囊性肾癌的诊治及预后(附31例报告)

Diagnosis,treatment and prognosis of cystic renal cell carcinoma (report of 31 cases)

目的提高囊性肾癌的诊治水平,提高对于囊性肾癌的认识。方法回顾性分析1994年6月-2004年6月收治的31例囊性肾癌患者的流行病学、病理学、临床表现、影像学特征及临床治疗资料,并与TNM分期构成与囊性肾癌组相同的21例非囊性肾癌比较预后。结果囊性肾癌无特征性的临床表现,术前影像学检查可以提供诊断线索,经病理确诊肾癌囊性变19例,多囊性肾癌9例,单纯性囊肿癌变3例。17例行根治性肾切除术,14例行单纯性肾切除术。术后21例获得随访,生存时间平均38个月。总体上与非囊性肾癌的预后无统计学差异。结论囊性肾癌是一类在影像学和大体病理上具有囊性改变的肾癌的统称,由3种病理学类型构成,术前正确鉴别各亚型是选择手术方式和判断预后的关键。

Objective To assess the diagnosis, treatment and prognosis of cystic renal cell carcinoma （CRCC）. Methods The epidemic, pathologic, clinical and radiological features of 31 cases of CRCC were retrospectively analyzed. CRCC was categorized using World Health Organization Classification of Tumours（2002）. The prognosis was compared with non-cystic renal cell carcinoma of 21 cases with the same TNM classification. Results The clinical features of CRCC were similar to those of non-CRCCs. Histopathologic examination demonstrated 19 cases of renal cell carcinoma cystic degeneration, 9 multilocular cystic renal cell carcinoma and 3 preexisting simple cyst cancerization. 21 cases were followed. The mean followup period was 38 months （ranging from 4 to 118）. The prognosis of cystic renal cell carcinoma is no better than that of the nonCRCCs. Conclusion Composed of 3 histopathologic types, cystic renal cell carcinoma refers to any type of renal carcinomas with cystic features, which may be observed by the radiological exams or during the operation. Proper diagnosis of the subtype is the key to choosing the surgical treatment and to assessing the prognosis.