肾肿瘤剜除和改良肾部分切除术21例临床效果观察

Clinical effects of simple tumor enucleation and modified partial nephrectomy in the treatment of early renal cell carcinoma(report of 21 cases)

目的评估单纯肿瘤剜除术和改良肾部分切除术治疗早期肾癌的临床效果。方法回顾性分析2006年2月至2009年4月间21例早期肾癌患者的临床资料，其中14例接受单纯肿瘤剜除术，7例改良肾部分切除术。结杲所有手术顺利完成，无1例出现严重并发症。平均热缺血时间（21土2）（17～28）min。所有切除标本都有完整的包膜，2例肿瘤〉4cm者包膜有灶状浸润，但未穿透包膜，切除的肿瘤周围肾实质内未见癌细胞。平均随访2．7年，所有患者存活，无局部复发和远处转移。1例出现肿瘤复发，但非原来手术部位，其余均无肿瘤复发。结论单纯肿瘤剜除术和改良肾部分切除术是治疗早期肾癌的安全、有效方法，能够有效保留肾单位和功能，防止肾功不全。

ODiocIive To evaluate the clinical effects of tumor enucleation and modified partial nephrectomy in the treatment of early renal cell cancer （RCC）. Methods The clinical and pathological data of 14 patients who underwent simple enucleation and 7 patients who underwent modified partial nephrectomy between February 2006 and April 2008 for pT1 RCC were retrospectively analyzed. The mean tumor size was 3.1 （2.2∽ 5.5） cm. Three patients suffered from bilateral RCC. Results All 24 tumors were surrounded by a continuous fibrous pseudocapsule. The mean ischemic time was （21 4-2）（17∽ 28） min. Signs of infiltration within pseudocapsule were detected in 2 patients whose tumor was larger than 4 cm. None of the patients had positive surgical margins. During the follow-up of 2.7 years, all patients survived without regional or remote metastasis. One patient recurred locally in the kidney and underwent tumor enucleation. Conclusions Simple tumor enucleation and modified partial nephrectomy are safe and effective nephron-sparing treatments that can provide excellent long- term local control and preservation of normal parenchyma.