存率分别为89.7%(70/78)、95.5%(33/34)、75.6%(21/28)、44.9%(7/15),5年生存率分别为Ⅰ期89.7%(70/78)、Ⅱ期86.8%(30/34)、Ⅳ期0%(0/15)。结论:经腹腔根治性肾切除术由于能首先处理肾血管和便于区域淋巴结清扫,出血少,疗效确切以及术中术后严重并发症少,可作为肾癌根治性肾切除的标准术式之一。

BACKGROUND ＆ OBJECTIVE： Renal cell carcinoma （RCC） is a common urologic malignant tumor. Radical nephrectomy is the major treatment for RCC. Approaching route selection, lymphadenectomy selection, and lymphadenectomy extension are debated. This study was to summarize our experience on transabdominal radical nephrectomy for RCC. METHODS： A total of 155 RCC patients were treated with radical nephrectomy and regional lymphadenectomy between Oct. 1999 and Dec. 2005 in Cancer Center of Sun Yat-sen University. The duration of operation, the amount of bleeding, the duration of postoperative hospitalization, complications, and survival rates of the patients were reviewed. RESULTS： No patient died during operation. The median duration of operation was 155 min （range, 60- 360 min）. The median amount of bleeding was 200 ml （range, 50-10 000 ml）. Sixteen patients received RBC transfusion with a mean of 11.5 units （1 unit of RBC is extracted from 200 ml whole blood）. In 23 （14.8%） patients, the amount of bleeding was more than 500 ml; 5 of the 23 patients underwent inferior vena cava thrombectomy, with median bleeding of 1 100 ml （range, 100-6 000 ml）. The median duration of postoperative hospitalization was 15 days （range, 6-46 days）. The intraoperative complications, treated intraoperatively without sequelae, included 2 cases of spleen injury, 1 case of inferior vena cava and duodenal injury, and 2 cases of vessel injury. The postoperative complications, cured conservatively, included 1 case of heart failure and 2 cases of incomplete ileus. The patients were followed up for 1- 78.6 months, with a median of 20.0 months. The 1-, 3-, and 5-year overall survival rates were 93.2%, 84.1%, and 74.8%, respectively. The 1-year overall survival rates were 100% for stage Ⅰ and stage Ⅱ patients, 88.2% for stage Ⅲ, and 53.8% for stage Ⅳ. The 3-year overall survival rates were 89.7% for stage Ⅰ, 95.5% stage Ⅱ, 75.6% for stage Ⅲ, and 44.9% for stage Ⅳ. The 5-year overall survival rates were 89.7% for stage Ⅰ, 86.8% for stage Ⅱ, and 0% for stage Ⅳ. CONCLUSIONS： Radical nephrectomy via transperitoneal route, with benefits of early ligating the renal vessels and easy to perform lymphadenectomy, has certain effect on RCC with less severe complications. It may be a standard surgical procedure for RCC.