摘要目的:评价腹腔镜下根治性肾切除术、保留肾单位手术以及射频消融术在多中心性肾细胞癌治疗中的临床价值,探索多中心性肾细胞癌的最佳治疗手段。方法:回顾性分析2009年1月~2013年5月31例多中心性肾细胞癌微创手术治疗的患者临床资料(肿瘤最大直径1.7~6.0 cm, 均为T1期(2009年TNM标准)。结果:术后30例(30/31)获随访随访时间4~55个月,平均随访28个月,1例出现转移。结论:初步数据证明多中心性肾细胞癌的微创手术治疗是可行的,为进一步考证其肿瘤学结果需要更大样本和长期的随访验证。
Abstract:Objective:To evaluate the role of laparoscopic or retroperitoneoscopic radical nephrectomy, partial nephrectomy and radio frequency ablation in patients with multifocal renal cell cancers and find a better surgical approach for these patients. Methods:We retrospectively analyzed the clinical information of a total of 31 patients with multifocal renal cell carcinomas treated with minimally invasive surgery between May 2009 and May 2013. The tumor diameter ranged from 1.7 cm to 6cm,all tumors were in T1(2009 TNM staging system). The feasibility of minimally invasive surgery for these patients was evaluated. Results:30 of 31 patients were followed up for an average period of 28 months (range from 4 to 55 months). Metastasis was found in 1 patient. Conclusions:Minimally invasive surgery for patients with multifocal renal cell cancers is a feasible approach. Both larger sample and longer follow-up period are necessary to verify its oncological outcomes.
巩会杰, 李世超, 黄庆波, 张旭. 微创手术在多中心性肾细胞癌的应用(附31例报告)[J]. 微创泌尿外科杂志, 2013, 2(5): 321-323.
Gong Huijie, Li Shichao, Huang Qingbo, Zhang Xu. The role of minimally invasive surgery in multifocal renal cell carcinoma (Report of 31 cases). JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2013, 2(5): 321-323.
[1]张旭,李宏召,马鑫,等.后腹腔镜保留肾脏手术治疗肾肿瘤.中华泌尿外科杂志,2005,26(3):160-162. [2]张旭,叶章群,陈忠,等.腹腔镜与开放根治性肾切除术临床疗效分析(附33例报告).中华泌尿外科杂志, 2002, 23(2): 97-99. [3]李泉林, 关宏伟, 张秋萍,等.肾细胞癌多中心病灶的相关因素研究. 中华外科杂志, 2001, 39 (7) : 532-533. [4]Tsivian M, Moreira DM, Caso JR, et al. Predicting occult multi-focality of renal cell carcinoma. Eur Urol, 2010,58(1):118-126. [5]李鸣, 叶章群, 何志嵩, 等.多中心肾癌临床特征分析.中华泌尿外科杂志,2010,31(2):77-80. [6]Lonser RR, Glenn GM, Walther M,et al . von Hippel-Lindau disease. Lancet, 2003,361(9374):2059-2067. [7]Na KY,Kim HS, Park YK, et al.Multifocal Renal Cell Carcinoma of Different Histological Subtypes in Autosomal Dominant Polycystic Kidney Disease. Korean J Pathol, 2012, 46(4): 382-386. [8]Simhan J, Canter DJ, Sterious SN,et al. Pathological Concordance and Surgical Outcomes of Sporadic Synchronous Unilateral Multifocal Renal Masses Treated with Partial Nephrectomy. J Urol, 2013, 189(1):43-47. [9]Kim WT, Ham WS, Ju HJ, et al. Clinical Characteristics of Renal Cell Carcinoma in Korean Patients with von Hippel-Lindau Disease Compared to Sporadic Bilateral or Multifocal Renal Cell Carcinoma. J Korean Med Sci, 2009, 24(6): 1145-1149. [10]Ginzburg S,Uzzo RG, Kutikov A. The role of Minimally Invasive Surgery in Multifocal Renal Cell Carcinoma. Curr Urol Rep. 2012, 13(3):202-210. [11]Lin YC, Turna B, Frota R, et al. Laparoscopic partial nephrectomy versus laparoscopic cryoablation for multiple ipsilateral renal tumors. Eur Urol.2008, 53(6):1210-1216. [12]Steinberg AP, Kilciler M, Abreu SC, et al. Laparoscopic nephron-sparing surgery for two or more ipsilateral renal tumors. Urology,2004,64(2):255-258. [13]Flum AS, Wolf JS Jr. Laparoscopic partial nephrectomy for multiple ipsilateral renal tumors using a tailored surgical approach. J Endourol,2010,24(4):557-561.