| 摘要: |
| 目的 总结分析我院15年的肾细胞癌临床数据,探讨技术的引进与改良对肾细胞癌外科治疗的微创率、手术切除率及安全性的影响。方法 回顾性分析我院自1995年1月至2009年11月收治的2 052例肾癌病例,按时间顺序分为3组: 1995年1月至1999年12月为第1组,2000年1月至2004年12月为第2组,2005年1月至2009年11月为第3组。比较各组的手术方式、手术切除率及安全性。结果 2 052例肾癌病例中,T1期1 516例；T2期以上536例,其中复杂性肾癌(伴淋巴结转移、静脉癌栓、侵犯周围脏器但可切除、肝肺孤立转移) 277例,完成根治手术217例、姑息性手术41例、未完成手术19例(包括术中因癌栓脱落死亡3例)。第1组共546例,全部采用开放手术,其中保留肾单位手术42例；复杂性肾癌89例,完成根治手术64例、姑息性手术16例、未完成手术9例(包括术中因癌栓脱落死亡2例)。第2组共673例,采用腹腔镜手术(经腰) 117例；开放手术556例,其中保留肾单位手术95例；复杂性肾癌88例,完成根治手术68例、姑息性手术13例、未完成手术7例(包括术中因癌栓脱落死亡1例)。第3组共833例,采用腹腔镜手术585例；开放手术248例,其中保留肾单位手术142例；复杂性肾癌100例,完成根治手术85例、姑息性手术12例、未完成手术3例,无围手术期死亡病例。结论腹腔镜技术的进步使肾细胞癌的手术治疗从开放手术转向微创,微创手术逐渐成为主流手术方式。手术操作技术的改进,使复杂性肾癌的安全性与切除率提高,保留肾单位手术应用越来越多,并逐渐向微创手术方向发展,单孔腹腔镜手术在肾癌外科治疗领域越来越受到重视。 |
| 关键词: 肾肿瘤 肾细胞癌 微创性外科手术 腹腔镜检查 安全性 |
| DOI：10.3724/SP.J.1008.2011.0929 |
| 投稿时间：2011-07-14修订日期：2011-09-07 |
| 基金项目:上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115), 上海市重点学科项目. |
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| Treatment of renal cell carcinoma: a single center clinical analysis (1995-2009) |
| WANG Lin-hui△,WANG Liang△,YANG Qing,YANG Bo,WU Zhen-jie,CHEN Wei,XIAO Cheng-wu,LIU Bing,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| ObjectiveTo summarize the clinical data of renal cell carcinoma (RCC) in our hospital in the past 15 years, and to investigate the mini-invasive rate, resection rate and safety of surgical treatment for RCC.MethodsWe retrospectively analyzed the clinical data of 2,052 consecutive cases with renal tumors during Jan.1995 to Nov.2009. The patients were divided into 3 groups according to the time they were treated. The 1st group: from Jan.1995 to Dec.1999; the 2nd group: from Jan.2000 to Dec.2004; and the 3rd group: from Jan.2005 to Nov.2009.The operation method, resection rate and safety were compared between different groups. ResultsAmong 2,052 patients, 1,516 had T1 stage RCC; 536 cases had T2-4 stage RCC, including 277 with locally advanced RCC (lymphatic metastasis, venous tumor thrombus, resectable local invasion, solitary hepatic or lung metastasis); 217 cases received radical nephrectomy, 41 received palliative surgery, and the surgical procedures were not finished in 19 cases(including 3 died during operation due to cancer embolus defluxion). All the 546 patients in the 1st group received open surgery,including 42 receiving nephron-sparing surgery; for 89 cases with locally advanced RCC, radical nephrectomy was done in 64 cases, palliative surgery in 16 cases, and surgery procedures were not finished in 9 cases (including 2 died during operation due to cancer embolus defluxion). Of the 673 cases in the 2nd group, 556 cases received open surgeries, including 95 receiving nephron-sparing surgery and 117 received laparoscopic surgery (via lumbar flank approach); for the 88 cases with locally advanced RCC, radical nephrectomy was done in 68 cases, palliative surgery in 13 cases, and surgery procedures were not finished in 7 cases (including 1 died during operation due to cancer embolus defluxion). Of the 833 cases in the 3rd group, 248 received open surgery, including 142 cases receiving nephron-sparing surgery and 585 received laparoscopic surgeries; 100 cases had locally advanced RCC, and 85 of them received radical nephrectomy, 12 received palliative surgery, and surgical procedures were not finished in 3 cases, with no death cases during the perioperative period. ConclusionMinimally invasive surgery has become the dominant approach for treatment for renal cell carcinoma owning to fast development of laparoscopy. Improvement in surgical technique has promoted the safety and resectable rate of locally advanced RCC, and nephron-sparing surgery has been more widely used and has gradually been done in a minimally invasive manner. Single-port laparoscopic surgery is gaining increasing attention in treatment of RCC. |
| Key words: kidney neoplasms renal cell carcinoma minimally invasive surgical procedures laparoscopy safety |
