囊性肾癌10年43例诊治分析  

Management of 43 cystic renal cell carcinomas in 10 years

作　　者：秦晓健[1] 张海梁[1] 叶定伟[1] 戴波[1] 朱耀[1] 施国海[1] 沈益君[1] 朱一平[1] 马春光[1] 肖文军[1] 林国文[1] 曹达龙[1] 

机构地区：[1]复旦大学附属肿瘤医院泌尿外科复旦大学上海医学院肿瘤学系, 上海200032

出　　处：《中华泌尿外科杂志》2014年第6期422-424,共3页Chinese Journal of Urology

摘　　要：目的 报道囊性肾癌的大宗病例长期随访结果,介绍诊治经验. 方法 回顾性分析2002年9月至2012年9月诊治的43例囊性肾癌病例.16例术前经CT或MRI影像学诊断为单纯囊肿,囊肿去顶减压术后病理诊断为癌,其中15例在初次术后2个月内行补充性肾切除,1例选择密切随访;27例为影像学检查诊断复杂囊肿接受手术,其中20例为体检发现的单纯肾囊肿,B超复查发现变异为复杂囊肿后再行手术. 结果 术后病理确认43例均为Ⅰ～Ⅱ期肾透明细胞癌,肿瘤分级Ⅰ～Ⅱ级本组所有单纯囊肿的复杂变异均明确为恶性.在囊肿去顶减压发现的囊性肾癌中,15例行补充肾切除,其中8例发现有癌残留;1例选择密切随访的病例术后96个月无复发43例患者随访12～ 132个月,中位时间48个月 无复发及转移病例. 结论 单纯肾囊肿存在癌变可能,单纯囊肿的复杂变异多为恶性 及时的手术治疗后,囊性肾癌的预后良好.Objective To present a cohort of cystic renal cell carcinoma （CRCC） with long-term follow up,and share our experience in the management of this disease.Methods From September 2002 to September 2012,43 cases of CRCC were treated.Among these patients,16 cases was diagnosed as simple renal cyst （SRC） by CT scan or MRI prior to operation,and malignant tumors were detected by pathological analysis following cyst decortications.Fifteen of them received supplementary nephrectomy within 2 months,whereas 1 patient underwent active surveillance.The other 27 patients underwent surgical treatment because CT or MRI confirmed complicated renal cysts,of which 20 cases were followed up once as SRC and monitored by uhrasound about every 6 months,until complicated variation of SRC was confirmed.Median follow up was 48 months （12 to 132 months）.Results Pathological studies confirmed stage Ⅰ to Ⅱ clear cell RCC in all 43 cases,with Fuhrman grade Ⅰ to Ⅱ.Especially,complicated variation of SRC universally turned out to be malignant.In decortication-detected malignancies,supplementary nephrectomy detected residual tumor in 8 out of 15 cases.There were no local recurrence or metastases during follow up,including the patient who chose active surveillance for 96 months.Conclusions RCC may be incidentally detected in SRC,and more attention should be paid to complicated variation of SRC during surveillance due to the extremely high probability of malignancy.Prognosis is good for CRCC with timely surgical treatment.

关 键 词：囊性肾癌 预后 诊断 治疗 

分 类 号：R737.11[医药卫生—肿瘤]