32例乳头状肾细胞癌临床诊治分析

The clinical analysis of 32 patients with papillary renal cell carcinoma

目的:分析总结乳头状肾细胞癌的临床特点.方法:回顾分析2008~2012年术后病理诊断为乳头状肾细胞癌的临床资料.结果:5年间乳头状肾细胞癌共32例,占同期肾细胞癌5.99%.其中男27例,女5例,年龄54.5(37~74)岁.就诊时10例腰痛,7例出现肉眼血尿,2例出现腰痛伴血尿,余无明显症状.25例行后腹腔镜手术,7例行开放手术治疗,两组手术时间无显著区别,但腹腔镜组平均术中出血量显著低于开放手术组.肿瘤平均最大径为5.1 cm.T1aN0M0 12例,T1bN0M0 15例,T2aN0M0 3例,T1bN1M0 1例,T3aN0M1 1例.24例获随访,随访时间9~46个月,均无瘤生存.结论:乳头状肾细胞癌好发于男性,与肾透明细胞癌对比,在临床表现上无明显差异,但影像学表现、病理形态及临床转归有所不同.根治性肾切除术是目前首选治疗方式,腹腔镜手术与开放手术治疗效果相似,微创优势显著.本病预后较好.

Objective:To investigate the clinical features of papillary renal cell carcinoma(PRCC).Methods:Retrospective analysis of the clinical data of patients with PRCC in our hospital from 2008to 2012.Results:There are 32 patients confirmed as PRCC by post-operative pathology,which account for 5.99%of all patients with renal cell carcinomas in the five years.27patients are male,5patients are female.The mean age was 54.5years(ranged from 37 to 74).10patients presented with lumbago,7with gross hematuria,2with both lumbago and hematuria,the rest are.25patients were treated with laparoscopic surgery and 7were treated with open surgery,with the similar mean operative time.The mean operative blood loss is significant less in laparoscopic surgery group than in the open surgery group.The average maximum diameter of tumors was 5.1cm.TNM stage:T1aN0M0in 12patients,T1bN0M0 in 15,T2aN0M0in 3,T1bN1M0in 1,and T3aN0M1in 1.24patients were followed up for 9-46months.All of them survived without tumor recurrent.Conclusions:Papillary renal cell carcinoma has similar clinical features with renal clear cell carcinoma,but it has special imaging and pathological characteristics,and a better prognosis.The gold treatment of PRCC is radical nephrectomy.The laparoscopic surgery has similar treatment efficacy to open surgery, but with significant micro-invasive advantages.