T1期肾细胞癌保留肾单位手术安全切除边距的研究

探讨保留肾单位手术治疗T1期肾细胞癌时肿瘤周围组织的安全切缘,并评价术中评价（IE）肿瘤切缘方法的效果。T1期肾癌根治术标本50例,连续组织切片检查包膜完整性及多中心病灶。回顾21例肾部分切除术患者的临床病理资料,IE方法为切除肿瘤后从顶部到肿瘤基底部沿最长轴切开,肉眼观察。肿瘤直径和包膜完整性为多中心灶的显著相关因素（P〈0.05）。21例肾部分切除术患者切缘范围为1mm~10mm均阴性,随访12个月~118个月（平均35个月）,均无瘤存活。IE评价术中切缘情况安全有效,对于IE观察假包膜完整者,切缘3mm~5mm即可,如观察假包膜不完整,切缘应达到5mm~10mm。

Research of Safety Excision Margin in Nephron Sparing Surgery for Patients with T1 Renal Cell Carcinoma

To provide a basis for the safety excision margins in nephron sparing surgery for patients with T1 renal cell carcinoma.And to determine the efficacy of a new method called by us as ＂intra-operative evaluation＂ for the assessment of surgical margin（SM）status.We retrospectively analyzed a total of 21 patients who had undergone partial nephrectomy（PN）for renal cell carcinoma.After the excision,the tumors were uniformly divided into two halves for the evaluation of the safety of SMs.Findings of IE were compared with the permanent section analysis in terms of SM status.50 kidneys suffered from radical nephrectomy for RCC were examined for any tumor invasion of the pseudocapsule,micro-multifocal carcinoma beyond pseudocapsule.IE showed intact margins and none of the patients had positive SM in the final pathological examination.There was no evidence of local recurrence or distant metastasis with a mean follow-up of 35（12~118）months.All patients were alive.The total incidence of multifocal carcinoma in this group was 4.0%.Tumor size and interrupted pseudocapsule were two significant predictors of multicentricity of RCC（P〈0.05）.IE of resected specimen was a safe and effective method for the evaluation of SMs in partial nephrectomy patients.The proper surgical margin was 3mm~5mm in patients with complete pseudocapsule,5mm~10mm in patients without complete pseudocapsule.