CAJ | 학술논문

目的：：探讨同时性散发性双侧肾癌的手术治疗策略.方法：回顾性分析64例同时性散发性双肾癌患者的临床及病理资料.男47例,女17例,年龄25~69岁,平均51岁.59例患者无任何临床症状为体检时发现,2例以血尿就诊,3例以腰痛就诊,均未伴淋巴结及远处转移.肿瘤临床分期为T1a38例,T1b17例,T2a9例.结果：64例患者均行后腹腔镜手术治疗.4例患者行双侧肿瘤的同期手术切除,2例发生术后急性肾功能衰竭,行短期透析治疗.60例行双侧肿瘤分期手术切除,其中33例行双侧保留肾单位手术(NSS-NSS组),19例先行一侧根治性肾切除术后行另一侧保留肾单位手术(RN-NSS组),7例先行保留肾单位手术后行另一侧根治性肾切除术(NSS-RN 组).双侧肿瘤切除术后各组肌酐分别为89、110、102μmol/L.1例行双侧根治性肾切除,术后行常规透析治疗.术后随访7~99个月,中位随访时间49个月,50例患者无瘤生存,2例局部复发,5例发生转移,7例死亡.结论：后腹腔镜分期保留肾单位手术是同时散发性双肾癌的首选治疗策略,在完整切除肿瘤的同时最大限度的保留肾功能.患者预后不因双侧肾脏受累而受到明显影响.
목적：：탐토동시성산발성쌍측신암적수술치료책략.방법：회고성분석64례동시성산발성쌍신암환자적림상급병리자료.남47례,녀17례,년령25~69세,평균51세.59례환자무임하림상증상위체검시발현,2례이혈뇨취진,3례이요통취진,균미반림파결급원처전이.종류림상분기위T1a38례,T1b17례,T2a9례.결과：64례환자균행후복강경수술치료.4례환자행쌍측종류적동기수술절제,2례발생술후급성신공능쇠갈,행단기투석치료.60례행쌍측종류분기수술절제,기중33례행쌍측보류신단위수술(NSS-NSS조),19례선행일측근치성신절제술후행령일측보류신단위수술(RN-NSS조),7례선행보류신단위수술후행령일측근치성신절제술(NSS-RN 조).쌍측종류절제술후각조기항분별위89、110、102μmol/L.1례행쌍측근치성신절제,술후행상규투석치료.술후수방7~99개월,중위수방시간49개월,50례환자무류생존,2례국부복발,5례발생전이,7례사망.결론：후복강경분기보류신단위수술시동시산발성쌍신암적수선치료책략,재완정절제종류적동시최대한도적보류신공능.환자예후불인쌍측신장수루이수도명현영향.
Objective:To discuss the surgical strategy in treating synchronous sporadic bilateral renal cell carci-noma.Methods:Clinical and pathological data of 64 patients with synchronous sporadic bilateral renal cell carcinoma were analyzed retrospectively.Of all the 64 patients,47 patients were males and 17 were females,the mean age was 51 (25-69)years.59 patients without symptoms were diagnosed with bilateral renal cell carcinoma during regular check-up,2 patients presented with hematuria and 3 with backache.None of these patients presented with lymphatic or distant metastasis.38 patients were diagnosed with T1a tumors,17 with T1b and 9 with T2a.Results:All the 64 patients underwent bilateral retroperitoneoscopic surgeries.Of the 4 patients undergoing single procedures,2 pa-tients developed acute renal failure and acquired temporarily hemodialysis.Of the 60 patients undergoing staged pro-cedures,bilateral NSS was performed in 34 patients (NSS-NSS group),RN followed by NSS in 19 patients (RN-NSS group)and NSS followed by RN (NSS-RN group)in 7 patients.The mean sCr of each group after bilateral sur-geries were 89μmol/L,110μmol/L,102μmol/L,respectively.1 patientundergoing bilateral RN required routine hemodialysis.The median follow up time was 49 (7-99)months.50 patients survived without tumor,2 patients de-veloped local recurrence,5 patients suffered from lymphatic or distant metastasis and 7 patients died in the last fol-low up.Conclusions:Retroperitoneoscopic staged NSS was the preferred choice for the management of synchronous sporadic bilateral renal cell carcinoma,which was superior in renal functional preservation with the complete resec-tion of tumors.There was not a significant difference in the prognosis between patients with synchronous sporadic bi-lateral renal cell carcinoma and unilateral renal cell carcinoma.