腹腔镜手术治疗囊性肾癌的临床分析与体会

张志强; 于德新; 谢栋栋; 王毅; 毕良宽; 张涛; 丁德茂; 闵捷; 陈磊; 邹慈; 王大明; 方露; 洪谦; 孙宏亮

doi:10.13201/j.issn.1001-1420.2019.06.014

腹腔镜手术治疗囊性肾癌的临床分析与体会

- 安徽医科大学第二附属医院泌尿外科(合肥, 230022)

详细信息

通讯作者: 于德新,E-mail:zhangzq_urology@126.com

中图分类号: R737.11

收稿日期: 2018-07-25

Clinical analysis and experience of cystic renal cell carcinoma treated by laparoscopic surgery

- Department of Urology, Second Affiliated Hospital of Anhui Medical University, Hefei, 230022, China

More Information

Corresponding author: YU Dexin, E-mail: zhangzq_urology@126.com

Received Date: 25 July 2018

摘要

摘要: 目的:总结腹腔镜手术治疗囊性肾癌(CRCC)的临床经验,提高临床诊治水平。方法:回顾性分析2014年10月~2018年5月我院收治的14例术前影像学诊断为CRCC并接受腹腔镜手术治疗的患者的临床资料,并定期随访。14例肾脏囊性疾病通过螺旋CT、超声检查或MRI初步诊断为CRCC,其中Bosniak分级Ⅱ、ⅡF、Ⅲ、Ⅳ级肾脏囊性疾病分别为4、2、6、2例。9例行腹腔镜保留肾单位手术(LNSS);3例行腹腔镜根治性肾切除术(LRN);1例行腹腔镜肾囊肿去顶减压术;1例行腹腔镜肾囊肿去顶减压术,术后病理考虑恶性病变再次行LNSS。结果:14例患者术后均恢复良好。术后病理检查结果显示,6例诊断为低度恶性潜能多房囊性肾癌(MCRNLMP),4例诊断为肾细胞癌囊性变(RCCC),3例诊断为单纯性肾囊肿,1例诊断为多房囊性肾瘤(MLCN)。其中11例CRCC中,T_1aN₀M₀期4例,T_1bN₀M₀期3例,T_2aN₀M₀期3例,T_2bN₀M₀期1例。随访2~46个月,其中1例RCCC患者术后9个月复发,其余均无复发和转移。结论:术前影像学诊断的CRCC病理类型多样,诊断较为困难,但Bosniak分级可以作为肾囊性肿瘤的诊断与治疗的重要依据。LNSS可作为治疗CRCC的优先选择方案,MCRNLMP预后良好,与临床分期及肿瘤体积无关,但RCCC预后不良,应根据术后病理个体化管理随访。
- 肾细胞癌 /
- 多房囊性肾癌 /
- 腹腔镜手术
Abstract: Objective: To summarize the diagnosis, treatment and survival outcomes of cystic renal cell carcinoma (CRCC) treated by laparoscopic surgery. Method: A retrospective study was conducted on 14 patients diagnosed with CRCC by imaging at our center from October 2014 to May 2018. The information of patients including clinical manifestation, imaging characteristics, pathologic, features treatment and prognosis were collected and summarized. Of the 14 cases of CRCC cases identified, 14 were diagnosed with CRCC by preoperative ultrasonography, computed tomography scan or magnetic resonance imaging. Laparoscopic nephron sparing surgery (LNSS) was performed on nine of 14 cases, laparoscopic radical nephrectomy (LRN) on three cases and retroperitoneal laparoscopic cyst unroofed on 1 case. Retroperitoneal laparoscopic cyst unroofed and subsequent laparoscopic nephron sparing surgery (LNSS) was performed on 1 case. Result: All patients had an uneventful recovery. After the operation, of the 14 cases of CRCC cases identified, 6 were MCRNLMP, 4 RCCC, 1 multilocular cystic nephroma and 3 benign cystic lesion by pathological examination. At the time of diagnosis, 4, 2, 6 and 2 had a Bosniak category Ⅱ, ⅡF, Ⅲ and Ⅳ cystic lesion, respectively. Among 11 CRCC, 4, 3, 3 and 1 were stage T_1a, T_1b, T_2a and T_2b, respectively. During the follow-up period of 2-46 months, no tumor recurrence or metastasis occurred among MCRCC, except that one with RCCC with cystic change had a local recurrence at 9 months.Conclusion: CRCC defined on preoperative imaging shows diversified pathologic subtypes. The Bosniak classification system has been used as a method for diagnosing and determining the management of cystic renal masses. LNSS should be regarded as the preferred surgical technique for CRCC. MCRNLMP carries an excellent prognosis, regardless of tumor size or pathological T stage, but RCCC with cystic change may have an unfavorable prognosis.
- renal cell carcinoma /
- multilocular cystic renal cell carcinoma /
- laparoscopic surgery

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