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目的探讨双侧散发性肾癌的手术治疗方式和预后特点。方法回顾性分析23例双侧散发性肾癌患者的资料,分析其临床、手术治疗和预后的特点。结果同步双侧肾癌12例,非同步11例。双侧散发性肾癌占同期肾癌的1.8%,男女比例6.67:1,平均年龄56岁;双侧行手术治疗17例(同步10例,非同步7例);一侧行手术治疗4例(同步1例,非同步3例),拒绝手术治疗2例(同步)。随访21例,平均时间26.7个月。患者1年生存率84.6%,5年生存率33.5%。同步双侧散发性肾癌患者术后肾功能不全发生率(18%)低于非同步患者(70%)(P=0.030)。结论双侧肾癌预后差,争取早期发现和切除肿瘤是治疗的关键;治疗过程中应尽可能采取保肾手术,以期在彻底切除肿瘤的同时尽可能保护患者的肾功能。
Objective To investigate the surgical treatment and prognosis of bilateral sporadic renal cell carcinoma. Methods The data of 23 patients with bilateral sporadic renal cell carcinoma were retrospectively analyzed. The clinical, surgical treatment and prognosis were analyzed. Results Synchronous bilateral renal cell carcinoma in 12 cases, 11 cases of non-synchronous. Bilateral sporadic renal cell carcinoma accounted for 1.8% of renal cell carcinoma in the same period, the ratio of male to female was 6.67: 1, the average age was 56 years. Seventeen cases were treated by bilateral surgery (synchronous 10 cases, non-synchronous 7 cases) (Synchronous 1 case, non-synchronous 3 cases), refused surgery in 2 cases (synchronous). Follow-up of 21 cases, the average time of 26.7 months. One-year survival rate of patients 84.6%, 5-year survival rate of 33.5%. The incidence of postoperative renal insufficiency in patients with synchronous bilateral sporadic renal cell carcinoma (18%) was lower than that in nonsynchronized patients (70%) (P = 0.030). Conclusion The prognosis of bilateral renal cell carcinoma is poor, and seeking for early detection and resection of the tumor is the key to the treatment. In the course of treatment, kidney-conserving surgery should be taken as much as possible so as to completely protect the renal function of the patient while completely removing the tumor.