摘要
目的探讨腹腔镜肾上腺切除术治疗非小细胞肺癌合并孤立性肾上腺转移的可行性,并评价其治疗效果和预后情况.方法回顾性分析2010年1月至2020年12月中国医学科学院肿瘤医院泌尿外科收治的28例接受腹腔镜肾上腺切除术的非小细胞肺癌孤立性肾上腺转移患者的临床基本资料、手术资料和术后病理以及预后相关指标的资料.结果28例患者均顺利完成腹腔镜肾上腺切除术,无中转开腹手术.肺癌术后出现同侧肾上腺转移患者14例,对侧肾上腺转移患者14例.明确肺癌诊断并且同时发现孤立性肾上腺转移患者7例,异时性肾上腺转移(metachronous adrenal metastasis,MAM)患者21例.肾上腺转移瘤的最大径平均为(2.90±1.14)cm,平均手术时间为(68.71±13.24)min,术中出血均为微量,无术中输血,术后切缘均为阴性,术后病理证实均为肺来源的肾上腺转移瘤.术后无局部复发,系统性复发脑转移2例、腹膜后转移1例、骨转移1例.胸腔镜肺叶切除术后到发现肾上腺转移的中位时间为10.5(0~96)个月.中位随访时间为23.0(4~98)个月.生存分析结果表明,MAM的患者生存时间明显大于同时性肾上腺转移(synchronous adrenal metastasis,SAM)转移患者,差异有统计学意义(P=0.023);肺癌原发灶合并淋巴结转移阳性的肾上腺转移患者生存时间明显短于无淋巴结转移的肾上腺转移患者,差异有统计学意义(P=0.002);而同侧与对侧肾上腺转移的患者术后生存时间差异无统计学意义(P=0.739).结论腹腔镜肾上腺切除术在治疗非小细胞肺癌孤立性肾上腺转移是安全、可行的,而且非小细胞肺癌无淋巴结转移的孤立性肾上腺转移患者可以获得长期生存获益,MAM的患者预后好于SAM的患者.
Objective To explore the feasibility of laparoscopic adrenalectomy in the treatment of non-small cell lung cancer with solitary adrenal metastasis,and to evaluate its therapeutic effect and prognosis.Methods A retrospective analysis of clinical data,surgical data,postoperative pathological data and prognostic indicators about 28 cases of laparoscopic adrenalectomy for non-small cell lung cancer with solitary adrenal metastasis in the Department of Urology,Cancer Hospital,Chinese Academy of Medical Sciences from January 2010 to December 2020.Results Laparoscopic adrenalectomy was successfully performed in all 28 patients without conversion to open surgery.There were 14 cases of non-small cell lung cancer complicated with ipsilateral adrenal metastasis(IAM)and 14 cases of contralateral adrenal metastasis(CAM).Synchronous adrenal metastasis(SAM)was found in 7 cases and metachronous adrenal metastasis(MAM)in 21 cases.The average length and diameter of adrenal metastases was(2.90±1.14)cm,and the average operation time was(68.71±13.24)min.There was no intraoperative blood transfusion,and the postoperative surgical resection margins was negative.Postoperative pathology confirmed all adrenal metastases from small cell lung cancer.There was no local recurrence after adrenalectomy,there were 2 cases of brain metastasis,1 case of retroperitoneal metastasis and 1 case of bone metastasis in systemic recurrence.The median time from lung cancer operation to adrenal metastasis was 10.5(0~96)months.The median follow-up time was 23.0(4~98)months.Prognostic survival analysis showed that the survival time of patients with MAM was significantly longer than that of patients with SAM(P=0.023),and the survival time of patients with adrenal metastasis with positive lymph node metastasis of lung cancer was significantly shorter than that of patients with adrenal metastasis without lymph node metastasis(P=0.002).There was no significant difference between the location of adrenal metastases(ipsilateral or contralateral to the primary focu
作者
赵钦欣
杨飞亚
邢念增
Zhao Qinxin;Yang Feiya;Xing Nianzeng(Department of Urology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100021,China)
出处
《泌尿外科杂志（电子版）》
2021年第3期41-45,共5页
Journal of Urology for Clinicians(Electronic Version)
基金
首都科技领军人才项目(项目编号:Z181100006318007)
北京市优秀人才培养青年骨干个人项目资助(项目编号:2018000032600G393)
关键词
孤立性肾上腺转移
肾上腺切除
腹腔镜
非小细胞肺癌
Solitary adrenal metastasis
Adrenalectomy
Laparoscopy
Non-small cell lung cancer
