肾脏偶发性小占位病变的诊治分析

Diagnosis and management of small renal masses

目的 探讨直径〈3cm的肾脏小占位病变的常见类型、影像学特征和常规诊疗步骤。方法 回顾性分析1998年1月至2005年10月间偶然发现的58例〈3cm的肾脏占位病变的临床资料。结果 58例患者共发现肾脏占位病变70个。直径〈1cm的占位病变5个，1～2cm为11个，2～3cm为54个。B超发现囊性占位36个，实质性占位34个，其中高回声占位21个，等回声占位4个，低回声占位9个。增强CT明显强化的病变19个，轻度强化20个，无明显强化31个。首诊时B超结合CT获确诊54例，未能确诊的4例，MRI、肾动脉造影及穿刺活检亦不确切。结论 对〈3cm的肾脏占位病变，B超结合CT检查可基本满足鉴别诊断的需要。少数诊断不确切的病例，腹腔镜肾部分切除术兼有诊断和治疗作用。手术耐受力差或不接受手术探查的未能确诊的患者可考虑影像学密切随访。

Purpose To evaluate category and imaging characteristics of small （〈3 cm） renal masses. Clinical routine of diagnosis and management were also discussed. Methods Retrospective study was conducted on the diagnosis and management of 58 cases presented with small renal masses incidentally discovered form Jan 1998 to Oct 2005. Results Of 70 masses found in 58 patients, 5 were less than 1 cm, 11 were 1-2 cm and 54 were 2-3 cm. Through ultrasound examination, 36 cystic and 34 solid renal masses were identified. Of solid masses, 21 were hyperechogenic, 4 were isoechogenic and 9 were hypoechogenic. Significant enhancement of CT value was found in 19 masses after contrast materials injection, slight enhancement in 20 masses and no enhancement in 31 masses. Totally 54 cases were diagnosed accurately by ultrasound and CT, 4 cases were not diagnosed by ultrasound, CT, MRI or combination. Conclusions Combination with ultrasound and CT obtained satisfying outcomes for diagnosis of small renal masses. Laparoscopic nephron-sparing nephrectomy should be considered as the first choice for patients with indeterminate diagnosis. Alternatively, closely imaging fol- lowing-up could be a choice for patients with bad general conditions and those who rejected operations.