双侧同时性肾癌治疗方式的选择

Synchronous bilateral renal cell carcinoma

目的探讨双侧同时性肾癌患者有效治疗方式的选择。方法双侧同时性肾癌14例。男12例，女2例。平均年龄45岁。临床表现腰部酸痛感4例、血尿2例、体检偶然发现8例。14例术前影像学检查均明确为双侧肾脏占位性病变。其中发现腔静脉癌栓1例，肾门或腹膜后淋巴结肿大2例。14全均未发现远处转移。Robson分期Ⅱ期11例，Ⅲ期3例。肿瘤直径1．0～8．5cm。行一期双侧手术6例，其中行双侧肾部分切除4例，一侧根治性肾切除、对侧肾部分切除2例。行二期手术8例，先行一侧部分切除术，1个月后行对侧根治性肾切除术3例；先行一侧根治性肾切除术，1个月后行对侧部分切除术2例；先行一侧部分肾切除术，1个月后行对侧肾部分切除术2例；1例伴有腔静脉癌栓患者一期于下腔静脉肝下水平放置静脉内支架加滤网防止癌栓脱落，再行根治性肾切除，1个月后再行对侧肾部分切除。结果14例共行22例次手术，均获成功。一期双侧手术者平均手术时间（263±52）min；二期手术者平均手术时间（155±46）min。病理报告：29个肿瘤中，透明细胞癌23个，未分化肿瘤4个，嫌色细胞癌2个。10例患者获随访，随防时间6～41个月。3例行一侧肾部分切除加对侧根治性肾切除患者SCr升高，但无需血液透析；1例术后14个月后双侧肺转移，25个月后死亡；1例术后21个月左侧肾窝肿瘤复发，经放疗及化疗，38个月后死亡；1例术后6个月死于脑血管意外；6例无瘤存活，1例腔静脉癌栓未切除者随访32个月存活。结论双侧肾肿瘤的处理原则为兼顾肾功能保留和。肾肿瘤治疗，治疗方案应根据患者全身情况及肿瘤大小、部位进行详细评估，尽可能保留足够的肾功能。

Objective To discuss the treatment of synchronous bilateral renal cell carcinoma. Methods Fourteen cases of synchronous bilateral renal cell carcinoma with 12 males and 2 females were treated from 1994 to 2005. Lumbago occurred in 4 cases and hematuria in 2 cases. All the cases were diagnosed with the CT scan, IVU, US and/or MR. Six cases received bilateral operation simultaneously, 8 cases received sequential operations. Radical nephrectomy on one side and partial nephrectomy on the opposite side was conducted in 8 patients. Partial nephrectomy on both sides was performed for 6 patients. Results Twenty-two operations were performed in 14 cases. The average operative time was （263!52） rain in simultaneous operation and （155±46）rain in others. The length of hospital stay was （11.54±2.1）d in simultaneous operation and （7.4±l.2）d in staging operation. Ten cases were followed up for 6-41 months. The renal function remained good in 7 patients. The SCr increased in 3 cases with no need for dialysis. One case died 25 months later with metastasis of lung. One case with local recurrence died 38 months later. One case died of cerebral hemorrhage. Conclusions The renal function and treating tumor must be considered in managing synchronous bilat-eral renal cell carcinoma. The geheral condition of patient and the position of tumor should be evalua ted in order to make a treatment plan.