52例BosniakⅡ类肾囊性病变的治疗策略探讨  

Therapeutic strategy of Bosniak category II renal cyst： a report of 52 cases

作　　者：梅方[1] 秦勇[1] 顾海[1] 刘渊[1] 王杭[2] 

机构地区：[1]杭州市红十字会医院泌尿外科,310003 [2]复旦大学附属中山医院泌尿外科

出　　处：《中华医学杂志》2013年第24期1897-1899,共3页National Medical Journal of China

摘　　要：目的探讨BosniakⅡ类肾囊性病变的临床治疗策略。方法收集2004至2011年行手术治疗的52例BosniakⅡ类肾囊性病变患者的资料，对其治疗及病理诊断结果进行回顾性分析。52例患者中男32例，女20例；平均年龄48岁。病变位于左侧25例，右侧23例，双侧4例；病变直径2．5～9．5cm，平均4．7cm。其中IIF类28例，非IIF类24例。结果47例患者行肾囊肿去顶减压术；5例行肾根治性切除术。5例中4例患者行肾囊肿去顶减压术中冰冻切片提示恶性，一期行患肾根治性切除；1例患者术后病理提示为恶性病变，二次手术行肾根治性切除。术后均行病理检查，5例为肾恶性肿瘤，均为肾透明细胞癌，病变恶变率为9．6％（5／52）；其中ⅡF类中恶性病变4例，恶变率为14．3％（4／28），非ⅡF类中恶性病变1例，恶变率为4．2％（1／24）。43例患者获得随访，其中恶性病变4例，良性病变39例；随访时间1～8年。恶性病变患者中1例术后3年出现肿瘤肺转移，经免疫治疗及靶向治疗后病情稳定；良性病变患者中9例术后2—5年出现囊肿复发。结论对BosniakⅡ类囊肿的处理应该遵循个体化原则，对于直径〉5em的Ⅱ类以及ⅡF类囊肿应该积极手术治疗，对于年轻的Ⅱ类囊肿患者应密切随访。Objective To evaluate the therapeutic strategy of Bosniak category II renal cyst. Methods A total of 52 cases of Bosniak category II renal cyst underwent surgery from 2004 to 2011. There were 32 males and 20 females with a mean age of 48 years. Their average diameter of renal cysts was 4. 7 cm. There were 25 left, 23 right and 4 bilateral lesions. Results Renal cystectomy （ n = 47 ） and radical nephrectomy （ n = 5 ） were performed. Four cases of renal cyst with cystectomy had malignancy confirmed with intraoperative frozen section and underwent radical nephrectomy immediately. One case underwent radical nephrectomy in second stage because of a confirmation of malignant renal cyst after cystectomy. Malignant renal cyst were found in 5 cases and benign lesions in 47. The malignancy rate was 9. 6% （5/52）with 14. 3% （4/28）in II F group and 4. 2% （1/24）in non-II F group. Forty-three cases were followed up for 1 - 8 years with 4 cases of malignancy and 39 cases of benign lesions. One case of malignancy had pulmonary metastasis at 3 years post-operation. Conclusions Operation should be performed in II F renal cyst and II cyst with a diameter of 〉 5 cm. Follow-ups should be performed in other category II renal cysts, especially in young patients.

关 键 词：肾疾病 囊性 外科手术 Bosniak分类 恶性肿瘤 

分 类 号：R692[医药卫生—泌尿科学]