多灶性肾细胞癌24例临床分析

Clinical analysis of 24 cases of multifocal renal cell carcinoma

目的:总结多灶性肾细胞癌(MRCC)的围手术期诊治要点。方法:从复旦大学附属中山医院2011年12月~2017年6月收治的2 852例肾细胞癌患者中,筛选出符合入组要求的24例MRCC,男15例,女9例,中位年龄50(26~72)岁。单侧肾多发病灶21例(其中孤立肾1例),双侧肾多发病灶3例,术前发现的癌灶数2~8个/例。所有患者术前均行彩超、CTU或肾脏增强MRI检查。结果:3例双侧MRCC和1例孤立肾MRCC患者,术前行基因检测,结果提示1例患者高度疑似VHL综合征(Von Hippel-Lindau syndrome)。24例患者共行26次手术,其中肾部分切除术(PN)8例次,根治性肾切除术(RN)18例次。24例患者术后病理均为肾透明细胞癌;癌灶直径0.6~10.6cm。8例PN平均热缺血时间(26.0±4.5)min,切缘均为阴性。随访时间最长71个月,最短6个月,23例患者未见肿瘤复发转移,1例患者因肿瘤转移术后行分子靶向治疗,于术后32个月出现肿瘤进展而死亡。结论:对于MRCC患者,术前应行超声、CT/MRI等多种影像学检查,以提高诊断准确性,避免遗漏。双侧MRCC患者应行基因检测鉴别遗传性或散发性肾癌。手术治疗是目前主要的治疗方法大多数病例可通过RN完整切除病灶;对病灶数较少或者遗传性肾癌患者,可选择PN。

Objective： To identify the main points of muhifocal renal cell carcinoma patients in the perioperative period. Method： We evaluated patients from a retrospectively maintained renal carcinoma database at Zhongshan hospital, Fudan university from December 2011 to June 2017. A total of 24 patients including 15 males and 9 fe- males were enrolled. The median age was 50 （range, 26-72） years old. Unilateral kidney multiple carcinomas were found in 21 cases while bilateral lesions in 3 cases. All of the patients underwent preoperative uhrasonography, CTU or enhanced MRI examination. Result： Gene detections were performed in bilateral muhifocal renal cell carci- noma patients. One patient was suspected VHL syndrome while the other 3 were excluded. All patients underwent surgical treatment including 8 partial nephrectomies and 18 radical nephrectomies. The pathology resuhs of the pa- tients were all clear cell carcinomas. The clamping time of PN procedures were （26.0±4.5） min and all the mar- gins were negative. All patients were followed up for 6 to 71 months so far. Twenty-three patients were up to now still alive without tumor recurrence, while 1 patient died of tumor metastasis 32 months after operation, although targeted therapy being used. Conclusion： To muhifocal renal cell carcinoma patients, accurate imaging examination should be performed before operation to avoid missing lesions. Gene analysis should be performed in bilateral focus patients to identify sporadic or hereditary disease. RN can eradicate the tumors safely while PN is a feasible option in hereditary instance.