单中心偶发肾癌与症状肾癌的临床诊疗分析  

Clinical analysis of incidental vs. symptomatic renal cell carcinoma:a single center experience

作　　者：徐磊[1] 王伟[2] 姚世杰[2] 徐子强[2] 马洪顺[2] 郝晓明[1] 

机构地区：[1]天津医科大学一中心临床学院,天津300070 [2]天津市第一中心医院泌尿外科,天津300192

出　　处：《现代泌尿外科杂志》2016年第11期848-852,共5页Journal of Modern Urology

摘　　要：目的分析并比较偶发肾癌与症状肾癌的临床诊疗特点,探讨两者预后有无差异,阐述早期检出肾癌的重要意义。方法回顾性分析2007年1月1日至2016年2月29日收治于我科的354例肾癌患者的临床资料,根据发现肾肿瘤的方式分为偶发肾癌组(n=217)和症状肾癌组(n=137),统计两组患者的病历资料,比较两组在临床特点、诊断方法、治疗方式及生存率上的差异。结果本组病例中偶发肾癌占全部肾癌的61.30%,健康体检是发现偶发肾癌的主要原因,而B超是发现肾占位的主要检查手段;两组患者在性别、年龄、糖尿病病史、吸烟史、身体质量指数(BMI)、肿瘤病理类型、肿瘤侧别和位置上差异无统计学意义(P>0.05);而在住院天数、高血压病史、肿瘤大小、肿瘤病理分期、分级、手术切除率、手术方式及范围上差异有统计学意义(P<0.05)。偶发肾癌组患者术后3年、5年、7年生存率分别为87.62%、77.78%及66.67%,均高于同期症状肾癌组,差异有统计学意义(P<0.05)。结论与症状肾癌相比,偶发肾癌具有肿瘤体积小、临床分期低、手术切除率高及预后好等特点,且检出率呈逐年增加趋势,因此早期发现肾癌对提高患者生活质量及生存率十分重要,B超作为一种无创、经济的筛查方法发挥了重要作用,健康查体有助于肾癌的筛查。ObjectiveTo analyze the clinical characteristics, diagnosis, treatment and prognosis of incidental renal cell carcinoma （IRCC） and symptomatic renal cell carcinoma （SRCC）, and to explore the significance of early detection of renal cell carcinoma. MethodsClinical data of 354 cases of renal cell carcinoma treated in our hospital during Jan. 2007 and Feb. 2016 were retrospectively analyzed. The patients were divided into two groups according to the clinical symptoms：IRCC group （n=217） and SRCC group （n=137）. The medical records were evaluated. ResultsThe incidence of IRCC was 61.30%, and there was an upward tendency of the rate from 2007 to 2015. IRCC cases were detected mainly by physical examinations, especially by B-ultrasound. There were no significant differences between the two groups in gender, age, diabetes, smoking history, BMI, tumor pathological type, side and location of tumor （P〉0.05）. There were statistically significances in hospital stay, hypertension, tumor size, pathological stage, pathological grading, resectability and surgical approach （P〈0.05）. The overall 3, 5 and 7-year survival rates in the IRCC group was 87.62%, 77.78% and 66.67%, respectively, and they were 73.91%, 63.16% and 57.69% respectively in the SRCC group. There was statistical difference between the two groups （P〈0.05）.ConclusionsThe incidence of IRCC is on the rise in recent years. Compared with the SRCC, IRCC has the characteristics of smaller size, lower stage and grade, higher resectability and better prognosis, thus the early detection is very important to improve patients＇ life quality and survival rate. B-ultrasound as a noninvasive, economic screening method has played an important role, and health examination contributes to the detection of early stage renal cell carcinoma.

关 键 词：偶发肾癌 临床诊疗 症状 高血压病史 手术切除率 身体质量指数 P>0.05 早期检出 

分 类 号：R737.11[医药卫生—肿瘤]