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目的探讨肾癌根治术邻近受侵器官一并切除的可行性及临床意义。方法对24例肿物直接侵犯至周围器官的肾癌患者施行邻近受侵器官一并切除的手术,其中左肾连同结肠脾曲、部分降结肠切除7例,部分胰体、胰尾、脾脏切除者5例,单纯连同脾脏切除者3例;右肾连同结肠肝曲切除4例,肝右后叶部分切除者4例,十二指肠降部部分切除1例。24例中部分腰大肌切除5例,合并结肠系膜部分切除者7例。术后9例行免疫治疗。结果本组24例无手术死亡,住院期间无严重并发症出现。术后21例获随访,随访时间3~240个月,1、3、5、8年生存率分别为90.5%(19/21)、42.9%(9/21),33.3%(7/21)及19.0%(4/21)。结论对于局限于周围器官受侵的肾癌,外科手术切除仍然是首选。患者条件允许时,将邻近受侵器官一并扩大切除,能达到肾癌根治切除的要求,在有一定普通外科经验的条件下,手术较为安全。有可能延长生存时间,并为后续的系统性治疗创造有利条件。
Objective To investigate the feasibility and clinical significance of resection of adjacent invading organs in radical nephrectomy. Methods Twenty-four patients with renal cell carcinoma who directly infiltrated into the surrounding organs underwent surgery to remove adjacent organs. The left kidney together with colon splenic flexure, partial descending colon resection in 7 cases, partial pancreatic tail, splenic resection (N = 5), simple spleen resection in 3 cases; right kidney with colon hepatectomy in 4 cases, right hindgut partial resection in 4 cases, partial descending part of the duodenum in 1 case. Among 24 cases, 5 cases were partial resection of psoas muscle and 7 cases were resected with partial resection of mesocolon. Nine patients received immunotherapy. Results The group of 24 patients died without surgery, no serious complications during hospitalization. Twenty-one patients were followed up for 3 to 240 months. The survival rates at 1, 3, 5 and 8 years were 90.5% (19/21), 42.9% (9/21) and 33.3% (7/21) And 19.0% (4/21) respectively. Conclusions Surgical resection is still the first choice for renal cancer limited to peripheral organ involvement. When the patient conditions permit, the adjacent organs to be expanded and removed together to achieve the desired radical resection of renal cell carcinoma, under the conditions of a certain general surgical experience, surgery is more secure. It is possible to prolong survival and create favorable conditions for subsequent systematic treatment.