CAJ | 학술논문

目的提高肾脏良恶性肿块的诊断与鉴别诊断水平,降低误诊率,避免误切肾脏.方法肾良性肿块患者9例,男6例,女3例,年龄30～76岁,平均56岁.肾癌患者52例,男性40例,女性12例,其中透明细胞癌37例,乳头状癌10例以及嫌色细胞癌5例.术前均行CT平扫及三期增强扫描,比较肾脏良性肿块与肾癌的CT影像学特点.结果所有肾肿块性病变均经手术及病理证实.9例患者中8例按肾癌行根治术,1例行肿瘤剜除术,术后病理均为肾脏良性病变.其中少脂肪血管平滑肌脂肪(AML)4例、嗜酸细胞瘤2例、平滑肌瘤、炎性假瘤和囊肿伴血肿机化各1例.52例肾癌平扫呈均匀或不均匀的等、稍低、稍高或混杂密度；增强扫描肿瘤呈不均匀、均匀明显或不明显强化.结论 CT是肾脏良恶性肿块诊断与鉴别诊断中一种重要的影像学手段,对于影像学表现不典型良性肿块病变者,术前穿刺病理活检或术中冰冻病理切片是避免误诊及误切肾脏的关键,从而选择合适的治疗方案,避免不必要的肾根治性术.
목적 제고신장량악성종괴적진단여감별진단수평,강저오진솔,피면오절신장.방법 신량성종괴환자9례,남6례,녀3례,년령30～76세,평균56세.신암환자52례,남성40례,녀성12례,기중투명세포암37례,유두상암10례이급혐색세포암5례.술전균행CT평소급삼기증강소묘,비교신장량성종괴여신암적CT영상학특점.결과 소유신종괴성병변균경수술급병리증실.9례환자중8례안신암행근치술,1례행종류완제술,술후병리균위신장량성병변.기중소지방혈관평활기지방(AML)4례、기산세포류2례、평활기류、염성가류화낭종반혈종궤화각1례.52례신암평소정균균혹불균균적등、초저、초고혹혼잡밀도；증강소묘종류정불균균、균균명현혹불명현강화.결론 CT시신장량악성종괴진단여감별진단중일충중요적영상학수단,대우영상학표현불전형량성종괴병변자,술전천자병리활검혹술중빙동병리절편시피면오진급오절신장적관건,종이선택합괄적치료방안,피면불필요적신근치성술.
Objective To improve the level of diagnosis and differentiation of renal benign mass with renal cell carcinoma(RCC),so as to lower the misdiagnosis rate.Methods This study included 9 cases of benign renal mass,whose age ranged from 30 to 76 years with a mean of 54 years and included 52 patients with RCC.Three subtypes of RCC were noted,including clear cell in 37 cases,papillary RCC in 10 cases and chromophobe RCC in 5 cases.Plain scan and three phase CT(corticomedullary,nephrographic and excretory phases)were done in all patients.The CT features of RCC and benign mass were compared.Results All the cases were underwent radical nephrectomy as RCC,while they were postoperatively diagnosed as benign renal mass.There were 4 cases of angiomyolipoma (AML)with minimal fat,two cases of oncocytoma,one case of leiomyoma,one case of inflammatory pseudotumor,and one case of cyst with hematoma and organization.Fifty-two cases of RCC showed homogenous or inhomogeous,equal,slightly lower,slightly higher or mixed density on unenhanced scan,inhomogenous obvious enhancement after administration of contrast media.And the most obviously enhanced portion of renal carcinomas were isodense or slightly hyperdense relative to adjacent renal cortex in corticomedullary phase.Conclusion CT is an important radiologic approach to diagnose and differentially diagnose malignant or benign kidney mass.For those patients with benign mass that is not a typical case on radiology,the preoperative needle biopsy or intraoperative frozen section pathological diagnosis is the key to avoid misdiagnose and mistake resection of the kidney,and choose the proper treatment approach to avoid unnecessary kidney radical resection.