CAJ | 학술논문

目的探讨根治性肾切除时是否需要常规切除同侧肾上腺.方法分析263例肾癌患者的临床资料.比较同侧肾上腺切除组与保留组手术时间、出血量、手术并发症以及生存率有无差异(t检验);分析肾上腺受侵患者的临床特点.生存分析采用Kaplan-Meier法,组间差异采用longrank检验.结果临床分期T_(1～2)N_0M_0 214例,T_(3～4)N_(0～2)M_0 26例,T_(1～4)N_(0～2)M_1 23例.根治性肾切除术时切除同侧肾上腺146例,保留同侧肾上腺117例.同侧肾上腺切除组与保留组手术时间、出血量、手术并发症比较差异均无统计学意义(P＞0.05).术后病理证实肾肿瘤侵及同侧肾上腺8例,其肾原发肿瘤最大径平均为9.7 cm,肿瘤最大径≥8 cm 5例,肿瘤位于肾上极6例,累及全肾2例.临床分期为Ⅰ期或Ⅱ期者切除同侧肾上腺129例,病理结果证实同侧肾上腺受侵仅4例(3.1%);Ⅲ期或Ⅳ期患者切除同侧肾上腺17例,病理证实同侧肾上腺受侵4例(23.5%).随访3～102个月,平均28个月.同侧肾上腺切除组与保留组按各病理分期比较生存率差异均无统计学意义.结论肿瘤直径≥8 cm、位于肾上极或累及全肾、临床分期≥Ⅲ期均是肾癌侵及肾上腺的危险因素,此类患者行根治性肾切除术时应切除同侧肾上腺,其余早期肾癌患者实施手术治疗时可以保留同侧肾上腺.
목적 탐토근치성신절제시시부수요상규절제동측신상선.방법 분석263례신암환자적림상자료.비교동측신상선절제조여보류조수술시간、출혈량、수술병발증이급생존솔유무차이(t검험);분석신상선수침환자적림상특점.생존분석채용Kaplan-Meier법,조간차이채용longrank검험.결과 림상분기T_(1～2)N_0M_0 214례,T_(3～4)N_(0～2)M_0 26례,T_(1～4)N_(0～2)M_1 23례.근치성신절제술시절제동측신상선146례,보류동측신상선117례.동측신상선절제조여보류조수술시간、출혈량、수술병발증비교차이균무통계학의의(P＞0.05).술후병리증실신종류침급동측신상선8례,기신원발종류최대경평균위9.7 cm,종류최대경≥8 cm 5례,종류위우신상겁6례,루급전신2례.림상분기위Ⅰ기혹Ⅱ기자절제동측신상선129례,병리결과증실동측신상선수침부4례(3.1%);Ⅲ기혹Ⅳ기환자절제동측신상선17례,병리증실동측신상선수침4례(23.5%).수방3～102개월,평균28개월.동측신상선절제조여보류조안각병리분기비교생존솔차이균무통계학의의.결론 종류직경≥8 cm、위우신상겁혹루급전신、림상분기≥Ⅲ기균시신암침급신상선적위험인소,차류환자행근치성신절제술시응절제동측신상선,기여조기신암환자실시수술치료시가이보류동측신상선.
Objective To explore if it is essential to excise ipsilateral adrenal gland in radical nephrectomy.Methods Two hundred and sixty-three patients underwent radical nephrectomy were analyzed retrospectively.The duration of operation,bleeding volumn,complications and survival rates were compared between the adrenalectomy and adrenal preserved groups.The clinical data of the patients with adrenal gland involvement were analyzed as well.Results There were 214 clinical localized(T_(1-2)N_0M_0 )renal cell carcinoma (RCC) patients,26 local advanced RCC(T_(3-4)N_(0-2)M_0 ) patients and 23 metastatic RCC(T_(1-4)N_(0-2)M_1) patients in this study.In the 263 patients,146 cases received ipsilateral adrenal gland excisions,while 117 cases had the ipsilateral adrenal glands preserved.The duration of operation,estimated blood loss and the complications did not differ significantly between these two groups.Only 8 patients had adrenal gland involvement.The mean size of the 8 tumors was 9.7 cm and 5 of them had a diameter ≥8 cm.In the 8 patients,6 had the tumor in the upper pole and 2 had the whole kidney involved.One hundred and twenty-nine clinical stage Ⅰ and Ⅱ patients had ipsilateral adrenal excised,while only 4 (3.1%) had adrenal gland involvement.Seventeen clinical stage Ⅲ and Ⅳ patients had ipsilateral adrenal excised,and 4 (23.5%) had adrenal gland involvements.The clinical stages of these 8 patients were stage Ⅲand Ⅳ.The patients were followed up for 28 months (3-102 months).There was no significant difference of 5-year survival rates between the ipsilateral adrenal gland excised and preserved patients categorized according to pathological stage.Conclusion For patients with renal cancer larger than or equal to 8 cm,localized in upper pole of kidney or with the whole kidney involve and with a clinical stage higher or equal to Ⅲ,it is essential to excise ipsilateral adrenal gland in radical nephrectomy,otherwise the ipsilateral adrenal can be preserved.