开放手术治疗复杂性肾门区肾癌保留肾单位22例报告

Open surgery for complex renal hilar renal carcinoma with preserved nephron:a clinical report of 22 cases

目的:分享保留肾单位的肾癌手术的处理技巧。方法:回顾性分析2018年1月至10月复杂性肾门区肾癌患者的临床资料。根据肾脏肿瘤测量评分系统(R.E.N.A.L)进行评估,选取总分大于9分的患者,同时患者存在腹痛、腰痛、血尿,伴或不伴有副瘤综合征表现。共入选患者22例,其中男14例,女8例;年龄52~75岁,平均(68.42±1.53)岁;肿瘤直径8~13 cm,平均(10.53±1.62)cm。均未发现有区域肿大淋巴结,分期均为T2N0M0。对患者均行保留肾单位的开放手术治疗。术后评估肾小球滤过率(GFR),并总结分析在保留肾单位的手术过程中的处理技巧、手术心得。结果:孤立肾肾门区肾癌患者10例,肾门区巨大肾癌(直径>10 cm)患者12例,经开放性肾癌保留肾单位手术治疗后均完全治愈。术后患者获1年随访,均全部存活,无肿瘤复发。手术过程中应用α-氰基丙烯酸正丁酯和娴熟的缝合技术可大大减少出血。其次,充分调动术者感官体验,更加完整地切除患肾肿瘤病灶,尽可能减少对残存肾单位的损伤,最大限度保留肾单位。结论:对复杂性肾门区肾癌行开放肾癌保留肾单位手术在当前仍为一种重要的手术选择,其具有暴露瘤体快、术中出血少、手术及热缺血时间短、手术切缘阳性率低、手术难度相对较小、术后并发症发生率低的优势,为一种行之有效的治疗措施。

Objective:To share management skills during nephron retention surgery.Methods:The clinical data of 22 patients with complicated renal cancer in our hospital from January 2018 to October 2018 were retrospectively analyzed.According to the renal tumor measurement scoring system(R.E.N.A.L),patients with a total score greater than 9 were selected.Secondly,abdominal pain,low back pain,hematuria,accompanied by secondary tumor syndrome or not,were included,including 14 males and 8 females,aged 52-75 years,with an average age of(68.42±1.53)years.The tumor diameter was 8-13 cm,with an average(10.53±1.62)cm.There were 10 patients with isolated renal hilar renal cancer and 12 patients with giant renal hilar renal cancer(>10 cm in diameter).No regional enlarged lymph nodes were found in T2N0M0.All cases were treated with open nephron sparing surgery.Postoperative GFR was evaluated,and the management skills and surgical experience in nephron-sparing surgery were summarized and analyzed.Results:All patients with complex renal cancer in this retrospective analysis underwent open nephron sparing surgery for renal carcinoma,including 10 patients with isolated renal hilar carcinoma and 12 patients with giant renal hilar carcinoma,who were completely cured after surgical treatment(100%).After 1 year follow-up,all patients survived(100%of the cases),and no patients had tumor recurrence.During surgery,the use of n-butyl cyanoacrylate and skilled suture techniques greatly reduced the incidence of bleeding.Secondly,concerns were paid to fully mobilize the surgeon's sensory experience,a more complete resection of the kidney tumor lesions,reducing the damage to the residual nephron as far as possible,maximizing the reserve of renal function.Conclusion:Open nephron sparing surgery is still an important surgical option for complex hilar renal carcinoma.It has the advantages of rapid exposure of tumor body,less intraoperative bleeding,short time of operation and hot ischemia,low positive rate of surgical margin,relatively small difficulty of operation and fewer incidence of postoperative complications,which can be regarded as an effective treatment.