CAJ | 학술논문

目的探讨囊性肾癌的诊断与治疗. 方法回顾性分析2005年1月至2013年4月收治的67例囊性肾癌患者的临床表现、诊断方法、手术方式、病理结果及预后情况.患者术前影像学检查均提示为囊肿相关性肾占位,其中59例考虑恶性病变.术中行冷冻病理检查59例,其中56例报告为肾脏恶性病变,2例报告为肾囊肿,1例报告为多房性肾囊肿.67例中行开放根治性肾切除术19例;开放保留肾单位手术12例;后腹腔镜下根治性肾切除术9例;后腹腔镜下保留肾单位手术20例;先行后腹腔镜下肾囊肿去顶减压术,后行根治性肾切除术6例;先行后腹腔镜下保留肾单位手术,再行根治性肾切除术1例. 结果 67例术后病理报告均为肾脏恶性病变,其中肾透明细胞癌伴囊性变31例,多房囊性肾细胞癌36例.62例获随访,随访时间10～110个月,中位时间56个月;其中7例术前或术中诊断为良性病变,术后病理诊断为恶性病变患者均获随访,时间61～ 103个月,中位时间82个月.62例随访病例均未见肿瘤复发和转移. 结论影像学检查对早期诊断囊性肾癌有帮助,术中可行冷冻病理检查.囊性肾癌的首选治疗方法为保留肾单位手术,预后良好.
목적 탐토낭성신암적진단여치료. 방법 회고성분석2005년1월지2013년4월수치적67례낭성신암환자적림상표현、진단방법、수술방식、병리결과급예후정황.환자술전영상학검사균제시위낭종상관성신점위,기중59례고필악성병변.술중행냉동병리검사59례,기중56례보고위신장악성병변,2례보고위신낭종,1례보고위다방성신낭종.67례중행개방근치성신절제술19례;개방보류신단위수술12례;후복강경하근치성신절제술9례;후복강경하보류신단위수술20례;선행후복강경하신낭종거정감압술,후행근치성신절제술6례;선행후복강경하보류신단위수술,재행근치성신절제술1례. 결과 67례술후병리보고균위신장악성병변,기중신투명세포암반낭성변31례,다방낭성신세포암36례.62례획수방,수방시간10～110개월,중위시간56개월;기중7례술전혹술중진단위량성병변,술후병리진단위악성병변환자균획수방,시간61～ 103개월,중위시간82개월.62례수방병례균미견종류복발화전이. 결론 영상학검사대조기진단낭성신암유방조,술중가행냉동병리검사.낭성신암적수선치료방법위보류신단위수술,예후량호.
Objective To investigate the diagnosis and treatment of cystic renal cell carcinoma.Methods The clinical data of 67 cases of cystic renal cell carcinoma treated from January 2005 to April 2013 were analyzed retrospectively.Preoperative imaging procedures indicated masses of renal cysts in 67 cases,including malignant tumors in 59 cases.Intraoperative pathological examination was performed in 59 cases and the pathological results showed malignant tumors in 56 cases,renal cyst in 2 cases and multilocular cyst of kidney in 1 case.The surgical procedures included radical nephrectomy (n=19),partial nephrectomy (n =12),retroperitoneal laparoscopic radical nephrectomy (n =9),retroperitoneal laparoscopic partial nephrectomy (n =20),retroperitoneal laparoscopic cyst unroofed then transferred to radical nephrectomy (n =6),and retroperitoneal laparoscopic partial nephrectomy transferred to radical nephrectomy (n =1).Results The 67 cases were diagnosed as renal carcinoma,including clear renal cell carcinoma with cystic changes in 31 cases and multilocular renal cell carcinoma in 36 cases.Sixty-two cases were followed up for 10-110 months (median 56 months),and there was no recurrence or metastasis,among which 7 cases diagnosed as benign pre-operation or intra-operation but malignant by pathological examination after surgery were followed up for 61-103 months (median 82 months).Conclusions Imaging plays an important role in the early diagnosis of cystic renal cell carcinoma.Intraoperative pathological examination should be performed in suspected cases.Nephron-sparing surgery is preferred with good outcome.