保留肾单位手术治疗早期肾癌的长期疗效观察

Long-term efficiency of nephron sparing surgery for early-stage renal cell carcinoma

目的 :探讨保留肾单位手术治疗早期肾癌的临床应用价值。方法 :对采取保留肾单位手术治疗的2 3例孤立肾或对侧肾功能不全的早期肾癌临床资料进行回顾性分析。结果 :术后均未发生严重并发症 ,术后病理均为T1a期 ,其中透明细胞癌 19例 ,嫌色细胞癌 2例 ,乳头状肾癌 1例 ,囊性肾癌 1例。术后平均随访 4 4 .7个月 ,肿瘤复发 1例 ,复发率为 4 .3%。 1年、3年无瘤生存率分别为 10 0 % (2 3/ 2 3)、93.8% (15 / 16 )。随访期间未出现肾功能衰竭而需透析治疗者。结论 :孤立肾或对侧肾功能不全的早期肾癌 ,是施行保留肾单位手术的绝对指征 ,在最大限度保留肾功能的前提下可以获得与根治性肾切除相似的疗效。

Objective:To assess the clinical value of nephron sparing surgery for the treatment of early stage renal cell carcinoma.Method:We reviewed the clinical data of 23 cases, who underwent nephron sparing surgery for early stage renal cell carcinoma from October 1996 to October 2002 in our hospital. These patients had solitary or abnormal contralateral kidney.Result:No severe complication related to the procedure was observed. The pathological stage was T1a in all patients. 19 were clear cell renal carcinoma, 2 were chromophobe cell renal carcinoma, 1 was papillary renal cell carcinoma and 1 was cystic renal cell carcinoma. The median follow up was 44.7 months. No patient progressed to renal failure, only one recurred and total recurrence rate was 4.3 %. The cancer specific 1 and 3 year survival rate was 100% and 93.8 %, respectively.Conclusion:Early stage renal cell carcinoma with solitary or abnormal contralateral kidney is the imperative indication of nephron sparing surgery. The effect of this surgery was as the same as that of radical nephrectomy.