Campbell S C, Novick A C, Streem S B, Klein E A
Department of Urology, Cleveland Clinic Foundation, Ohio 44195.
J Urol. 1993 Sep;150(3):808-13. doi: 10.1016/s0022-5347(17)35619-7.
Coexistence of renal cell carcinoma and renal artery disease is an unusual and challenging problem. From 1969 to 1991, 34 patients presented with localized renal cell carcinoma and renal artery disease affecting all of the functioning renal parenchyma. These patients represented 4 categories: 1) a solitary kidney with renal cell carcinoma and renal artery disease (5), 2) bilateral renal cell carcinoma and coexistent renal artery disease (5), 3) unilateral renal cell carcinoma and contralateral renal artery disease (13), and 4) unilateral renal cell carcinoma and bilateral renal artery disease (11). Atherosclerosis was the most common cause of renal artery disease (30), followed by medial fibroplasia (2), renal artery aneurysm (1) and arteriovenous malformation (1). A total of 23 patients (68%) presented with azotemia (serum creatinine 1.5 mg./dl. or more) and 11 (32%) presented with hypertension. All patients underwent complete surgical excision of renal cell carcinoma. A nephron sparing operation was performed preferentially (30 patients) and bilateral renal cancer operations were staged. Eight patients underwent simultaneous partial (6) or radical (2) nephrectomy and surgical renal revascularization. There were no operative deaths. Postoperatively, preservation of renal function was achieved in 33 patients and 1 required chronic dialysis. At mean followup of 47 months 23 patients (68%) were alive with no evidence of malignancy and 2 were alive with recurrent renal cell carcinoma. Three patients died of metastatic renal cell carcinoma, while 6 died of unrelated causes. All of the latter 6 patients were free of renal cell carcinoma at death. Nephron sparing surgery combined occasionally with renal arterial reconstruction can yield gratifying results in this complex patient population.
肾细胞癌与肾动脉疾病并存是一个罕见且具有挑战性的问题。1969年至1991年，34例患者表现为局限性肾细胞癌和影响所有功能性肾实质的肾动脉疾病。这些患者分为4类：1）单肾合并肾细胞癌和肾动脉疾病（5例），2）双侧肾细胞癌合并肾动脉疾病（5例），3）单侧肾细胞癌合并对侧肾动脉疾病（13例），4）单侧肾细胞癌合并双侧肾动脉疾病（11例）。动脉粥样硬化是肾动脉疾病最常见的原因（30例），其次是中层纤维增生（2例）、肾动脉瘤（1例）和动静脉畸形（1例）。共有23例患者（68%）出现氮质血症（血清肌酐1.5mg./dl或更高），11例（32%）出现高血压。所有患者均接受了肾细胞癌的完整手术切除。优先进行保留肾单位手术（30例患者），双侧肾癌手术分期进行。8例患者同时进行了部分（6例）或根治性（2例）肾切除术及肾血管重建手术。无手术死亡病例。术后，33例患者肾功能得以保留，1例需要长期透析。平均随访47个月时，23例患者（68%）存活且无恶性肿瘤证据，2例存活但有复发性肾细胞癌。3例患者死于转移性肾细胞癌，6例死于无关原因。后6例患者死亡时均无肾细胞癌。在这一复杂患者群体中，保留肾单位手术偶尔联合肾动脉重建可取得令人满意的结果。
