常规超声与超声造影在肾肿瘤伴静脉瘤栓“301分级系统”诊断中的临床应用研究

Clinical application of conventional and contrast-enhanced ultrasound in the diagnosis of renal tumor with venous thrombus by “301 classification” system

目的:探讨常规超声及超声造影在肾肿瘤伴静脉瘤栓"301分级系统"诊断中的临床应用价值。方法:回顾性分析2016年1月-2018年12月收治的80例肾肿瘤伴静脉瘤栓患者,其中男62例,女18例,年龄24~86岁,中位年龄55.5岁。肾脏肿瘤位于左侧30例,位于右侧50例。所有患者均在术前行常规超声并按照"301分级系统"进行分级,所有患者行超声造影检查以判断静脉瘤栓是否合并血栓。80例患者中,有19例术前接受靶向治疗,对该批患者分别进行常规超声及超声造影检查,对比治疗前后原发肿瘤的大小、静脉内瘤栓高度的变化和原发肿瘤及瘤栓内是否有坏死,评估术前靶向治疗的疗效。结果:按照常规超声结果,患者的"301分级"为0级(右)5例,0a级(左)4例,0b级(左)3例,Ⅰ级22例,Ⅱ级33例,Ⅲ级7例,Ⅳ级6例。超声造影结果显示12例腔静脉瘤栓患者合并血栓,其中血栓位于瘤栓近心端者4例,血栓位于远心端者8例。19例接受靶向治疗患者治疗后瘤栓最大径减小0.29~1.45 cm,平均0.35 cm,11例瘤栓高度明显降低,4例瘤栓降级,14例原发肿瘤和瘤栓内可见组织坏死。术后所有患者均恢复良好出院。术后病理检查结果提示透明细胞癌60例,乳头状细胞癌7例,血管平滑肌脂肪瘤4例,其余类型9例。结论:常规超声和超声造影对肾肿瘤合并静脉瘤栓的"301分级"诊断及对瘤栓与血栓鉴别诊断具有重要意义,并且对接受靶向治疗患者的疗效评估具有指导性意义。

objective:To explore the clinical value of conventional ultrasound and contrast-enhanced ultrasound in the diagnosis of renal tumors with venous thrombus by"301 classification system".Methods:A retrospective analysis was made on 80 cases of renal tumors with venous thrombus from January 2016 to December 2018.Among the 80 cases of renal tumors with venous thrombus,62 were males and 18 were females,with a median age of 55.5 years(24-86 years).There were 30 cases of renal tumors on the left and 50 cases on the right.All patients were examined by conventional ultrasound and contrast-enhanced ultrasound before operation.All patients were graded according to"301 classification system"by conventional ultrasound.By contrast-enhanced ultrasound,whether venous tumor thrombus combined with thrombus or not was judged.Nineteen of the 80 patients received preoperative targeted therapy,and these patients were examined by conventional ultrasound and contrast-enhanced ultrasound before and after treatment.The size of primary tumors,the height of intravenous tumor thrombus and the necrosis of primary tumors and tumor thrombus were compared before and after treatment,and the efficacy of preoperative targeted therapy was evaluated.Results:The patients were graded according to"301 classification system"by conventional ultrasound.There were 5 cases of grade 0(right),4 cases of grade 0 A(left),3 cases of grade 0b(left),22 cases of gradeⅠ,33 cases of gradeⅡ,7 cases of gradeⅢand 46 cases of gradeⅣ.By contrast-enhanced ultrasound,bland thrombus was found in 12 patients with vena cava tumor thrombus.The bland thrombus was located in the proximal end of the tumor thrombus in 4 cases and in the distal end of the tumor thrombus in 8 cases.Ultrasonography was performed on 19 patients receiving targeted therapy before and after treatment.The maximum diameter of tumor thrombus was reduced by 0.35 cm(0.29-1.45 cm),the height of tumor thrombus was reduced in 11 cases,the grade of tumor thrombus was reduced in 4 cases,and necrosis was seen in 14 cases of primary tumor and tumor thrombus.All patients recovered well and discharged after operation.Postoperative pathology revealed clear cell carcinoma in 60 cases,papillary cell carcinoma in 7 cases,angiomyolipoma in 4 cases and other types in 9 cases.Conclusion:Conventional ultrasound and contrast-enhanced ultrasound are of great significance in the diagnosis of renal tumors with venous tumor thrombus according to"301 classification system"and in the differential diagnosis of tumor thrombus and bland throm-bus,as well as in the evaluation of therapeutic effect for patients receiving targeted therapy.