后腹腔镜技术治疗双侧肾癌的有效性与安全性研究

Oncological efficacy and safety of retroperitoneal laparoscopic surgery for bilateral renal cell carcinoma

目的:探讨后腹腔镜技术治疗双侧肾癌的方法及疗效。方法:回顾性分析2004年1月～2010年6月11例双侧肾细胞癌患者的临床资料,同时型6例,异时型5例,肿瘤直径平均(2.8±1.8)cm。11例患者均分期行后腹腔镜手术治疗,其中8例行双侧肾部分切除术,3例行一侧肾癌根治及对侧肾部分切除术。结果:所有手术均顺利完成,无中转开放,平均手术时间(102±27)min,平均热缺血时间(23.0±7.7)min,术中平均出血量(80.0±43.5)ml,术后平均住院时间(10.6±2.0)d。术后平均随访(3.5±2.0)年,9例未见复发及转移且术后肾功能无异常,1例术后肌酐升高,1例肺转移予靶向药物治疗至今。结论:后腹腔镜技术治疗双侧肾癌安全、可行、有效,具有创伤小、恢复快的优点,但其远期疗效尚需大样本对照研究和长期随访观察。

Objective：To present the experience of retroperitoneal laparoscopic surgery for bilateral renal cell carcinoma. Method：From January 2004 to june 2010,11 cases of bilateral renal cell carcinoma（BRCC）were retrospectively analyzed.Among the 11 csaes,6 had synchronous BRCC and 5 had asynchronous BRCC.The mean tumor size was（2.8±1.8） cm in diameter.All of the 11 patients received two-stage retroperitoneal laparoscopic operation.8 patients underwent bilateral retroperitoneal laparoscopic nephron-sparing surgery（LNSS）,3 patients underwent unilateral retroperitoneal laparoscopic nephron-sparing surgery plus contralateral retroperitoneal laparoscopic radical nephrectomy（LRN）. Result：11 cases were operated successfully without conversion to open surgery.The mean operation time was（102±27） min,and mean warm ischemia time（WIT）was（23.0±7.7） min,and mean blood loss was（80.0±43.5） ml,and mean postoperative hospital stay was（10.6±2.0） days.In a mean follow up for（3.5±2.0） years,9 patients＇ renal function remains well without tumor recurrence and metastasis,1 patient serum creatinine up to abnormal level immediately after second surgery,1 had lung metastasis but still alive with targeted therapy. Conclusion：retroperitoneal laparoscopic surgery is safe、feasible and effective for BRCC with less trauma and faster recovery of its advantages,but its long-term effects still need to study with large samples compare and long-term follow-up.