CAJ | 학술논문

目的探讨BosniakⅡ类和Ⅲ类囊肿的治疗原则. 方法 2005-2008年手术治疗BosniakⅡ类和Ⅲ类囊肿68例,其中男48例,女20例；年龄23～ 78岁,平均40岁.病变位于左侧37例,右侧31例；病变直径2.1 ～9.5 cm,平均5.1 cm.BosniakⅡ类囊肿31例,其中ⅡF 13例,Ⅲ类囊肿37例.术前诊断为良性病变49例,行肾囊肿去顶减压术,其中5例术中冰冻切片提示恶性病变行根治性肾切除,4例术后病理切片提示恶性病变行二期根治性肾切除.术前诊断为恶性病变19例,其中行肾部分切除术14例,一期行根治性肾切除5例. 结果 68例患者中,病理报告恶性病变21例(30.9％),良性病变47例(69.1％).BosniakⅡ类囊肿中恶性病变3例(9.7％),Ⅲ类囊肿中恶性病变18例(48.6％).术前诊断为良性病变而病理诊断为恶性病变行根治性肾切除9例(18.4％,9/49),术前诊断为恶性病变而术后病理诊断为良性7例(36.8％,7/19).42例患者获随访,随访时间8 ～ 65个月,平均31个月.其中恶性病变15例,良性病变27例.恶性病变患者术后1～4年出现肿瘤复发和(或)转移3例,良性病变术后2～5年出现复发性囊肿6例. 结论 BosniakⅡ类和Ⅲ类囊肿手术时应尽可能行部分肾切除,也可以将囊肿完全切除后行冰冻切片,因为仅取部分囊壁组织有可能漏诊其他部位的恶性病变.
목적 탐토BosniakⅡ류화Ⅲ류낭종적치료원칙. 방법 2005-2008년수술치료BosniakⅡ류화Ⅲ류낭종68례,기중남48례,녀20례；년령23～ 78세,평균40세.병변위우좌측37례,우측31례；병변직경2.1 ～9.5 cm,평균5.1 cm.BosniakⅡ류낭종31례,기중ⅡF 13례,Ⅲ류낭종37례.술전진단위량성병변49례,행신낭종거정감압술,기중5례술중빙동절편제시악성병변행근치성신절제,4례술후병리절편제시악성병변행이기근치성신절제.술전진단위악성병변19례,기중행신부분절제술14례,일기행근치성신절제5례. 결과 68례환자중,병리보고악성병변21례(30.9％),량성병변47례(69.1％).BosniakⅡ류낭종중악성병변3례(9.7％),Ⅲ류낭종중악성병변18례(48.6％).술전진단위량성병변이병리진단위악성병변행근치성신절제9례(18.4％,9/49),술전진단위악성병변이술후병리진단위량성7례(36.8％,7/19).42례환자획수방,수방시간8 ～ 65개월,평균31개월.기중악성병변15례,량성병변27례.악성병변환자술후1～4년출현종류복발화(혹)전이3례,량성병변술후2～5년출현복발성낭종6례. 결론 BosniakⅡ류화Ⅲ류낭종수술시응진가능행부분신절제,야가이장낭종완전절제후행빙동절편,인위부취부분낭벽조직유가능루진기타부위적악성병변.
Objective To reassess the treatment of Bosniak category Ⅱ-Ⅲ renal cyst.Methods Sixty-eight cases of Bosniak category Ⅱ-Ⅲ renal cyst were operated from 2005 to 2008 in our institute.The average patient age was 40 years with the average renal cyst diameter of 5.1 cm.There were 37 left lesions and 31 right lesions with 31 cases of category Ⅱ (including 13 cases of category Ⅱ F) and 37 cases of category Ⅲ.Renal unroofing were performed in 49 cases with 9 cases found malignant and followed by radical nephrectomy,19 cases were diagnosed as malignancy preoperatively and nephron sparing surgery or radical nephrectomy were performed in these cases.Results Malignant lesions were found in 21 cases and benign lesions were found in 47 cases.The malignant rate was 9.7％ in category Ⅱ (15.4％ in category Ⅱ F),48.6％ in category Ⅲ.Nine cases were diagnosed benign preoperatively but confirmed malignancy after operation; 7 cases were diagnosed malignancy preoperatively but confirmed benign after operation.Forty-two cases were followed up for 8-65 months with 15 cases of malignancy and 27 cases of benign lesions.The recurrence of renal cyst occurred in 6 cases of benign lesions and recurrence and metastasis occurred in 3 cases of malignancy in 1-5 years.Conclusions It is difficult to draw a therapeutic principle for Bosniak category Ⅱ-Ⅲ renal cyst because of the uncertainty of the lesion.Partial nephrectomy or renal cystectomy is a good choice in the treatment of Bosniak category Ⅱ-Ⅲ renal cysts.