中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2011年
11期
750-753
,共4页
肾肿瘤%病理学,外科%冷冻切片%诊断%肾切除术
腎腫瘤%病理學,外科%冷凍切片%診斷%腎切除術
신종류%병이학,외과%냉동절편%진단%신절제술
Kidney neoplasms%Pathology,surgical%Frozen sections%Diagnosis%Nephrectomy
目的 探讨术中快速冷冻切片病理检查对肾脏占位性病变性质的诊断价值以及在术中确定相应手术方式中的作用. 方法 2006年1月至2010年12月行术中快速冷冻切片病理检查的肾脏占位性病变患者195例.男114例,女81例.年龄17 ～78岁,平均52岁.病变位于右肾104例,左肾89例,双肾2例.体检发现129例,有临床症状66例.占位病变长径≤4.0 cm者128例,4.1 ～7.0 cm者49例,＞7.0 cm者18例.比较术中快速病理和术后常规石蜡切片病理的诊断结果.肾肿瘤患者行肾切除术或肾部分切除术,比较两组患者术中快速病理诊断结果. 结果 术中快速病理诊断结果为透明细胞癌115例,乳头状细胞癌2例,嫌色细胞癌2例,肾腺癌12例,恶性肾肿瘤1例,未分化癌1例,良性肾肿瘤47例,肾囊肿8例,尿路上皮癌7例.术后石蜡切片病理诊断结果为透明细胞癌122例,乳头状细胞癌8例,嫌色细胞癌6例,肉瘤样癌2例,肾母细胞瘤1例,良性肾肿瘤41例,肾囊肿8例,尿路上皮癌7例.术中快速病理检查诊断肾脏恶性病变的敏感性为96.6％,特异性100.0％,良恶性诊断准确率为97.4％.病理亚型诊断符合率分别为透明细胞癌94.3％,乳头状细胞癌25.0％,嫌色细胞癌16.7％,肉瘤样癌和肾母细胞瘤0,良性肿瘤97.6％,尿路上皮癌100.0％.180例肾肿瘤患者中57例行肾部分切除术,123例行肾切除术.两组肿瘤最长径≤4.0 cm患者分别占80.7％ (46/57)和62.6％(77/123),差异有统计学意义(P=0.015);两组快速病理诊断为恶性病变患者分别占31.6％(18/57)和93.5％(115/123),差异有统计学意义(P＜0.001). 结论 术中快速冷冻切片病理检查诊断肾脏恶性病变的敏感性、特异性和准确率高;病理亚型中,肾脏透明细胞癌和尿路上皮癌的诊断符合率高.手术方式的选择与肾脏肿瘤大小和术中快速冷冻切片病理结果有关.
目的 探討術中快速冷凍切片病理檢查對腎髒佔位性病變性質的診斷價值以及在術中確定相應手術方式中的作用. 方法 2006年1月至2010年12月行術中快速冷凍切片病理檢查的腎髒佔位性病變患者195例.男114例,女81例.年齡17 ～78歲,平均52歲.病變位于右腎104例,左腎89例,雙腎2例.體檢髮現129例,有臨床癥狀66例.佔位病變長徑≤4.0 cm者128例,4.1 ～7.0 cm者49例,＞7.0 cm者18例.比較術中快速病理和術後常規石蠟切片病理的診斷結果.腎腫瘤患者行腎切除術或腎部分切除術,比較兩組患者術中快速病理診斷結果. 結果 術中快速病理診斷結果為透明細胞癌115例,乳頭狀細胞癌2例,嫌色細胞癌2例,腎腺癌12例,噁性腎腫瘤1例,未分化癌1例,良性腎腫瘤47例,腎囊腫8例,尿路上皮癌7例.術後石蠟切片病理診斷結果為透明細胞癌122例,乳頭狀細胞癌8例,嫌色細胞癌6例,肉瘤樣癌2例,腎母細胞瘤1例,良性腎腫瘤41例,腎囊腫8例,尿路上皮癌7例.術中快速病理檢查診斷腎髒噁性病變的敏感性為96.6％,特異性100.0％,良噁性診斷準確率為97.4％.病理亞型診斷符閤率分彆為透明細胞癌94.3％,乳頭狀細胞癌25.0％,嫌色細胞癌16.7％,肉瘤樣癌和腎母細胞瘤0,良性腫瘤97.6％,尿路上皮癌100.0％.180例腎腫瘤患者中57例行腎部分切除術,123例行腎切除術.兩組腫瘤最長徑≤4.0 cm患者分彆佔80.7％ (46/57)和62.6％(77/123),差異有統計學意義(P=0.015);兩組快速病理診斷為噁性病變患者分彆佔31.6％(18/57)和93.5％(115/123),差異有統計學意義(P＜0.001). 結論 術中快速冷凍切片病理檢查診斷腎髒噁性病變的敏感性、特異性和準確率高;病理亞型中,腎髒透明細胞癌和尿路上皮癌的診斷符閤率高.手術方式的選擇與腎髒腫瘤大小和術中快速冷凍切片病理結果有關.
