肾单位保留术治疗解剖性孤立肾肾癌的临床疗效

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摘要目的探讨肾单位保留术治疗解剖性孤立肾肾癌的临床疗效。方法回顾性分析武警湖北总队医院2010-04至2019-11收治的12例解剖性孤立肾肾癌患者的临床资料,其中男8例,女4例,平均年龄(48.67±2.34)岁。肿瘤直径为4.62 cm(2.2~8.2 cm)。临床分期4例为T_1aN₀M₀,6例为T_1bN₀M₀,2例为T₂N₀M₀。12例均行手术治疗,其中开放肾单位保留术9例,后腹腔镜下肾单位保留术3例。对两种不同术式,术后当天和术后1周复查肾功能结果进行分析,并对手术时间、失血量及热缺血时间进行分析。术后随访12~36个月,分析患者预后情况。结果 12例均顺利完成手术,9例开放手术时间为142 min(115~172 min),失血量为253 ml(175~420 ml),热缺血时间为34 min(25~41 min);3例腹腔镜手术时间为112 min(96~131 min),失血量为197 ml(120~270 ml),热缺血时间为25 min(23~27 min)。术后当天和术后1周平均血肌酐值分别为239 μmol/L(136~302 μmol/L)、186 μmol/L(92~287 μmol/L)。12例围手术期均未输血,腹腔镜手术均未中转开放,围手术期均无出血、尿漏、肠梗阻、急性肾损伤等严重并发症,无需暂时血液透析。术后病理检查肾透明细胞癌7例,乳头状肾细胞癌4例,肾嫌色细胞癌1例。术后随访12例,失访1例,1例术后10个月死于肺炎,1例术后21个月死于心血管意外,余9例均无瘤存活。结论肾单位保留术治疗解剖性孤立肾肾癌临床疗效显著。

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	王劭亮
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关键词 ：孤立肾, 肾癌, 肾单位保留术, 肾部分切除术

Abstract：Objective To investigate the clinical effect of nephron sparing surgery in the treatment of anatomic solitary renal tumor. Methods A retrospective analysis was conducted on 12 patients with anatomic solitary renal tumor admitted to Hubei Provincial Corps Hospital of Chinese People's Armed Police Force from April 2010 to November 2019, including 8 males and 4 females, with an average age of (48.67±2.34) years. The tumor was 4.62 cm (2.2-8.2 cm). The clinical stage was T_1aN₀M₀ in 4 patients, T_1bN₀M₀ in 6 cases and T₂N₀M₀ in 2 cases. All the 12 patients underwent surgical treatment, including open nephron sparing surgery in 9 cases and laparoscopic nephron sparing surgery in 3 cases. The results of renal function reexamination on the day and 1 week after operation of the two different operation methods were analyzed, and the operation time, blood loss and hot ischemia time were analyzed. The patients were followed up for 12 to 36 months and the prognosis was analyzed. Results All the 12 patients completed the operation successfully. The open operation time of 9 cases was 142 min (115-172 min), the blood loss was 253 ml (175-420 ml), and the warm ischemia time was 34 min (25-41 min). The laparoscopic operation time of 3 cases was 112 min (96-131 min), the blood loss was 197 ml (120-270 ml) and the warm ischemia time was 25 min (23-27 min). The mean serum creatinine values were 239 μmol/L (136-302 μmol/L) and 186 μmol/L (92-287 μmol/L) on the day and 1 week after surgery respectively. None of the 12 patients underwent perioperative blood transfusion, and laparoscopic surgery was not converted to open one. There were no serious complications such as bleeding, urine leakage, intestinal obstruction or acute kidney injury during the perioperative period, and no need for temporary blood dialysis. After operation, there were 7 cases of renal clear cell carcinoma, 4 cases of renal papillary cell carcinoma and 1 case of renal chromophobe cell carcinoma. All the 12 cases were followed up after surgery, and 1 case was lost to follow-up. One patient died of pneumonia 10 months after surgery, one patient died of cardiovascular accident 21 months after surgery, and the remaining 9 patients survived with no tumor. Conclusions Nephron sparing surgery is effective in the treatment of anatomic solitary renal carcinoma.

Key words： solitary kidney renal carcinoma nephron sparing surgery partial nephrectomy

收稿日期: 2023-10-20

ZTFLH:

R737.11

通讯作者: 陈蓉,E-mail:chenr2024@126.com

作者简介: 王劭亮,博士,副主任医师。

引用本文:

王劭亮, 王书龙, 陈蓉, 张昆林, 石璇. 肾单位保留术治疗解剖性孤立肾肾癌的临床疗效[J]. 武警医学, 2025, 36(2): 93-96. WANG Shaoliang, WANG Shulong, CHEN Rong, ZHANG Kunlin, SHI Xuan. Clinical effect of nephron sparing surgery in treatment of anatomic solitary renal carcinoma. Med. J. Chin. Peop. Armed Poli. Forc., 2025, 36(2): 93-96.

