介入联合手术切除及免疫疗法治疗中晚期巨大肾癌

Intervention,excision and immunotherapy combination of large renal carcinoma in middle - advanced stage

目的探讨中晚期巨大肾癌中，联合应用经肾动脉化疗栓塞（TACE）、手术及免疫疗法的价值以及疗效。方法治疗前检查，了解患者分期，选择人组病例。其中联合治疗组22例，首先应用吉西他滨等化疗乳剂行肾癌经动脉化疗栓塞术（Transcatheter Arterial Chemo—Embolization，TACE），3天-7天后行肾癌根治术，术后5～20天行白介素-2（Interleukin-2，IL-2）的免疫治疗。单纯手术组23例，单纯行肾癌根治术。对比两组患者的围手术前输血量、手术时间以及3年和5年总生存率。结果联合治疗组疗过程中，发现动静脉瘘2例，异常供血2例。单纯手术组2例下腔静脉癌栓与血管壁粘连的患者，不能完全切除癌栓，术中1例患者死于肺梗死。围手术期输血量、手术时间、3年及5年总生存率，联合治疗组分别为409．45mL、122．27min、72．7％、63．6％。单纯手术组分别为717．39mL、171．82min、43．5％、33．3％。两组数据分别对比，经统计学分析，差异均具有统计学意义（P〈0．05）。讨论肾癌TACE、手术及免疫疗法，联合应用于巨大中晚期肾癌中，可以降低手术风险，减少围手术期输血量，缩短手术时间，增加患者的3年及5年总生存率。

Objective To explore the value and treatment effect of renal TACE, excision and immuno-therapy combination therapy of large renal carcinoma in middle - advanced stage. Methods Before the treat-ment, patients were examined, patients stages were confirmed, and suitable cases were chosen. The 22 patients in combined treatment group first underwent renal carcinoma TACE with chemotherapy emulsion like gemcitabine, etc. Three to seven days later, all these patients had the radical nephrectomy. Three days after the radical opera- tion, IL -2 immunotherapy was performed on 22 patients. The 23 patients in the surgery group merely underwent radical nephrectomy. Perioperative blood transfusion, operation time, 3 - year - overall survival and 5 - year - o-verall survival of the two groups have been compared. Results In combined treatment group,2 cases of arteriove-nous fistula and 2 cases of abnormal blood supply were found in the course of renal carcinoma TACE. In surgery group, two patients had adhesion of inferior vena cava （ IVC ） tumor thrombus and vessel wall, whose cancer thrombus could not be completely resected. One patient died of pulmonary infarction during the operation. Periop-erative blood transfusion, operation time ,3 - year - overall survival and 5 - year - overall survival of the combined treatment group are 409.45 mL, 122.27 rain,72.7% and 63.6% ;717.39 mL, 171.82 min,43.5% and 33.3% of the surgery groups, respectively. Compared with the two sets of data by SPSS, we found that each was P 〈 0.005. It is which showed that the difference between the two groups has statistics significance. Conclusion Re-nal TACE, excision and immunotherapy combination of large renal carcinoma in middle - advanced stage can make the following benefits possible：decreasing operation risks, reducing perioperative blood transfusion, shorten-ing operation time and increasing 3 - year - overall survival and 5 - year - overall survival in those patients.