小切缘保肾手术治疗早期肾细胞癌的长期疗效观察
Long-term outcomes of mini-margin nephron sparing surgery for renal cell carcinoma
目的 探讨小切缘保肾手术治疗肾细胞癌的安全性及有效性.方法 1998年1月至2006年12月采用5 mm以上切缘对115例直径≤4 cm的T1a期肾细胞癌患者施行保肾手术.肿瘤平均直径3.3 cm(1.0~4.0 cm),其中双侧肾癌同时保肾手术3例,对侧肾脏正常的单侧肾癌112例.随访观察其远期效果.结果 115例患者手术均成功完成,手术时间80~120 min,平均90 min.术中出血量50~200 ml,均不需输血.98例患者采用肾蒂阻断,局部低温手术,阻断时间20~25 min,平均22 min.17例局限于肾上、下极且体积较小者采用手捏法控制出血,不阻断肾蒂,也不需要局部降温.115例切缘常规冰冻病理检查均未发现肿瘤残留.3例于住院期间出现二次肉眼血尿,经卧床、抗炎、止血治疗痊愈,无尿瘘、感染及需手术处理的大出血等并发症.所有患者均获随访,平均随访时间62个月,其中局部复发1例(异位复发),局部复发率0.9%,所有患者均存活至今,未发生远处转移.结论 小切缘保肾手术有利于保留更多的功能性肾单位,且并发症少,是直径4 cm以下早期肾癌安全、有效的治疗手段.
更多Objective To study the safety and effects of mini-margin nephron sparing surgery(NSS)for renal cell carcinoma(RCC).Methods From January 1998 to December 2006,115 cases of RCC with diameter of 4 am or less and stage of T1aN0M0 were treated with NSS using a margin of 5 mm or more. The mean diameter of the tumors was 3.3 cm(range 1.0-4.0 cm).Of the eases,3 were with synchronous bilateral cancer while 112 cases were with Bonnal opposite kidneys. The clinical results were followed and analyzed. Resuits All of the operations were technically sueeessful. The mean duration of surgical procedures was 90 min(ranged 80-120 min). The blood loss was 50-200 ml. No patient needed blood transfusion.Renal arteries were occluded in 98 cases under hypothermic technique for a mean duration of 22 min(20-25 min). While in 17 cases,renal parenchyma squeezing was used for bleeding control.All of the 115 cases were of negative margin by weather frozen or routine pathologic study. The mean follow-up was 62 months(6-96 months). Local recurrence was found in 1 case during follow-up,with a local recurrence rate of 0.9%, while no distant metastasis was detected.All the patients were alive with no evidence of tumor bearing until last evaluation. Secondary gross hematuria occurred in 3 cases during hospital stay and cured by bed limitation. There were no major complications such as bleeding and urinary leakage or urinoma requiring re-operation.Conclusions Mini-margin nephron sparing surgery is likewise safe and effective in treating early localized renal cell carcinoma 4 cm or less. It provides excellent renal function preservation,favorable long-term progression-free survival,and is not associated with an increased risk of local recurrence.
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