CAJ | 학술논문

目的报道囊性肾癌的大宗病例长期随访结果,介绍诊治经验. 方法回顾性分析2002年9月至2012年9月诊治的43例囊性肾癌病例.16例术前经CT或MRI影像学诊断为单纯囊肿,囊肿去顶减压术后病理诊断为癌,其中15例在初次术后2个月内行补充性肾切除,1例选择密切随访;27例为影像学检查诊断复杂囊肿接受手术,其中20例为体检发现的单纯肾囊肿,B超复查发现变异为复杂囊肿后再行手术. 结果术后病理确认43例均为Ⅰ～Ⅱ期肾透明细胞癌,肿瘤分级Ⅰ～Ⅱ级本组所有单纯囊肿的复杂变异均明确为恶性.在囊肿去顶减压发现的囊性肾癌中,15例行补充肾切除,其中8例发现有癌残留;1例选择密切随访的病例术后96个月无复发43例患者随访12～ 132个月,中位时间48个月无复发及转移病例. 结论单纯肾囊肿存在癌变可能,单纯囊肿的复杂变异多为恶性及时的手术治疗后,囊性肾癌的预后良好.
목적 보도낭성신암적대종병례장기수방결과,개소진치경험. 방법 회고성분석2002년9월지2012년9월진치적43례낭성신암병례.16례술전경CT혹MRI영상학진단위단순낭종,낭종거정감압술후병리진단위암,기중15례재초차술후2개월내행보충성신절제,1례선택밀절수방;27례위영상학검사진단복잡낭종접수수술,기중20례위체검발현적단순신낭종,B초복사발현변이위복잡낭종후재행수술. 결과 술후병리학인43례균위Ⅰ～Ⅱ기신투명세포암,종류분급Ⅰ～Ⅱ급본조소유단순낭종적복잡변이균명학위악성.재낭종거정감압발현적낭성신암중,15례행보충신절제,기중8례발현유암잔류;1례선택밀절수방적병례술후96개월무복발43례환자수방12～ 132개월,중위시간48개월 무복발급전이병례. 결론 단순신낭종존재암변가능,단순낭종적복잡변이다위악성 급시적수술치료후,낭성신암적예후량호.
Objective To present a cohort of cystic renal cell carcinoma (CRCC) with long-term follow up,and share our experience in the management of this disease.Methods From September 2002 to September 2012,43 cases of CRCC were treated.Among these patients,16 cases was diagnosed as simple renal cyst (SRC) by CT scan or MRI prior to operation,and malignant tumors were detected by pathological analysis following cyst decortications.Fifteen of them received supplementary nephrectomy within 2 months,whereas 1 patient underwent active surveillance.The other 27 patients underwent surgical treatment because CT or MRI confirmed complicated renal cysts,of which 20 cases were followed up once as SRC and monitored by uhrasound about every 6 months,until complicated variation of SRC was confirmed.Median follow up was 48 months (12 to 132 months).Results Pathological studies confirmed stage Ⅰ to Ⅱ clear cell RCC in all 43 cases,with Fuhrman grade Ⅰ to Ⅱ.Especially,complicated variation of SRC universally turned out to be malignant.In decortication-detected malignancies,supplementary nephrectomy detected residual tumor in 8 out of 15 cases.There were no local recurrence or metastases during follow up,including the patient who chose active surveillance for 96 months.Conclusions RCC may be incidentally detected in SRC,and more attention should be paid to complicated variation of SRC during surveillance due to the extremely high probability of malignancy.Prognosis is good for CRCC with timely surgical treatment.