175例局限性肾癌保留肾单位手术治疗结果分析

Clinical analysis of nephron sparing surgery for localized renal cell carcinomas in 175 cases

目的评价保留肾单位手术(nephron sparing surgery,NSS)治疗局限性肾细胞癌的临床效果。方法回顾性分析自1999年6月至2008年11月因肾细胞癌而施行NSS治疗的175例患者的临床资料。结果23例患者为绝对适应证,50例为相对适应证,102例为选择性适应证。手术方式均为肾部分切除术,159例行术中阻断肾蒂,平均阻断时间15 min,最短5 min,最长30 min。术后病理结果显示肾透明细胞癌163例,乳头状肾细胞癌4例,嫌色细胞癌6例,多房囊性肾细胞癌2例。肿瘤平均直径为2.8 cm(0.5～7.0cm),其中T1aN0M0153例,T1bN0M022例。手术切缘距肿瘤0.1～2.0 cm,平均为0.7 cm。所有病例手术切缘均为阴性。术后出现并发症7例,围手术期未见患者出现急性肾功能衰竭。中位随访时间为33个月(3～119个月),1例局部复发,1例出现远处转移,5年肿瘤特异性生存率及5年总生存率分别为98.5%和95.9%。结论对于局限性肾细胞癌,NSS对肿瘤控制的疗效满意,手术并发症发生率较低,且部分保留了患肾功能,是一种安全可靠的术式。

Objective To evaluate the clinical outcomes of nephron sparing surgery（NSS） for localized renal cell carcinomas. Methods A retrospective analysis was performed for 175 patients who were affected by renal cell carcinoma and treated with NSS between June 1999 and November 2008. Results NSS was done for absolute indication in 23 patients,for relative indication in 50 patients,and for elective indication in 102 patients.All was treated with partial nephrectomy.The renal vessel was clamped in 159 cases intraoperatively,the mean intraoperative renal interrupted time was 15 min（range 5 to 30 min）.The histological subtype was clear cell carcinoma in 163 cases,papillary renal cell carcinoma in 4 cases,chromophobe in 6 cases,multilocular cystic renal cell carinoma in 2 cases.The mean tumor size was 2.8 cm（range 0.5 to 7.0 cm）.The mean size of surgical margin was 0.7 cm and surgical margin were negative in all cases.Seven patients had postoperative complications and no perioperative acute renal failure occurred.After a median follow-up of 33 months（range 3 to 119 months）,one patient had developed local recurrence,one patient had developed distant progression.5 year cancer specific survival rates and overall survival rates were 98.5% and 95.9%. Conclusions For patients with localized renal cell carcinomas,NSS can achieve an effective oncologic outcome and a low local recurrence rate,which is an effective and safe operation and can provid functional advantage by the maximal preservation of unaffected renal parenchyma.