肾散发多发恶性肿瘤的诊治体会

Experience of diagnosis and treatment for renal multiple malignant tumors

目的探讨肾散发多发恶性肿瘤的诊治方法。方法回顾性分析2013年5月至2017年11月收治的4例肾多发恶性肿瘤患者的临床资料，均为男性。年龄54-82岁，平均64岁。4例均无家族病史。病程7d-6个月，平均2个月。1例表现为腰部不适，另3例为体检发现肾脏肿瘤。肿瘤位于左、右肾各2例。肿瘤数目1例为2个，3例为3个。完善超声和CT检查，超声检查表现为等回声结节；CT检查表现为不规则软组织影，部分突出肾外，增强后有不均匀强化，诊断考虑为肾癌。3例行腹腔镜根治性肾切除术，1例为孤立肾行腹腔镜肾部分切除术。结果本组4例手术均顺利完成。3例腹腔镜根治性肾切除术的手术时间189-271min，平均230rnin；出血量50-100ml，平均83ml；术后住院时间5-14d，平均9．7d；其中1例术后出现肠梗阻，对症治疗后好转。1例腹腔镜肾部分切除术因肾脏3个肿瘤距离较远，为减少肾动脉阻断时间中转开放手术，手术时间207min，肾动脉阻断时间15min，出血量50ml，术后住院时间6d。术后病理回报：3例为透明细胞癌；1例2个肿瘤为透明细胞癌，1个肿瘤为乳头状癌。术后随访2-55个月，平均38个月，4例均无肿瘤复发。结论同侧。肾多发恶性肿瘤临床少见，腹腔镜根治性肾切除术疗效确切，对于合适的病例也可选择肾部分切除术。

Objective To investigate the diagnosis and treatment of ipsilateral multiple renal malignant tumors. Methods 4 patients with multiple renal malignant tumors were retrospectively reviewed from May 2013 to November 2017. All cases were males ,with average age of 64 years old （ranging 54- 82 years old）. Two eases were found that tumor located in right side. The duration of disease ranged from 7 days to 6 months, with an average of 2 months. One case was found the tumor due to the complaining of lumbar discomfort, and other 3 eases were found by physical examination. The number of tumors was 2 in 1 ease, and 3 in 3 cases. The sonographic features of the tumors were iso-echoic nodules. CT showed irregular soft tissue shadow, partially prominent outside the kidney, and heterogeneous enhanced after enhancement. 3 cases were undergone laparoscopic radical nephrectomy and 1 case which was solitary kidney, was undergone laparoscopic partial nephrectomy. Results All operations were performed successfully. 3 cases were undergone laparoscopic radical nephrectomy, which the operative time was 189- 271 rain （average,230 min） ,and blood loss was 50 - 100 ml （mean 83 ml）. Postoperative hospitalization time was 5 - 14 days, average 9.7 days. 1 ease occurred intestinal obstruction after surgery, which was improved after treatment. 1 case was found the close distance of 3 tumors during the laparoseopic surgery. In order to short the ischemie duration, open surgery conversion was performed in this case. The total operation time was 207min. The ischemic time was 15rain and blood loss was 50 ml. The postoperative hospital stay was 6 days. Pathological reported that 3 cases were clear cell carcinoma, another 1 case was clear cell carcinoma with papillary carcinoma. All patients were followed up for 2 - 55 months （ mean 38 months ）. No recurrence sign was recorded in all cases. Conclusion Ipsilateral multiple renal malignant tumors are rare, laparoscopic radical nephrectomy is effectie. Meanwhile, partial nephreetomy can also be chosen in some optimal cases.