链接本文:

https://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 https://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2025/V36/I2/93

[1]	Ljungberg B,Albiges L, Ghanem Y,et al.European association of urology guidelines on renal cell carcinoma:the 2022 update[J].Eur Urol,2022,145(22):1676-1677.
[2]	Egen L,Quan A,Gottstein L,et al.Relevance of positive surgical margins in localized renal cell carcinoma after surgical resection: predictive factors and survival implications[J].Clin Genitourin Cancer,2024,22(4):102-110.
[3]	Takagi T,Omae K,Yoshida K,et al.Comparisons of survival and surgical outcomes between minimally invasive partial nephrectomy and radical nephrectomy in elderly patients with stage 1 renal cell carcinoma[J].Geriatr Gerontol Int,2024,24(3):269-274.
[4]	Zabell J,Isharwal S,Dong W,et al.Acute kidney injury after partial nephrectomy of solitary kidneys:impact on long-term stability of renal function[J].J Urol,2018,200(6):1295-1301.
[5]	Uhlig J,Strauss A,Rucker G,et al.Partial nephrectomy versus ablative techniques for small renal masses:a systematic review and network meta-analysis[J].Eur Radiol,2019,29(3):1293-1307.
[6]	Rintoul S,Fernando A,Nair R,et al.Open nephron-sparing surgery in patients with a complex tumour in a solitary kidney:technical,oncological and functional outcomes[J].BJU Int,2021,128(4):431-434.
[7]	张乐飞,易发现.肾部分切除术的研究进展[J].中国微创外科杂志,2020,20(2):164-167.
[8]	过菲,张超,吴震杰,等.孤立肾肾肿瘤外科保肾治疗策略的选择及初步探讨[J].临床泌尿外科杂志,2022,37(9):680-684.
[9]	Fernando A,Fowler S,O'Brien T.Nephron-sparing surgery across a nation-outcomes from the british association of urological surgeons 2012 national partial nephrectomy audit[J].BJU Int,2016,117(10):874-882.
[10]	张宗勤,王正,刘冰,等.机器人辅助腹腔镜肾部分切除术中冰水肾脏降温对肾功能的保护效果[J].中华医学杂志,2021,101(46):3799-3803.
[11]	Baiocco J A,Ball M B,Pappajohn A K,et al.A comparison of outcomes for standard and multiplex partial nephrectomy in a solitary kidney:the national cancer institute experience[J].Urol Oncol,2019,37(6):356.e1-356.e7.
[12]	王强,张旭.肾部分切除术治疗复杂性肾肿瘤的研究现状及进展[J].微创泌尿外科杂志,2016,5(5):314-320.
[13]	Ygal B,François A,Karim B,et al.Partial nephrectomy in solitary kidneys:comparison between open surgery and roboticassisted laparoscopy on perioperative and functional outcomes (UroCCR-54 study)[J].World J Urol,2023,41(4):315-324.
[14]	孟锐,孙博,邹练.泌尿外科达芬奇机器人辅助与传统腹腔镜围术期指标比较[J].武警医学,2019,30(6):496-498.
[15]	Gadus L,Chmelik F,Matejkova M,et al.Transperitoneal laparoscopic and robotic partial nephrectomy for renal cancer in patients with previous abdominal surgery: a single centre experience[J].Indian J Surg,2023,27(4):1-9.
[16]	周昕,孔飞燕,常德辉.消融术治疗早期肾脏肿瘤的研究进展[J].临床泌尿外科杂志,2020,35(4):321-325.
[17]	Rusinek M,Salagierski M,Rózański W,et al.Comparison of the results of therapy for ct1 renal carcinoma with nephron-sparing surgery (NSS) vs percutaneous thermal ablation (TA)[J].J Pers Med,2022,12(3):495-504.
[18]	Meng H,Yang H,Jia H P,et al.Efficacy and safety of CT-guided microwave ablation for stage T1a renal cell carcinoma in patients with a solitary kidney[J].Int J Hyperthermia,2021,38(1):691-695.
[19]	Abdelsalam M E,Awad A,Baiomy A,et al.Outcomes of radiofrequency ablation for solitary T1a renal cell carcinoma:a 20-year tertiary cancer center experience[J].Cancers (Basel),2023,15(3):909-917.
[20]	Krieger J R,Lee F T, Cormick T,et al.Micro wave ablation of renal cell carcinoma[J].J Endourol,2021,35(S2):S33-S37.
[21]	Pandolfo S D,Loizzo D,Beksac A T,et al.Percutaneous thermal ablation for cT1 renal mass in solitary kidney:a multicenter trifecta comparative analysis versus robot-assisted partial nephrectomy[J].Eur J Surg Onc,2023,49(8):486-490.