老年双肾透明细胞癌38例诊疗并文献复习

Bilateral renal clear cell carcinoma in the elderly： 38 cases of diagnosis and treatment and related literature review

目的探讨老年双肾透明细胞癌的诊断、治疗方法及预后。方法回顾性分析2010-2014年我科收治的38例老年双肾透明细胞癌的临床资料。38例均经B超、CT等检查确诊后分组，肾癌根治术联合微波消融术组（A组）13例行息侧后腹腔镜肾癌根治术联合对侧微波消融术，双侧微波消融术组（B组）25例行双侧后腹腔镜针微波消融术。术后随访24～36个月，定期复查B超、CT和肾功能等。结果38例老年患者均手术成功，无中转开放者，术后未出现外科并发症，病理证实均为双侧肾透明细胞癌。双侧微波消融术组（B组）与肾癌根治联合微波消融术组（A组）相比，手术时间短（P=0．012），术中失血量少（P=0．000），住院时间明显减少（P=0．021），差异均有统计学意义。术后肾功能均有不同程度下降，与术前相比，B组术后1周尿素氮、肌酐和肌酐清除率的变化率均小于A组（P=0．008，0．009和0．006）义；术后3个月随访，尿素氮、肌酐和肌酐清除率的变化率均小于A组（P=0．037、0．020和0．018），差异有统计学意义。平均随访30个月，无肿瘤局部复发或转移。结论老年早期双。肾原发透明细胞癌的治疗，在兼顾患者全身情况和肿瘤治疗的情况下采用微波消融术治疗，临床安全有效，预后好，值得临床应用和推广。

Objective To investigate the diagnosis, treatment and prognosis of bilateral renal clear cell carcinoma in the elderly. Methods Clinical data from 38 cases of elder patients admitted with bilateral renal clear cell carcinoma in our department from 2010 to 2014 were retrospectively analyzed. Among the total 38 cases diagnosed by B ultrasound and CT, 13 cases（A group）were treated with laparoscopic radical nephrectomy on one side, combined with microwave ablation on the other sider another 25 cases（B group）were treated with microwave ablation on bilateral sides. Patients were followed up for 24-36 months, with regularly checking by B ultrasound, CT and renal function. Results The operations were successful in total 38 cases （A＋B group）, and no postoperative complications were found. All cases were diagnosed as pathologically proven bilateral renal clear cell carcinoma. Postoperative renal functions of the cases were decreased at different degrees as compared with preoperative renal functions, but not needing dialysis treatment. The microwave ablation on bilateral sides（B Group）versus A Group, significantly decreased the surgical time cost（P= 0. 012）and hospital stay （P = 0. 021）. For both A and B group, postoperative renal function were declined in different degree. The damage extents of blood urea nitrogen, creatinine and ereatinine clearance rate were less in group B than in group A at one week after surgery（P = 0. 008,0. 009 and 0. 006）. Atpostoperative follow-up for 3 month,it was found that the damage extents of blood urea nitrogen, creatinine and creatinine clearance rate were less in group B than in group A（P= 0. 037,0. 020 and 0. 018）. At postoperative follow-up for 30 months in average, no local recurrence or metastasis was found. Diagnosis of bilateral kidney clear cell carcinoma in the elderly mainly depended on B ultrasound,CT scan and MRI imaging. Conclusions As to the treatment of elderly patients with early renal clear cell carcinoma, considering both the general healthy condition of patients and tumor therapy and choosing microwave ablation might be good for efficiency and prognoses.