목적 탐토술중쾌속냉동절편병리검사대신장점위성병변성질적진단개치이급재술중학정상응수술방식중적작용. 방법 2006년1월지2010년12월행술중쾌속냉동절편병리검사적신장점위성병변환자195례.남114례,녀81례.년령17 ～78세,평균52세.병변위우우신104례,좌신89례,쌍신2례.체검발현129례,유림상증상66례.점위병변장경≤4.0 cm자128례,4.1 ～7.0 cm자49례,＞7.0 cm자18례.비교술중쾌속병리화술후상규석사절편병리적진단결과.신종류환자행신절제술혹신부분절제술,비교량조환자술중쾌속병리진단결과. 결과 술중쾌속병리진단결과위투명세포암115례,유두상세포암2례,혐색세포암2례,신선암12례,악성신종류1례,미분화암1례,량성신종류47례,신낭종8례,뇨로상피암7례.술후석사절편병리진단결과위투명세포암122례,유두상세포암8례,혐색세포암6례,육류양암2례,신모세포류1례,량성신종류41례,신낭종8례,뇨로상피암7례.술중쾌속병리검사진단신장악성병변적민감성위96.6％,특이성100.0％,량악성진단준학솔위97.4％.병리아형진단부합솔분별위투명세포암94.3％,유두상세포암25.0％,혐색세포암16.7％,육류양암화신모세포류0,량성종류97.6％,뇨로상피암100.0％.180례신종류환자중57례행신부분절제술,123례행신절제술.량조종류최장경≤4.0 cm환자분별점80.7％ (46/57)화62.6％(77/123),차이유통계학의의(P=0.015);량조쾌속병리진단위악성병변환자분별점31.6％(18/57)화93.5％(115/123),차이유통계학의의(P＜0.001). 결론 술중쾌속냉동절편병리검사진단신장악성병변적민감성、특이성화준학솔고;병리아형중,신장투명세포암화뇨로상피암적진단부합솔고.수술방식적선택여신장종류대소화술중쾌속냉동절편병리결과유관.
Objective To evaluate the value of intraoperative frozen section examination (IFS) in the diagnosis and surgical procedures selection for renal occupying lesions. Methods From January 2006 to December 2010,IFS was used in 114 men and 81 women with renal occupying lesions.The mean age was 52 years (range 17 -78).In 104,89,and 2 patients,lesions were in the right,left and bilateral kidneys,respectively.All patients underwent physical examination,129 were asymptomatic at presentation while clinical symptoms were observed in 66.The largest dimension of the tumors were 4 cm or less in 128 patients,4- 7 cm in 49,and larger than 7 cm in 18,respectively.The outcomes between IFS and postoperative routine paraffin section examination were compared.In cases with renal tumors nephrectomy or partial nephrectomy was performed.The results of IFS were compared between the 2 groups. Results The sensitivity and specificity of IFS for renal malignant lesions was 96.6％ and 100％,respectively.The total accuracy rate of IFS for renal occupying lesions was 97.4％.By subgroup analysis,the accuracy rate of clear cell carcinoma,papillary cell carcinoma,chromophobe cell carcinoma,sarcomatoid cancer,nephroblastoma,benign tumor and urothelial cancer was 94.3％,25.0％,16.7％,0,0,97.6％ and 100.0％,respectively.Partial nephrectomy and nephrectomy were performed in 57 and 123 patients with renal tumors,respectively.The surgical procedures selection was significantly associated with the lesion size (4 cm or less for 80.7％ vs 62.6％,P =0.015) and the malignant lesion diagnosed by IFS (31.6％ vs 93.5％,P＜0.001). Conclusion The accuracy of frozen section analysis for renal malignant lesions during surgery is reliable and significantly high,and the results can exert an important impact on surgical procedures selection.
