CAJ | 학술논문

目的：探讨后肾腺瘤的临床特点及治疗方法,以提高对该病的诊断和治疗水平。方法回顾性分析我院泌尿外科2011年1月至2014年6月连续收治的8例后肾腺瘤病例,并记录其临床症状、实验室检查、影像学资料、手术方式、术后病理检查结果及随访结果。同时利用 PubMed数据库搜索相关文献进行综合分析和总结。结果8例中,男性3例,女性5例,年龄21~71岁；5例患者体检时发现,3例因腰痛就诊。肿瘤位于左肾5例,右肾2例,双肾1例。4例患者施行了保留肾单位的肿瘤剜除或微波消融手术,2例患者施行了后腹腔镜肾肿瘤根治性切除术,另2例患者施行了开放性肾肿瘤根治性切除加邻近器官联合切除术。6例术后病理检查肿瘤直径为1.5~5.2 cm,报告为后肾腺瘤；施行开放手术的2例术后病理检查肿瘤直径为6.0~11.4 cm,报告为后肾腺瘤合并肉瘤样癌,同时有邻近器官转移。结论后肾腺瘤是一种临床上罕见的肾脏肿瘤性病变,影像学上不易与肾脏恶性肿瘤性病变区分。如肾脏占位合并有红细胞增多症者应高度怀疑后肾腺瘤可能,可在术前进行肿瘤穿刺活检以明确诊断。后肾腺瘤一般体积较小,预后较好,治疗方法优先考虑行保留肾单位的肾部分切除术,也可选择如肿瘤冷冻、微波消融等微创治疗方法。如果肿瘤最大直径超过6.0 cm,合并肉瘤样癌的可能性大大增加,其预后极差,应优先考虑行根治性肾肿瘤切除术。
목적：탐토후신선류적림상특점급치료방법,이제고대해병적진단화치료수평。방법회고성분석아원비뇨외과2011년1월지2014년6월련속수치적8례후신선류병례,병기록기림상증상、실험실검사、영상학자료、수술방식、술후병리검사결과급수방결과。동시이용 PubMed수거고수색상관문헌진행종합분석화총결。결과8례중,남성3례,녀성5례,년령21~71세；5례환자체검시발현,3례인요통취진。종류위우좌신5례,우신2례,쌍신1례。4례환자시행료보류신단위적종류완제혹미파소융수술,2례환자시행료후복강경신종류근치성절제술,령2례환자시행료개방성신종류근치성절제가린근기관연합절제술。6례술후병리검사종류직경위1.5~5.2 cm,보고위후신선류；시행개방수술적2례술후병리검사종류직경위6.0~11.4 cm,보고위후신선류합병육류양암,동시유린근기관전이。결론후신선류시일충림상상한견적신장종류성병변,영상학상불역여신장악성종류성병변구분。여신장점위합병유홍세포증다증자응고도부의후신선류가능,가재술전진행종류천자활검이명학진단。후신선류일반체적교소,예후교호,치료방법우선고필행보류신단위적신부분절제술,야가선택여종류냉동、미파소융등미창치료방법。여과종류최대직경초과6.0 cm,합병육류양암적가능성대대증가,기예후겁차,응우선고필행근치성신종류절제술。
Objective To explore the clinic characteristics of metanephric adenoma (MA),in order to improve our understanding of this disease. Methods We retrospectively summarized clinical data of 8 cases of MA from January 2011 to June 2014 in our hospital.Information of all patients with MA was col-lected and analyzed including their symptoms,laboratory examinations,imaging studies,surgical proce-dures and pathological data,and related articles were retrieved to analyze the clinic characters of MA. Re-sults There were three male and five female patients and their age ranged from 2 1 to 7 1 .Three of them had flank pain and others were found asymptomatically.Seven of them were found MA unilaterally,other one patient was found bilaterally.Four patients had nephron sparing surgery or microwave ablation,other two patients had retroperitoneal laparoscopic nephrectomy and the rest two had combined kidney and viscera organ resection.Of all cases,six were pathologically confirmed as MA with the maximum diameter ranging from 1 .5 to 5 .2 cm,while other two patients were reported as MA combined with sarcomatoid carcinoma with the maximum diameter ranging from 6 .0 to 1 1 .4 cm. Conclusions MA is a rare renal tumor which is difficult to identify from renal cancers.The renal tumor in patient with polycythemia may suggest the di-agnosis of MA.After confirmation by ultrasound-guided core-needle biopsy,conservative treatment by par-tial nephrectomy can be performed as a priority,while cryotherapy and microwave ablation can also be se-lected.However,radical nephrectomy should be performed when the tumor size is greater than 6 .0 cm.