摘要
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（￡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T1-2N0M0 214例，T3～4 N0～2 M0 26例，T1～4 N0～2 M1 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9．7cm，肿瘤最大径≥8cm 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≥8cm、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。
Objeetive 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（T1-2 N0 M0 ） renal cell carcinoma （RCC） patients, 26 local advanced RCC（T3-4 N0-z M0 ） patients and 23 metastatic RCC（T1-4N0-2M1） 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 corrfpliCations 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 ≥8cm. 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 Ⅲ and 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 ipsilat- eral adrenal gland in radical nephrectomy, otherwise the ipsilateral adrenal can be preserved.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2010年第1期35-37,共3页
Chinese Journal of Urology
关键词
肾切除术
肾上腺
预后
Nephrectomy
Adrenal glands
Prognosis
