术前介入化疗栓塞治疗对中晚期肾癌手术的影响

Influence of preoperative interventional treatment on operation of middle-advanced kidney cancer

目的探讨术前动脉化疗栓塞对中晚期肾癌手术情况的影响，评价其在临床治疗中的意义。方法选择中晚期肾癌术前介入化疗栓塞患者20例为术前介入组，同期类似大小肿瘤单纯手术切除患者20例为单纯手术组，分别对2组患者的手术情况进行对比研究。结果术前介入组所有患者均未发生严重并发症。术前介入组术中平均出血量（183．4-24）rnl，平均输血量（176±38）ml，平均手术时间（92±7）min，均明显少于单纯手术组[平均出血量：（479±70）ml，平均输血量（413±66）m1，平均手术时间（122±10）min]（P〈0．05或P〈0．01）；术前介入组术中见肿瘤体积缩小，瘤体表面静脉萎陷，肾周形成明显水肿带，易于分离；瘤体标本切面见大面积肿瘤组织坏死及纤维组织增生。单纯手术组瘤体表面血管怒张，与周围粘连，分离容易出血。结论中晚期肾癌患者术前介入治疗可以缩短手术时间，减少术中出血量，提高手术成功率。

Objective To investigate the effect of preoperative interventional chemoembolization on tumor histological structure in middle-advanced kidney cancer and to evaluate the clinical significance. Methods Twenty patients who underwent preoperative embolization plus radical nephrectomy were recruited to embolization group and 20 patients who just underwent radical nephrectomy were selected as control group. The surgical conditions were studied. Results All the patients in embolization group had no serious complications. In embolization group, the amount of blood loss during operation was （ 183 ±24 ） ml and the operation time was （ 92 ± 7 ） min, which were significantly lower than those in control group [ blood loss during operation： （479 ± 70）ml; operation time： （122 ± 10） min; P 〈 0.05 or P 〈 0.01 ]. In embolization group, the tumor mass softened; its surface pale and the peripheral veins shrinked and the perinephric edema zone was formed, while in control group the tumor surface blood vessels were extented and tumor tissue was adhered with surrounding tissues and bleeding was easy to occur during dissection. Conclusion The preoperative embolization can decrease operation time and blood loss, and increase operation success rate of middle-advanced kidney cancer.