肾脏偶发瘤诊治体会

The diagnosis and treatment of incidentally detected tumor of the kidney

目的提高肾脏偶发瘤的术前诊断率和手术治愈率。方法回顾性分析66例。肾脏偶发瘤患者的术前影像学特点诊断、治疗方法及预后。患者中男40例，女26例；年龄33—67岁，平均52岁。均因体检或行临近器官检查发现肿瘤。肿瘤位于左肾36例，右肾30例。肿瘤直径1．2—4．8cm，其中〉3．0cm者4例。结果66例患者中肾癌36例，行肾癌根治术30例，肾切除术6例；肾错构瘤24例，肾囊肿6例，均行手术治疗。B超诊断肾癌26例，准确率72．2％；CT诊断32例，准确率88．9％。结论肾脏偶发瘤的术前诊断是关键，影像学检查对术前诊断的意义最大。术中可疑病例应行冰冻病理检查，以提高肿瘤的手术治愈率，偶发肾癌的术式选择应根据患者的具体情况决定。

Objective To improve the preoperative diagnosis and cure rate of incidentally detected tumor of the kidney. Methods The imaging characteristics, diagnosis and treatment as well as prognosis of66 patients （40 men and 26 women） with incidental tumor of the kidney were retrospectively analyzed. The patient age ranged from 33 to 67 years with a mean of 52 years. Of these cases,36 had tumor on the left and 30,on the right. Results Of the 66 patients,36 had renal carcinoma （for them radical nephrectomy was performed in 30 cases and nephrectomy in 6） ,24 had hamartoma of the kidney and 6 had renal cyst. They all underwent surgery. Among the 36 renal carcinoma patients,26 cases were diagnosed correctly by Bultrasound with an accuracy of 72.2% ,and 32 cases were diagnosed correctly by CT with an accuracy of 88. 9%. Conclusions For the treatment of incidentally detected tumor of the kidney, diagnosis is the key. Imaging examinations are of the most importance,especially for preventing the missed diagnosis of renal carcinoma. Intraoperatively,the suspected case should be checked with frozen sections to increase the curative rate. The choice of surgical modality should be determined based on individual case.