肾癌肾部分切除术的临床价值及合适的手术切缘的探讨

Our experience of partial nephrectomy for renal carcinoma: the role and proper surgical margin

目的 :探讨肾癌肾部分切除术 (保留肾单位手术 )的临床价值及合适的手术切缘。方法 :回顾性分析15例行肾部分切除术的肾癌患者临床资料 ,其中双侧异时性肾癌且一侧为多发肿瘤 2例 ,单发肿瘤 13例。肿瘤直径 2～ 6cm ,均为T1期 (1997年TNM分期标准 )。对 15例肾癌患者行肾部分切除术 ,手术切缘位于肿瘤外 1cm。另取肾癌根治性手术标本 2 1例 ,于体外沿假包膜行肾肿瘤剜除术 ,并随机切取肿瘤边缘 0 .3cm、0 .5cm及 1cm处肾实质及肾蒂处淋巴脂肪组织行病理检查。结果 :15例患者随访 12～ 72个月 ,平均 4 1个月 ,未见并发症及残肾内肿瘤复发。 2 1例标本于体外行肿瘤剜除后肉眼下均无肿瘤组织残留 ,送检组织均无肿瘤细胞浸润。结论 :肾部分切除术能安全有效地治疗局限的早期肾癌患者 ,而手术切缘为肿瘤边缘 1cm处较为合适。

Objective:To evaluate the role of partial nephrectomy (nephron sparing surgery) in patients with renal carcinoma and its proper surgical margin.Method:We retrospectively analyzed a total of 15 patients who had undergone partial nephrectomy (nephron sparing surgery) for renal cell carcinoma between Sep 1997 and Sep 2002, among these patients, 2 cases were bilateral asynchronous and multicentric tumor, 13 cases were unifocal tumor. The tumor's diameter ranged from 2 cm to 6 cm, all tumor staged in T 1(1997TNM staging system). 15 cases underwent partial nephrectomy with a surgical margin of 1 cm. We also selected radical nephrectomy specimens of 21 patients(T 1), performed surgical enucleation ex vivo and carefully investigated the surgical margin of 0.3, 0.5, 1 cm and the para-vessels(renal) lymph nodes pathologically.Result:The patients were followed up for an average period of 41.2 months (range12 to72 months), no surgical complication or local tumor recurrence has been observed. And no tumor invasion found in surgical margin of 0.5, 1.0 cm and the para-vessels lymph nodes.Conclusion:Partial nephrectomy (nephron sparing surgery) is safe and effective therapeutic means for the renal cell carcinoma patients with small, localized tumors, and the proper surgical margin is 1 cm.