【摘要】 目的 探讨T1b期肾癌行NSS的适应证选择、安全性及其临床效果。方法 对47例T1b期肾癌患者实施肾部分切除术。结果 OPN及LPN的热缺血时间分别为(15.3±5.8)min,(22.1±7.2)min。术后并发症:迟发性肾脏出血1例,术后肾动脉瘤1例,下肢深静脉血栓1例,分别予二次手术、选择性肾动脉栓塞术、抗凝等治疗。术后随访时间5个月~10年,5例失访,14例肿瘤转移。结论 T1b期肾癌选择肾部分切除术是安全可行的。需要综合考虑患者意愿、主要脏器功能状况、肿瘤与肾血管的解剖关系、残留肾单位的比例及术者擅长的术式等多种因素。因此,NSS有望成为T1b期肾癌的标准术式之一。更多还原

【Abstract】 Objective To investigate the indication,safety and clinical effectiveness of nephronsparing surgery(NSS)for stage Tib renal cell carcinoma(RCC).Methods A total of 47 Tib RCC patients in our hospital received partial nephrectomy.The mean diameter of the carcinomas was(49.3 ± 14.5) mm.The contralateral kidney was normal in 31,benign in 14 and malignant in 2 cases.Open partial nephrectomy(OPN)and laparoscopic partial nephrectomy(LPN) were performed in 35 and 12 cases.The renal artery was clamped during resection.The size of surgical margin was 5 mm.Collecting system was sutured in 41 cases.Results The operation was successfully performed in all patients.The mean warm ischemia time(WIT)was(15.3 ±5.8)min in OPN and(22.1 ±7.2)min in LPN.The postoperative complications included delayed renal hemorrhage in 1 case,renal artery aneurysm in 1 case and deep venous thrombosis of lower extremity in 1 case.These patients were treated with reoperation,Selective renal artery embolization and anticoagulants.During the follow-up of 5- 120 months,5 cases were missing and 14 cases were diagnosed as metastases.Conclusion The WIT can be achieved in 30 minutes for Tib NSS.The postoperative complications,injury on renal function and metastases are not increased in this group.NSS is effective and safe in treating stage Tib renal carcinomas.Patient preference,functions of the main organ,anatomy of tumor and vessels,ratio of residual nephron and other factors should be considered comprehensively.Therefore,NSS might be the standard surgical procedures for stage 1 RCC in the future.更多还原