青少年肾细胞癌14例报告  

Renal cell carcinoma in adolescents (report of 14 cases)

作　　者：仓晨[1] 郭剑明[1] 张立[1] 张正望[1] 张永康[1] 王国民[1] 

机构地区：[1]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《中华泌尿外科杂志》2005年第9期588-589,共2页Chinese Journal of Urology

摘　　要：目的提高青少年肾细胞癌的诊断和治疗水平.方法1992-2004年收治20岁以下青少年肾细胞癌患者14例.男8例,女6例.年龄10～20岁,平均17岁.血尿8例,腰部疼痛6例,腹部肿块5例,发热3例,消瘦2例,尿路刺激症状1例,贫血、乏力1例.14例均行B超、KUB加IVU和CT检查.肿块直径2.5～13.0 cm,≤3.0 cm者2例,4.0～10.0 cm者10例,＞10.0 cm者2例.术前Robson分期:Ⅰ期2例,Ⅱ期7例,Ⅲ期4例,Ⅳ期1例.14例均行肾癌根治术,8例术后行免疫治疗.结果病理诊断透明细胞癌11例,颗粒细胞癌2例,混合型癌1例.11例随访1～9年,术后2年内死亡2例,其中1例Robson分期Ⅲ期,肿块直径10.0 cm,病理为颗粒细胞癌,另1例Robson分期Ⅳ期,肿块直径13.0 cm,病理为混合型癌.余9例均无瘤存活,包括8例术后行免疫治疗者.结论对有肾癌相关症状的青少年宜尽早行影像学检查.根治术是青少年肾细胞癌的标准治疗手段,术后联合免疫治疗可提高生存率.预后与病理类型、肿瘤分期密切相关.Objective To improve the diagnosis and treatment of renal cell carcinoma in adolescents. Methods The data of 14 cases of renal cell carcinoma under the age of 20 years from 1992 to 2004 were analyzed retrospectively. There were 8 males and 6 females; their mean age was 17 years （age range, 10-20 years）. The clinical presentation was as follows： hematuria in 8 cases, low back pain in 6, abdominal mass in 5, fever in 3, pathologic leanness in 2, urinary irritation in 1, and anemia and hypodynamia in 1. All the cases underwent B-ultrasonography, KUB plus IVU and CT examination. The tumors ranged 2.5-13.0 cm in diameter, specifically, ≤3.0 cm in 2 cases, 4.0-10.0 cm in 10 cases, and〉10.0 cm in 2 cases. Preoperative Robson staging showed stage Ⅰ tumor in 2 cases, stage Ⅱ in 7 cases, stage Ⅲ in 4 cases, and stage Ⅳ in 1 case. All the 14 cases underwent radical nephrectomy; of them 8 cases received immunotherapy postoperatively. Results Eleven cases were pathologically diagnosed as clear cell carcinoma, 2 cases as granular cell carcinoma, 1 case as mixed cell carcinoma. Of the 14 cases, 11 were followed up for 1-9 years. Two of them died within 2 years after operation. Of the 2, one case had granular cell carcinoma （Robson stage Ⅲ, tumor diameter of 10.0 cm）; the other had mixed cell carcinoma （Robson stage Ⅳ, tumor diameter of 13.0 cm）. The remaining 9 cases were alive and free of tumor, including 8 cases who underwent postoperative immunotherapy. Conclusions It is recommended that imaging examinations should be done as earlier as possible in adolescents who have renal cancer related symptoms. Radical nephrectomy remains a standard therapy for this disease. Combined immunotherapy after surgery can improve survival rate. Prognosis is closely related with pathological types and clinical stages.

关 键 词：肾肿瘤 青少年 肾细胞癌 Robson分期 肾癌根治术 颗粒细胞癌 腹部肿块 病理诊断 尿路刺激症状 免疫治疗 

分 类 号：R737.11[医药卫生—肿瘤] R737.110.6[医药卫生—临床医学]