保留肾单位手术在选择性T2期肾癌中的临床应用

The clinical application of nephron-sparing surgery （NSS）in selective T2 renal cell carcinoma

目的 探讨保留肾单位手术在治疗临床T2期肾癌中的安全性及有效性.方法 回顾性分析2010年3月至2013年5月接受保留肾单位手术治疗的26例临床T2期肾癌患者的临床资料.男17例,女9例.年龄39 ～ 74岁,平均52岁.肿瘤直径7.2 ～16.5cm,平均10.3 cm.肿瘤R.E.N.A.L评分6 ～10分,平均7.5分.分析患者的临床病理特征、肿瘤控制效果和肾功能变化情况.结果 所有患者均顺利完成手术,切缘阴性.其中透明细胞癌21例（80.8％）,乳头状肾细胞癌4例15.4％）,嫌色细胞癌1例（3.8％）.平均肾蒂阻断时间（28.3±12.5）min（7例无肾蒂阻断）.3例需要术中输血;1例术后出现尿漏,经保守治疗后痊愈;1例术后肾功能进行性恶化而需要接受长期血液透析治疗.术前、术后血清肌酐平均水平分别为121 iμmol/L和136.μmol/L（P=0.06）.术后随访22 ～47个月,无肿瘤转移或复发病例.结论 保留肾单位手术在治疗选择性临床T2期肾癌安全,可以取得较好的肿瘤控制效果并能保护肾功能,R.E.N.A.L评分是评估T2期肾癌保留肾单位手术可行性的一个重要指标.

Objective To investigate the safety and efficacy of nephron-sparing surgery （NSS）for selective T2 stage renal tumor.Methods The surgical database of 26 patients treated with NSS for clinical T2 stage renal cell carcinomas between March 2010 and May 2013 were collected and analyzed retrospectively.There were 17 males and 9 females,with a mean age of 52 years （39-74 years）,mean tumor size of 10.3 cm（7.2-16.5 cm）,and mean R.E.N.A.L score of 7.5 （6-10）.Patients＇demographics,clinical characteristics,oncologic outcomes,renal function were reviewed.Results The renal masses were removed successfully and the surgical margins were negative.There were 21 （80.8%） cases of clear cell carcinoma,4 （15.4%） papillary carcinoma and 1 （3.8%） chromophobe carcinoma.The mean ischemia time was （28.3 ± 12.5） minutes （7 patients were clamp-free）.Three patients needed transfusion,one experienced urine fistula and cured by conservative treatment,and one patient＇s renal function got progressive worsening and required long-term hemodialysis.The average serum creatinine was 121 μ mol/L before and 136 μmol/L after surgery （P =0.06）.After a period of 22-47 months＇ follow-up,no patient had local recurrence or metastasis.Conclusions NSS can be safely performed and provide effective oncologic outcomes for selective patients with clinical T2 stage renal cell carcinomas.R.E.N.A.L nephrometry is an important factor and should be used to evaluate the feasibility of NSS.