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目的探讨保留肾单位的肾癌切除术的适应证及术中处理。方法肾癌患者53例。男32例,女21例。年龄21～76岁。病程1周～13个月。均经B超检查发现为单侧肾脏肿瘤,均除外对侧肾病变。肿瘤位于肾上极和下极者38例行肾部分切除术,肿瘤位于肾中部者15例行肾楔形切除术。术中肾血管全阻断,10～15min放松肾蒂钳,肾创面采用止血纱布填塞加可吸收线涤纶布外固定缝合。术后行干扰素治疗(500万U皮下注射,隔日1次,共3个月),每3个月复查。结果肿瘤切除时间7～21min,平均12min。53例患者均经术中冰冻切片及术后病理学检查确诊为肾细胞癌,切缘阴性。肾癌最大直径6cm者1例,余均＜4cm。临床分期均为T_1N_0M_0。术后随访6～48个月。肿瘤无复发,术侧肾脏功能良好。结论肾癌的快速切除可缩短肾血管全阻断时间,手术效果满意。对于直径＜4cm单发肿瘤或肿瘤直径＞4cm但位于肾浅表呈外凸性生长的T_1肾癌,保留肾单位的肾癌切除术是值得积极尝试的治疗方式之一。
Objective To investigate the indications and intraoperative management of nephron excision for retaining nephron. Methods 53 cases of renal cell carcinoma patients. There were 32 males and 21 females. Age 21 to 76 years old. Course of 1 week ~ 13 months. B-ultrasound were found to be unilateral renal tumors, except contralateral kidney disease. Tumor located in the upper pole and the lower pole of 38 cases of partial nephrectomy, tumor in the middle of the kidney were 15 cases of renal wedge resection. Intraoperative renovascular full-block, 10 ~ 15min to relax the renal tweezers, renal wounds with hemostatic gauze padding plus absorbable polyester cloth outside the suture. Postoperative interferon treatment (5 million U subcutaneous injection, every other day, a total of 3 months), every 3 months review. Results Tumor resection time 7 ~ 21min, an average of 12min. Fifty-three patients were diagnosed as renal cell carcinoma by intraoperative frozen section and postoperative pathology, and the negative margins were found. Kidney cancer, a maximum diameter of 6cm in 1 case, I <4cm. Clinical stage are T_1N_0M_0. The patients were followed up for 6 to 48 months. No recurrence of tumor, the side of the kidney function well. Conclusion The rapid excision of renal cell carcinoma can shorten the time of total renovascular occlusion, and the operation result is satisfactory. Renal cancer nephron excision is one of the most promising treatments for T 1 RCC with tumors <4 cm in diameter or tumors> 4 cm in diameter but present in superficial tumors.