透明细胞乳头状肾细胞肿瘤23例的临床特点及术后中长期随访报告

Clinical Characteristics and Medium to Long-term Follow-ups of Surgery for 23 Cases of Clear Cell Papillary Renal Cell Tumor

目的探讨透明细胞乳头状肾细胞肿瘤的临床病理特点及手术后中长期效果。方法2013年10月~2024年1月,我科对23例透明细胞乳头状肾细胞肿瘤分别行肾部分切除术或根治性肾切除术。行肾部分切除术者,通过经腹入路或经腹膜后入路,游离并阻断肾动脉,切除肿瘤并对创面进行缝合。行根治性肾切除术者,游离肾动静脉及输尿管,Hem-o-lok夹闭后切断,再将肾脏装袋取出。结果手术均顺利完成,18例腹腔镜手术,5例机器人辅助腹腔镜手术。17例行肾部分切除术,手术时间73~229 min,中位数149 min;阻断时间9~35 min,中位数21 min;出血量10~100 ml,中位数20 ml;术后住院时间3~28 d,中位数6 d。6例行根治性肾切除术,手术时间110~232 min,中位数123 min;出血量5~200 ml,中位数10 ml;术后住院时间3~7 d,平均4 d。术后病理均为透明细胞乳头状肾细胞肿瘤,核分级(WHO/ISUP分级)Ⅰ~Ⅱ级。23例术后随访7~121个月,平均53个月,其中10例随访>3年,9例随访>5年。1例术后1年发现对侧肾脏病变行腹腔镜肾部分切除术,病理为透明细胞乳头状肾细胞肿瘤,此后复查显示双肾有囊肿,距第1次术后7年发现双肾实性结节,考虑复发,主动监测2年(每3~6个月复查CT),病情稳定;1例术后29个月发现贲门管状腺癌,行胃镜下切除,随访121个月无复发;余21例无复发。结论透明细胞乳头状肾细胞肿瘤术前诊断困难,手术是有效治疗方法,预后较好,但部分病例会复发或合并多原发癌,术后应注意复查。

Objective To investigate the clinicopathologic characteristics of clear cell papillary renal cell tumor and the medium to long-term effect of surgical treatment.Methods A total of 23 cases of clear cell papillary renal cell tumor treated in our department from October 2013 to January 2024 were retrospectively analyzed.For patients undergoing partial nephrectomy,the renal artery was dissociated and blocked through abdominal or retroperitoneal approach to remove the tumor,and then the wound was sutured.For patients undergoing radical nephrectomy,the renal artery,vein,and ureter were dissociated and clipped by Hem-o-lok for cutting off,and then the kidney was removed.Results The operations were accomplished in all the patients,including 18 laparoscopic operations and 5 robot-assisted laparoscopic operations.Among them,17 cases underwent partial nephrectomy,with an operating time of 73-229 min(median,149 min),blocking time of 9-35 min(median,21 min),blood loss of 10-100 ml(median,20 ml),and postoperative hospitalization time of 3-28 d(median,6 d).Six cases underwent radical nephrectomy,with an operating time of 110-232 min(median,123 min),blood loss of 5-200 ml(median,10 ml),and postoperative hospitalization time of 3-7 d(median,4 d).Postoperative pathology showed clear cell papillary renal cell tumor with nuclear grade(WHO/ISUP grade)ofⅠ-Ⅱ.The 23 cases were followed up for 7-121 months(mean,53 months),of which 10 cases were followed up for more than 3 years and 9 cases for more than 5 years.One case was found to have contralateral renal lesions one year after operation and underwent laparoscopic partial nephrectomy,with a pathological result of clear cell papillary renal cell tumor.Subsequent re-examinations showed that there were cysts in both kidneys.At 7 years after the first operation,solid nodules in both kidneys were found,and a recurrence was considered.The patient was given active monitoring for 2 years(CT re-examinations every 3-6 months)and was in stable condition.Another case was found gastric cardia tubular adenocarcinoma at 29 months after operation and was resected under gastroscopy.No recurrence was found during follow-ups for 121 months.The remaining 21 cases had no recurrence.Conclusions Preoperative diagnosis of clear cell papillary renal cell tumor is difficult,and surgery is an effective method for treating this disease.Medium to long-term follow-up shows a good prognosis,but there are still some cases of recurrence or combined with multiple primary cancer.Postoperative follow-ups should be noted.