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目的探讨淋巴结清扫在肾癌根治术中的临床意义。方法回顾性分析1998年1月至2005年12月收治的158例肾癌根治术患者,并根据术中淋巴结清扫范围的不同分为单纯肾癌根治术组(Ⅰ组)、加行区域性淋巴结清扫术组(Ⅱ组)和加行扩大淋巴结清扫术组(Ⅲ组),所有患者资料均来源于信访、走访、电话随访和门诊复查,并对其中105例肾透明细胞癌患者术后3年生存率进行分析。结果术后随访1～8年,140例患者获得随访,其中39例死亡。肾透明细胞癌术后3年生存率:Ⅰ组:T_(1～3)N_0M_080．0%;Ⅱ组:T_(1～3)N_0M_076．7%, T_(1～3)N_1M_033．3%;Ⅲ组:T_(1～3)N_0M_074．2%,T_(1～3)N_1M_050．0%,T_4N_(1～3)M_1 33．3%;各组3年生存率的差异均无统计学意义(P值均＞0．05)。9例淋巴结肿大患者术后3年生存率为33．3%。结论肾癌的预后主要与肿瘤分期有关;以单纯肾癌根治术为首选,不主张在手术中盲目扩大淋巴结清扫范围。
Objective To investigate the clinical significance of lymph node dissection in radical nephrectomy. Methods A total of 158 patients with radical nephrectomy who were treated from January 1998 to December 2005 were retrospectively analyzed. According to the range of lymph node dissection, they were divided into simple renal cell carcinoma group (group Ⅰ), regional lymph node All patients were from petition, visit, telephone follow-up and outpatient review. Among 105 patients with clear cell carcinoma of renal cell carcinoma, 3 years after operation Survival rates were analyzed. Results The patients were followed up for 1 to 8 years and 140 patients were followed up, of which 39 patients died. The 3-year survival rate of renal clear cell carcinoma after operation was as follows: group Ⅰ: T_ (1 ~ 3) N_0M_080.0%; Ⅱ group: T_ (1 ~ 3) N_0M_076.7% and T_ (1-3) N_1M_033.3% Group Ⅲ: T_ (1 ~ 3) N_0M_074.2%, T_ (1 ~ 3) N_1M_050.0%, T_4N_ (1 ~ 3) M_1 33.3%; There was no significant difference in the 3-year survival rates between groups (P> 0.05). Three patients with lymphadenopathy had a 3-year survival rate of 33.3%. Conclusions The prognosis of renal cell carcinoma is mainly related to the stage of neoplasm. Radical nephrectomy alone is the first choice. It is not advocated that the range of lymph node dissection should be expanded blindly.