长期血透患者获得性囊性肾病合并肾癌8例报告并文献复习  

Acquired cystic kidney disease associated renal cell carcinoma in long-term hemodialysis patients: report of 8 cases and review of literature

作　　者：陈恕求[1] 陈明[1] 张晓文[1] 柳靖[1] 胡向农[1] 杨瑜[1] 高明[2] 

机构地区：[1]东南大学附属中大医院泌尿外科,南京210009 [2]东南大学附属中大医院肾脏内科

出　　处：《临床泌尿外科杂志》2012年第1期33-35,共3页Journal of Clinical Urology

摘　　要：目的:学习长期血透患者获得性囊性肾病合并肾癌的筛查和诊治方法。方法:回顾性分析我院维持性血透获得性囊性肾病合并肾癌患者8例,均为B超和CT诊断为双肾多发性囊肿合并肾实质性占位,并行后腹腔镜下根治性肾切除术,术后维持规律性血透,并严密随访。结果:长期血透患者226例,获得性囊性肾病105例(46.5%),获得性囊性肾病合并肾癌8例(3.5%),在获得性囊性肾病中发生率为7.6%(8/105),其中男5例,女3例,年龄(58.6±16.4)岁,血透(12.2±6.9)年。8例患者(9次)行后腹腔镜下根治性肾切除术,手术均成功,出血(45.2±20.3)ml,手术时间(72.5±20.3)min,无严重手术并发症,术后病理3例为透明细胞癌和6例为乳头状癌。住院天数为(7.5±2.4)d。随访12～63个月,无瘤存活5例。结论:肾癌在获得性囊性肾病患者中发病率高,随着血透患者寿命的延长,血透3年后需重视和建立肾癌筛查机制,腹腔镜下根治性肾切除术安全有效、恢复快,并注重患者心脑血管疾病及糖尿病等并发症的积极治疗,有助于进一步延长血透患者寿命。Objective： To summarize the screening, diagnosis and therapy of acquired cystic kidney disease （ACKD）associated renal cell carcinoma（RCC）in long-term hemodialysis patients. Method： Retrospective analysis 8 cases of ACKD associated RCC. All patients underwent abdominal ultrasound and CT scanning for hematuria or low back pain or periodical systemic screening. CT scanning showed multiple cystic in both kidneys and a tumor in one or two kidneys. 8 patients underwent laparoscopic radical nephrectomy for renal tumor. Result：Total of 226 pa- tients,including 105 cases of ACDK（46.5%） ,and RCC were detected in 8 cases of all patients（3.5G） and of 105 patients with ACDK （7.6%）, 1 of 8 patients was bilateral RCC. The RCC patients underwent hemodialysis for （12.2±6.9） years. 5 cases of male and 3 cases of female,mean age （58.6± 16.4） years. 9 cases of RCC underwent laparoscopic radical nephrectomy successfully, and operative time was （72.5 ± 20.3） minutes and the estimated blooding loss was （45.2±20.3） milliliters. 9 cases of tumor confirmed clear cell carcinoma（3 cases） and papillary eareinoma（6 cases）by pathological examination. The mean hospital stay was （7.5 ± 2.4） days. Follow up ranged from 12 to 63 months. Five patients survived free of tumor recurrence. Conclusion：The incidence of RCC is higher in ACKD in long-term hemodialysis patients than in rest of the population,and with the prolonged lifetime of he- modialysis patients,it is important to pay attention to RCC screening of 2〉3 years hemodialysis patients. Laparo- scopic radical nephreetomy is safety for RCC patients with ACKD.

关 键 词：肾癌 血透 获得性囊性肾病 筛查 

分 类 号：R737.11[医药卫生—肿瘤]