摘要
目的探讨非遗传性双侧同时性肾癌的诊治原则。方法回顾性分析2009年1月至2016年12月收治的36例非遗传性双侧同时性肾癌患者的临床资料,男30例,女6例。年龄26~77岁,平均55岁。36例共74个肾占位,其中34例双侧均为单发占位,2例为一侧肾脏有2个占位。占位直径1~11 cm,平均(6.8±4.1)cm。行保留肾单位手术(NSS)者的R.E.N.A.L.评分为4~12分,平均(6.1±3.4)分;中山评分为3~13分,平均(6.9±3.7)分。按手术方式分为4组:A组16例,术前肌酐63~103μmol/L,平均(80.9±11.4)μmol/L,行双侧NSS;B组7例,术前肌酐59~87 μmol/L,平均(75.7±8.9)μmol/L,先行一侧NSS再行对侧根治性肾切除术(RN);C组7例,术前肌酐57~107μmol/L,平均(77.6±19.2)μmol/L,先行一侧RN再行对侧NSS;D组6例,仅一侧行NSS或RN,对侧未行手术,其中2例为术前拟行NSS,术中发现肿瘤累及肾盂及输尿管上段,改行RN。16例行双侧NSS患者中,4例先行高评分侧肿瘤手术,二期行低评分侧肿瘤手术;11例先行低评分侧肿瘤手术,二期行高评分侧肿瘤手术;1例同期行双侧手术。对A、B、C组术后指标进行分析。结果 A、B、C组30例手术均顺利完成。NSS手术时间60~110 min,平均(88.6±23.6)min;RN手术时间40~90 min,平均(72.3±21.4)min。NSS热缺血时间12~40 min,平均(29.5±9.7)min。A组一期术后1个月肌酐62~117μmol/L,平均(89.4±15.8)μmol/L;二期术后1个月肌酐57~392μmol/L,平均(129.6±74.9)μmol/L;均无复发转移。B组一期术后1个月肌酐64~115 μmol/L,平均(94.0±14.4)μmol/L;二期术后1个月肌酐93~453μmol/L,平均(190.4±117.2)μmol/L;1例发生肺转移。C组一期术后1个月肌酐84~113 μmol/L,平均(90.1±12.1)μmol/L;二期术后1个月肌酐88~156μmol/L,平均(121.4±24.8)μmol/L;1例发生肺转移。B组1例二期术后出现少尿,行血液透析治疗1周后好转。3组一、二期术后肌酐与术前比较差异均无统计学意义(P>0.05)。30例一期术后住院时间3~16 d,平均(6.7±3.4)d;二期�
Objective To investigate the principles of diagnosis and treatment of non-hereditary bilateral synchronous renal cell carcinoma. Methods This retrospective study analyzed 36 cases of non-hereditary bilateral synchronous renal cell carcinoma in our hospital from January 2008 to December 2016, including 30 males and 6 females. A total of 74 renal tumors were found, in which 34 patients had bilateral single kidney tumor and 2 patients had two tumors in one kidney. The diameter of tumors ranged from 1cm to 11 cm, with an average of (6.8±4.1)cm. The patients that underwent nephron-sparing surgery(NSS) got 4-12 points, with an average of (6.1±3.4) points in R. E.N.A.L. score and 3-13 points, with an average of (6.9±3.7) points in Zhongshan score. The patients are classified into 4 groups according to operation methods. In group A, 16 patients underwent bilateral NSS, which the preoperative creatinine was 63-103 μmol/L with an average of (80.9±11.4)μmol/L. In group B, 7 patients underwent one side of NSS before contralateral radical nephrectomy (RN), which preoperative creatinine was 59-87 μmol/L with an average of (75.7±8.9)μmol/L. In group C, 7 patients underwent one side of RN before contralateral NSS, preoperative creatinine was 57-107 μmol/L, with an average of (77.6±19.2)μmol/L. In group D, 6 patients underwent one side of NSS or RN and spare the contralateral side, 2 of which shifted from NSS to RN after finding tumor invaded pelvis and upper ureter during surgery. Of all the 16 patients with bilateral NSS, 4 patients underwent surgery on the side where tumor had a higher score in the first phase and then the side where tumor had a lower score in the second phase, 11 underwent surgeries in an opposite order. One patient underwent bilateral NSS simultaneously. Group A, B and C are taken into final analysis.Result All the 30 patients underwent surgery successfully. The operation time of NSS ranged from 60 to 110 min with an average of (88.6±23.6)min and RN ranged from 40 to 90 min with an average of (7
作者
王杭
许培榕
张思弘
朱延军
姜帅
胡骁轶
何敏坷
郭剑明
Wang Hang;Xu Peirong;Zhang Sihong;Zhu Yanjun;Jiang Shuai;Hu Xiaoyi;He Minke;Guo Jianming(Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第5期361-364,共4页
Chinese Journal of Urology
关键词
肾癌
手术
保留肾单位手术
Renal carcinoma
Surgery
Nephron-sparing surgery
