肾后唇或前唇切开肾部分切除术治疗靠近肾门的内生型肾癌的初步经验

Use of posterior or anterior renal lip incision for partial nephrectomy in the treatment of renal hilum endophytic renal cell carcinoma

目的 介绍肾后唇或前唇切开肾部分切除术治疗靠近肾门的内生型肾癌的经验.方法 2011年9月至2013年5月收治5例女性肾肿瘤患者,肿瘤均靠近肾门结构.年龄51 -72岁,中位值54岁.血肌酐52.6- 75.4μmol/L,中位值53.9 μmoL/L.影像学检查均表现为肿瘤紧邻肾门血管和/或集合系统.肿瘤直径2.8-4.8 cm,中位值4.0 cm.3例为右肾癌,左肾正常,但合并高血压和糖尿病;1例为左肾癌根治术后,右侧孤立肾肾癌;1例为左肾癌,右肾正常,无影响肾功能的全身性疾病.手术取平卧位或健侧卧位,全麻下行肾部分切除术,其中采用肾后唇切开3例,前唇切开2例.阻断肾动脉后将肾后唇或前唇切开,在肿瘤假包膜外分离,完整剥离肿瘤.用3-0可吸收线在肾创面皮髓质交界部位连续缝合止血.如集合系统有损伤,用3-0可吸收线缝合修复.最后用2-0可吸收线连续缝合肾切缘. 结果 本组5例手术时间155- 215 min,中位值195 min.肾动脉阻断时间15-70 min,中位值35 min.术后住院时间7-9d,中位值8d.术后无出血和漏尿.病理诊断为肾透明细胞癌3例,乳头状肾细胞癌和肾髓质间质细胞瘤各1例.术后3个月复查CT示患肾形态恢复正常;血肌酐59.4- 75.4 μmol/L,中位值63.0 μmol/L.随访12.2-32.7个月,中位值24.2个月,5例均无瘤生存. 结论 肾后唇或前唇肾实质切开肾部分切除术治疗靠近肾门的内生型肾癌的近期疗效满意,远期疗效有待进一步观察.

Objective To introduce our experience of performing posterior or anterior renal lip incision for partial nephrectomy in the treatment of renal hilum endophytic renal cell carcinoma.Methods From Jan.2010 to Jan.2014,five female patients with renal hilum tumors were treated in our institute.The median age was 54 （51-72） years.The median tumor diameter was 4.0 （2.8-4.8） cm.The median preoperative creatinine was 53.9 （52.6-75.4） μmol/L.One of them was solitary kidney with absolute indication; three cases had basic disease with relative indication; one was with selective indication.The patients were put in supine or lateral position.After general anesthesia,we preformed partial nephrectomy by cutting posterior renal lip in 3 cases and the anterior lip in 2 cases.We clamped the renal artery,opened the renal posterior or anterior lip,then dissected the tumor beside the pseudo-capsule.After removing the tumor,we used 3-0 absorption suture to control bleeding and repair the opened collecting system.Finally,we used 2-0 absorption suture to close the renal defect.Results The median operation time was 195 （155-215） min; the median renal warm ischemia time was 35 （15-70） min; the median postoperative hospital stay was 8 （7-9） d.There was no secondary bleeding and urine leakage happened.The pathological results showed that 3 cases with clear cell carcinoma,1 with papillary carcinoma and 1 with renal medullary interstitial cell tumor.All patients showed normal kidney shape.The median postoperative creatinine was 63.0 （59.4-75.4） μmol/L.After a median follow up of 24.2 mon,all patients survive without tumor recurrence.Conclusions The short-term result of posterior or anterior renal lip incision partial nephrectomy in treating endophytic renal hilum endophytic renal cell carcinoma is safe and feasible.