肾静脉癌栓术前漏诊的临床特点分析  

The clinical characteristic analysis of preoperative misdiagnosis of renal vein tumor thrombus in renal cell carcinoma

作　　者：江卫星 寿建忠 曹传振 康向朋 毕新刚 张瑾 肖振东 李长岭 马建辉 Jiang Weixing;Shou Jianzhong;Cao Chuanzhen;Kang Xiangpeng;Bi Xingang;Zhang Jin;Xiao Zhendong;Li Changling;Ma Jianhui(Department of Urology,National Cancer Center,National Clinical Research Center For Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Image,National Cancer Center,National Clinical Research Center For Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院泌尿外科,北京100021 [2]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院影像科,北京100021

出　　处：《中华泌尿外科杂志》2019年第2期86-90,共5页Chinese Journal of Urology

摘　　要：目的 分析术前肾静脉癌栓漏诊病例的临床特点,以提高术前诊断准确率。 方法 回顾性分析2000年1月至2015年9月我院收治的128例肾癌伴肾静脉癌栓患者的临床资料,根据术前是否漏诊肾静脉癌栓将患者分为漏诊组(39例)和未漏诊组(89例),以2015年1—6月收治的病理确诊的无肾静脉癌栓的40例肾癌患者为无癌栓组。漏诊组男29例,女10例;年龄(61.4±11.1)岁;体重指数(26.74±3.12)kg/m^2;卡氏功能状态(KPS)评分<80分2例;副瘤综合征1例;癌栓Mayo分级0级。未漏诊组男74例,女15例;年龄(60.2±9.7)岁;体重指数(25.12±1.93)kg/m^2;KPS评分<80分5例;副瘤综合征7例;癌栓Mayo分级0级。无癌栓组男31例,女9例;年龄(59.5±10.7)岁;体重指数(24.48±2.56)kg/m^2;KPS评分<80分3例;副瘤综合征3例。漏诊组与未漏诊组、漏诊组与无癌栓组患者一般资料的比较差异均无统计学意义(P>0.05)。比较漏诊组与未漏诊组、漏诊组与无癌栓组患者肿瘤位置、肿瘤直径、影像学相关数据资料等。 结果 漏诊组和未漏诊组患者肾脏中部肿瘤比例[56.4%(22/39)与38.2%(34/89)]、肿瘤周围侧支静脉血管比例[33.3%(13/39)与31.5%(28/89)]和CT检查肾静脉造影剂充盈不佳比例[42.9%(9/21)与61.8%(21/34)],差异均无统计学意义(P>0.05)。漏诊组和无癌栓组比较结果显示,漏诊组肾肿瘤位于肾腔中部的患者比例、肾肿瘤周围有侧支静脉血管患者比例及肾静脉造影剂充盈不佳比例均明显高于无癌栓组 [30.0%(12/40),P=0.018;10.0%(4/40),P=0.012;16.7%(4/24),P=0.002]。 结论 肾癌肾静脉癌栓易漏诊,术前患者如存在肾脏中部肿瘤、肾静脉造影剂充盈不佳、肾肿瘤侧支静脉血管应警惕合并癌栓的可能性,临床上应提高认识。Objective To improve the accuracy of preoperative diagnosis of renal vein tumor thrombus in renal cell carcinoma (RCC), the clinical characteristics of RCC with misdiagnosis of renal vein tumor thrombus (RVTT) were analyzed.Methods Clinical data of 128 patients with RCC accompanied with RVTT from January 2000 to September 2015 were studied retrospectively. According to whether RVTT failed to be detected preoperatively, all patients were divided into 39 cases of misdiagnosis group and 89 cases of no misdiagnosis group. Forty cases of RCC with pathologically confirmed no RVTT were selected as no tumor thrombus group from January 2015 to June 2015. Misdiagnosis group included 29 males and 10 females, with age of (61.4±11.1) years old, body mass index of (26.74±3.12) kg/m^2, KPS<80 in 2 cases, paraneoplastic syndrome and Mayo grade 0 in 1 case. No misdiagnosis group consisted of 74 males and 15 females, with age of (60.2±9.7) years old, body mass index of (25.12±1.93) kg/m^2, KPS<80 in 5 cases, paraneoplastic syndrome and Mayo grade 0 in 7 cases. No tumor thrombus group comprised of 31 males and 9 females, with age of (59.5±10.7) years old, body mass index of (24.48±2.56) kg/m^2, KPS<80 in 3 cases, and paraneoplastic syndrome in 3 cases. There was no significant difference in general clinical data between misdiagnosis group and no misdiagnosis group, and misdiagnosis group and no tumor thrombus group (P>0.05). The tumor location, tumor diameter and imaging data were compared between misdiagnosis group and no misdiagnosis group, and misdiagnosis group and no tumor thrombus group.Results There was no significant difference in term of tumor locating in the middle pole [56.4% (22/39) vs. 38.2% (34/89)], tumor with collateral vessels [33.3% (13/39) vs. 31.5% (28/89)] and renal vein contrast agents filling defect [42.9% (9/21) vs. 61.8% (21/34)] between misdiagnosis group and no misdiagnosis group (P>0.05). The proportion of renal tumor locating in the middle pole, tumor with collateral vessels and renal vein contras

关 键 词：肾癌 癌栓 肾静脉 漏诊 

分 类 号：R737.11[医药卫生—肿瘤]