CAJ | 학술논문

目的总结腹腔镜肾根治性切除术(LRN)治疗小儿肾脏恶性肿瘤的初步经验,评估其安全性和有效性.方法回顾性分析2010年1月至2013年9月,上海市儿童医院/上海交通大学附属儿童医院和复旦大学附属儿科医院采用LRN治疗的7例小儿肾脏恶性肿瘤患儿的临床资料、手术方法和疗效.其中,男5例,女2例;年龄1.5～11岁,平均(4.3±2.5)岁;左侧肾肿瘤4例,右肾3例;肿瘤最大直径4.5～10 cm,平均(6.8±2.5)cm,术前CT或MRI检查均未超过中线.Ⅰ期经腹腔途径LRN手术6例,经细针穿刺活检、化疗后6周后LRN手术1例.结果 7例均腹腔镜下完成LRN,无中转开腹者;手术时间70～150 min,平均97 min;出血量5～30 ml,平均13.5 ml,均未术中输血.术后住院时间(含术后首次化疗时间)6～11 d,平均8.5d.术后病理检查证实FH型肾母细胞瘤5例,肾横纹肌样肉瘤1例,肾癌1例.按COG分期肿瘤Ⅰ期6例,Ⅱ期1例.手术后按照NWTS-4化疗5例.术后随访0.3～2.9年,平均(1.9±1.5)年;术后无瘤生存6例,失访1例.结论经腹腔途径LRN治疗小儿肾脏恶性肿瘤是可行的,对早期和较小的肾脏肿瘤是安全有效的,但要选择适当的病例并由腹腔镜经验丰富的医师进行.其远期效果尚需大样本多中心对照研究和长期随访进一步证实.
목적 총결복강경신근치성절제술(LRN)치료소인신장악성종류적초보경험,평고기안전성화유효성.방법 회고성분석2010년1월지2013년9월,상해시인동의원/상해교통대학부속인동의원화복단대학부속인과의원채용LRN치료적7례소인신장악성종류환인적림상자료、수술방법화료효.기중,남5례,녀2례;년령1.5～11세,평균(4.3±2.5)세;좌측신종류4례,우신3례;종류최대직경4.5～10 cm,평균(6.8±2.5)cm,술전CT혹MRI검사균미초과중선.Ⅰ기경복강도경LRN수술6례,경세침천자활검、화료후6주후LRN수술1례.결과 7례균복강경하완성LRN,무중전개복자;수술시간70～150 min,평균97 min;출혈량5～30 ml,평균13.5 ml,균미술중수혈.술후주원시간(함술후수차화료시간)6～11 d,평균8.5d.술후병리검사증실FH형신모세포류5례,신횡문기양육류1례,신암1례.안COG분기종류Ⅰ기6례,Ⅱ기1례.수술후안조NWTS-4화료5례.술후수방0.3～2.9년,평균(1.9±1.5)년;술후무류생존6례,실방1례.결론 경복강도경LRN치료소인신장악성종류시가행적,대조기화교소적신장종류시안전유효적,단요선택괄당적병례병유복강경경험봉부적의사진행.기원기효과상수대양본다중심대조연구화장기수방진일보증실.
Objective To review the preliminary experiences of two children's hospitals in Shanghai and evaluate the laparoscopic radical nephrectomy (LRN) in children with Wilms' tumor and renal cancer.Methods From January 2010 to October 2013,the medical records were reviewed for 7 cases undergoing LRN for renal tumor at Shanghai Children's Hospital/Shanghai Jiao Tong University and Children's Hospital of Fudan University.There were 5 boys and 2 girls with an average age of (4.3±2.5) (1.5-11) years.There were left (n =4) and right (n =3) renal tumors.The greatest average tumoral size was (6.8 ± 2.5) (4.5-10) cm without crossing lateral vertebral edge.Six cases underwent LRN and one was operated after 6 weeks preoperative chemotherapy.Results All cases underwent LRN successfully without conversion.The average operative duration was 97 (70-150) min,blood loss volume 13.5 (5-30) ml and median hospital stay 8.5 (6-11) days.The pathologic examinations revealed Wilms' tumors (n =5),rhabdoid tumor (n =1) and renal carcinoma (n =1).Five of them underwent chemotherapy according to the COG (Children's Oncological Group) protocol.And 6 cases had a median follow-up period of (1.9 ± 1.5) (0.3-2.9) years.Conclusions The children with early and small-sized Wilms' tumor or renal cancer may be safely treated with LRN.However,multicenter prospective studies with a longer follow-up period and a larger sample size are necessary for comparing the outcomes of laparoscopic approaches.