囊性肾癌67例临床诊治分析  

Clinical analysis of cystic renal cell carcinoma ： a report of 67 cases

作　　者：徐立奇[2] 谢立平[1] 郑祥毅[1] 夏丹[1] 汪朔[1] 孟宏舟[1] 刘犇[1] 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003 [2]解放军第一一三医院泌尿外科

出　　处：《中华泌尿外科杂志》2014年第4期245-248,共4页Chinese Journal of Urology

基　　金：国家临床重点专科建设项目资助

摘　　要：目的 探讨囊性肾癌的诊断与治疗. 方法 回顾性分析2005年1月至2013年4月收治的67例囊性肾癌患者的临床表现、诊断方法、手术方式、病理结果及预后情况.患者术前影像学检查均提示为囊肿相关性肾占位,其中59例考虑恶性病变.术中行冷冻病理检查59例,其中56例报告为肾脏恶性病变,2例报告为肾囊肿,1例报告为多房性肾囊肿.67例中行开放根治性肾切除术19例;开放保留肾单位手术12例;后腹腔镜下根治性肾切除术9例;后腹腔镜下保留肾单位手术20例;先行后腹腔镜下肾囊肿去顶减压术,后行根治性肾切除术6例;先行后腹腔镜下保留肾单位手术,再行根治性肾切除术1例. 结果 67例术后病理报告均为肾脏恶性病变,其中肾透明细胞癌伴囊性变31例,多房囊性肾细胞癌36例.62例获随访,随访时间10～110个月,中位时间56个月;其中7例术前或术中诊断为良性病变,术后病理诊断为恶性病变患者均获随访,时间61～ 103个月,中位时间82个月.62例随访病例均未见肿瘤复发和转移. 结论 影像学检查对早期诊断囊性肾癌有帮助,术中可行冷冻病理检查.囊性肾癌的首选治疗方法为保留肾单位手术,预后良好.Objective To investigate the diagnosis and treatment of cystic renal cell carcinoma.Methods The clinical data of 67 cases of cystic renal cell carcinoma treated from January 2005 to April 2013 were analyzed retrospectively.Preoperative imaging procedures indicated masses of renal cysts in 67 cases,including malignant tumors in 59 cases.Intraoperative pathological examination was performed in 59 cases and the pathological results showed malignant tumors in 56 cases,renal cyst in 2 cases and multilocular cyst of kidney in 1 case.The surgical procedures included radical nephrectomy （n=19）,partial nephrectomy （n =12）,retroperitoneal laparoscopic radical nephrectomy （n =9）,retroperitoneal laparoscopic partial nephrectomy （n =20）,retroperitoneal laparoscopic cyst unroofed then transferred to radical nephrectomy （n =6）,and retroperitoneal laparoscopic partial nephrectomy transferred to radical nephrectomy （n =1）.Results The 67 cases were diagnosed as renal carcinoma,including clear renal cell carcinoma with cystic changes in 31 cases and multilocular renal cell carcinoma in 36 cases.Sixty-two cases were followed up for 10-110 months （median 56 months）,and there was no recurrence or metastasis,among which 7 cases diagnosed as benign pre-operation or intra-operation but malignant by pathological examination after surgery were followed up for 61-103 months （median 82 months）.Conclusions Imaging plays an important role in the early diagnosis of cystic renal cell carcinoma.Intraoperative pathological examination should be performed in suspected cases.Nephron-sparing surgery is preferred with good outcome.

关 键 词：癌 肾细胞 囊性 诊断 治疗 保留肾单位手术 

分 类 号：R737.11[医药卫生—肿瘤]