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目的:通过分析接受肾部分切除术的孤立肾肾细胞癌患者的临床资料,总结孤立肾肾部分切除术的临床应用经验。方法:从1999年1月~2012年11月,共有15例孤立肾肾癌患者接受了肾部分切除术。统计分析所有患者的临床资料,包括术前基本情况、手术情况、术后肾功能、术后病理以及随访情况等,总结临床经验。结果:患者中位年龄50(39~71)岁,男女比例4∶1。平均手术时间150min。15例患者中有10例在手术中阻断肾动脉,平均热缺血时间为24min,另外5例采用手指轻压止血。中位失血量300ml。肿瘤中位大小2.5(1.5~7.0)cm。14例患者病理类型为透明细胞癌,1例为乳头状肾细胞癌。所有患者肿瘤切缘均为阴性。所有患者术后血肌酐水平都有不同程度升高,但在手术后1个月内都降至术前基线水平,无患者需要血液透析。2例患者出现血尿或者急性肾功能不全等围手术期并发症,经保守治疗缓解。患者中位随访时间51(10~167)个月,无远期手术并发症。随访过程中,有1例患者在术后14个月发现骨转移,在术后32个月死亡;2例患者出现患肾新发病灶,目前持续应用靶向药物治疗。结论:肾部分切除术对于孤立肾肾癌患者是一种安全有效的治疗方法,肿瘤治疗效果满意,肾功能得到最大限度保留。
OBJECTIVE: To summarize the clinical experience of partial nephrectomy of kidney by analyzing the clinical data of patients with isolated renal cell carcinoma who underwent partial nephrectomy. Methods: From January 1999 to November 2012, a total of 15 patients with isolated renal cell carcinoma underwent partial nephrectomy. Statistical analysis of all patients clinical data, including the basic preoperative situation, surgical conditions, postoperative renal function, postoperative pathology and follow-up, etc., to summarize clinical experience. Results: The median age of patients was 50 (39-71) years old, the ratio of male to female was 4: 1. The average operation time 150min. Ten of the fifteen patients blocked the renal artery during surgery, with an average of 24 minutes of warm ischemia and the other five were light-pressed with a finger to stop the bleeding. The median blood loss 300ml. The median tumor size was 2.5 (1.5-7.0) cm. The pathological types of 14 patients were clear cell carcinoma and 1 case of papillary renal cell carcinoma. Tumor margins were negative in all patients. Postoperative serum creatinine levels in all patients increased to varying degrees, but within one month after surgery, they all dropped to the preoperative baseline level, and no patient needed hemodialysis. Two patients had hematuria or acute renal insufficiency and other perioperative complications, the conservative treatment to ease. The median follow-up time was 51 (10 to 167) months, with no long-term surgical complications. During the follow-up, one patient found bone metastases 14 months after the operation and died at 32 months after surgery. Two patients developed new lesions of the kidney and the current continuous application of targeted drug therapy. Conclusion: Partial nephrectomy is a safe and effective treatment for patients with isolated renal cell carcinoma. The therapeutic effect is satisfactory and the renal function is preserved to the maximum.