行根治性肾切除术治疗肾转移性恶性肿瘤六例  

Radical nephrectomy for renal metastatic malignant neoplasms:a report of 6 cases

作　　者：王辉清[1] 刘亚巍 许传亮[1] 杨波[1] 张振声[1] 高旭[1] 侯建国[1] 汤昊[3] 孙颖浩[1] 

机构地区：[1]上海长海医院泌尿外科,上海200433 [2]总参警卫局卫生保健处 [3]南京军区总医院

出　　处：《上海医学》2013年第7期626-629,I0002,共5页Shanghai Medical Journal

摘　　要：目的为进一步提高肾转移性恶性肿瘤的诊治水平提供参考。方法回顾性分析6例肾转移性恶性肿瘤患者的诊断和治疗情况,男4例,女2例,年龄43~65岁,平均年龄为（53±10）岁。原发肿瘤分别为支气管肺鳞癌3例、胃腺癌1例、急性粒细胞性白血病1例和肝癌1例,分别于原发病手术治疗后5~41个月内经B超检查偶然发现肾脏转移性病灶,病程中患者均无肉眼血尿和其他不适症状。6例患者均行根治性肾切除术,术前均经B超、CT或磁共振（MRI）检查,均未行细针穿刺活组织检查（FNAB）。肿瘤大小为3.5cm×4.2cm至6.0cm×8.5cm。其中1例患者B超检查示肾脏实性低回声占位;CT检查示肾脏等密度影,增强期明显强化,可见假包膜影;术前诊断为肾癌。5例患者B超检查示肾脏区边界不清楚的团块,呈低回声,内部回声不均匀;CT检查示肾脏肿块多数呈少或无外凸,弥漫浸润生长,密度不均,边界不清,增强后出现轻度强化,并与周围肾脏组织边界不清,无包膜,有＂毛刺样＂改变;术前诊断为肾转移性鳞癌。结果手术过程均顺利,术中出血量50~800mL,平均出血量为（250±173）mL,均未输血。6例患者术后均诊断为肾转移性恶性肿瘤,均无手术并发症发生,于术后7~10d出院。除1例肝癌患者外,其余5例患者均根据原发病行相应的化疗。随访2~36个月,1例急性粒细胞性白血病肾转移患者失访,3例支气管肺鳞癌和1例胃腺癌患者均死亡（术后存活时间为7~15个月）,1例肝癌肾转移患者术后2个月尚在随访中。结论虽然恶性肿瘤患者一旦出现肾转移,其生存期相当有限,但对于原发性肿瘤的转移仅局限于肾脏的患者,采取根治性肾切除术治疗并进一步明确肾脏肿瘤的性质还是具有一定意义的。Objective To provide reference for the diagnosis and treatment of malignant tumor metastatic to the kidney.Methods The clinical data of 6patients with renal metastatic neoplasms were retrospectively analyzed.There were 4men and 2women with an average age of（53±10）years（range,43-65years）.Primary tumors：bronchiogenic cancer in 3cases,gastric cancer,acute granulocytic leukemia,and hepatocellular carcinoma each in one case.All metastatic neoplasms were found accidentally in kidney by B-ultrasound 5months to 41months after primary tumor treatment.No patients had any symptoms,such as hematuria.They underwent radical nephrectomy and were detected by B ultrasound,CT or MRI preoperatively,but received no fine needle aspiration biopsy（FNAB）.The tumor size ranged from 3.5cm×4.2cm to 6.0cm×8.5cm.In one case,Bultrasound showed renal solid hypoechoic mass,and CT showed kidney bottom density image which was strengthened significantly during enhanced stage and pseudocapsule.Preoperative diagnosis was renal cell carcinoma.In the other 5cases,B-ultrasound showed uneven hypoechoic masses with unclear border,and CT showed diffused infiltrative growth,uneven density,strengthened lightly in the kidney mass,and no capsule with glitch.Preoperative diagnosis was metastatic renal squamous cell carcinoma.Results Surgical operation went smoothly.The mean intraoperative blood loss was（250±173）mL（range,50-800mL）.Postoperative diagnosis was renal metastatic neoplasm in all the 6patients.No patient received blood transfusion and all of them,gained good recovery and were discharged 7-10days after surgery.All patients received chemotherapy except for the case with hepatocellular carcinoma.Five patients had been followed up for 2months to 3years,and 4patients died（3 with bronchiogenic cancer and 1 with gastric adenocarcinoma,postoperative survival time：7-15 months）.One patient with acute granulocytic leukemia was lost.Conclusion Although survival time is very short in the patients with renal metastatic malignant neo

关 键 词：肾转移性恶性肿瘤 诊断 治疗 

分 类 号：R737.11[医药卫生—肿瘤]