后腹腔镜技术治疗双侧肾癌的有效性与安全性研究

张东旭; 李勋钢; 徐丹枫; 崔心刚; 王军凯; 陈露; 余丹; 汪凯

后腹腔镜技术治疗双侧肾癌的有效性与安全性研究

- 1 第二军医大学附属长征医院泌尿外科(上海, 200003

详细信息

通讯作者: 徐丹枫,E-mail:xu-danfeng@hotmail.com

中图分类号: R572

收稿日期: 2011-10-15

Oncological efficacy and safety of retroperitoneal laparoscopic surgery for bilateral renal cell carcinoma

- Department of Urology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China

More Information

Corresponding author: XU Danfeng, E-mail: xu-danfeng@hotmail.com

Received Date: 15 October 2011

摘要

摘要: 目的:探讨后腹腔镜技术治疗双侧肾癌的方法及疗效。方法:回顾性分析2004年1月~2010年6月11例双侧肾细胞癌患者的临床资料,同时型6例,异时型5例,肿瘤直径平均(2.8±1.8) cm。11例患者均分期行后腹腔镜手术治疗,其中8例行双侧肾部分切除术,3例行一侧肾癌根治及对侧肾部分切除术。结果:所有手术均顺利完成,无中转开放,平均手术时间(102±27)min,平均热缺血时间(23.0±7.7) min,术中平均出血量(80.0±43.5)ml,术后平均住院时间(10.6±2.0)d。术后平均随访(3.5±2.0)年,9例未见复发及转移且术后肾功能无异常,1例术后肌酐升高,1例肺转移予靶向药物治疗至今。结论:后腹腔镜技术治疗双侧肾癌安全、可行、有效,具有创伤小、恢复快的优点,但其远期疗效尚需大样本对照研究和长期随访观察。
- 后腹腔镜术 /
- 肾癌 /
- 双侧 /
- 治疗 /
- 预后
Abstract: Objective:To present the experience of retroperitoneal laparoscopic surgery for bilateral renal cell carcinoma.Method:From January 2004 to june 2010,11 cases of bilateral renal cell carcinoma(BRCC)were retrospectively analyzed.Among the 11 csaes,6 had synchronous BRCC and 5 had asynchronous BRCC.The mean tumor size was (2.8±1.8) cm in diameter.All of the 11 patients received two-stage retroperitoneal laparoscopic operation.8 patients underwent bilateral retroperitoneal laparoscopic nephron-sparing surgery(LNSS),3 patients underwent unilateral retroperitoneal laparoscopic nephron-sparing surgery plus contralateral retroperitoneal laparoscopic radical nephrectomy(LRN).Result:11 cases were operated successfully without conversion to open surgery.The mean operation time was (102±27) min,and mean warm ischemia time(WIT)was (23.0±7.7) min,and mean blood loss was (80.0±43.5) ml,and mean postoperative hospital stay was (10.6±2.0) days.In a mean follow up for (3.5±2.0) years,9 patients' renal function remains well without tumor recurrence and metastasis,1 patient serum creatinine up to abnormal level immediately after second surgery,1 had lung metastasis but still alive with targeted therapy.Conclusion:retroperitoneal laparoscopic surgery is safe、feasible and effective for BRCC with less trauma and faster recovery of its advantages,but its long-term effects still need to study with large samples compare and long-term follow-up.
- retroperitoneal laparoscopic /
- renal cell carcinoma /
- bilateral /
- treatment /
- prognosis

HTML全文

参考文献(15)

[1]	张旭.泌尿外科腹腔镜手术学[M].北京:人民卫生出版社,2008,9,57-75.
[2]	DILLENBYRG W,POULAKIS V,SKRIAPAS K,etal.Retroperitoneoscopic versus open surgical radicalnephrectomy for large renal cell carcinoma in clinicalstage cT2or cT3a:quality of life,pain and reconvales-cence[J].Eur Urol,2006,49:314-322.
[3]	彭波,郑军华,徐丹枫,等.后腹腔镜肾癌根治切除术与开放手术的疗效比较[J].第二军医大学学报,2006,27:1167-1169.
[4]	JEMAL A,SIEGEL R,WARD E,et al.Cancer Statis-tics,2006[J].CA Cancer J Clin,2006,56:106-130.
[5]	MARSHALL F F,STEWART A K,MENCK H R.The National Cancer Data Base:Report on kidneycancers.The american college of surgeons cmmissionon cancer and the Aamerican cancer society[J].Canc-er,1997,80:2167-2174.
[6]	ZINCKE H,SWANSON S K.Bilateral renal cell car-cinoma:influence of synchronous and asynchronousoccurrence on patient survival[J].J Urol,1982,128:913-915.
[7]	SIMMONS M N,BRANDINA R,HERNANDEZ AV,et al.Surgical management of bilateral synchronouskidney tumors:functional and oncological outcomes[J].J Urol,2010,184:865-872.
[8]	PATEL A R,LEE B H,CAMPBELL S C,et al.Bilat-eral Synchronous Sporadic Renal Tumors:PathologicConcordance and Clinical Implications[J].Urology,2011,78:1095-1099.
[9]	ROTHMAN J,CRISPEN P L,WONG Y N et al.Pathologic concordance of sporadic synchronous bilat-eral renal masses[J].Urology,2008,72:138-142.
[10]	BLUTE M L,ITANO N B,CHEVILLE J C,et al.The effect of bilaterality,pathological features andsurgical outcome in nonhereditary renal cell carcinoma[J].J Urol,2003,169:1276-1281.
[11]	KLATTE T,WUNDERLICH H,PATARD J J,et al.Clinicopathological features and prognosis of synchro-nous bilateral renal cell carcinoma:An internationalmulticentre experience[J].BJU Int,2007,100:21-25.
[12]	SASCHA P,DRAGAN C,FREDERIK R,et al.Bilat-eral synchronous sporadic renal cell carcinoma:surgi-cal management,oncological and functional outcomes[J].BJU Int,2007,100:26-29.
[13]	LJUNGBERG B,COWAN N C,HANBURY D C,etal.EAU guidelines on renal cell carcinoma:the 2010update[J].Eur Urol,2010,58:398-406.
[14]	CHING C B,LI J,GILL I S,et al.Functional and On-cologic Outcomes of Bilateral Open Partial Nephrecto-my Versus Bilateral Laparoscopic Partial Nephrecto-my[J].J Endourol,2011,25:1193-1197.
[15]	HARA N,NISHIYAMA T,YOSHIMURA N,et al.Management for Patients with De Novo or RecurrentTumors in the Residual Kidney after Surgery forNonfamilial Bilateral Renal Cell Carcinoma[J].AdvUrol,2009,30:135-143.