高密度肾囊肿诊治18例分析

The diagnosis and treatment of high-density renal cyst in 18 cases

目的探讨高密度肾囊肿的诊断和治疗。方法收集1996-2005年诊治高密度肾囊肿患者18例,12例无临床症状,体检偶然发现,4例因患侧腰部酸胀不适检查发现,2例因血尿就诊。所有患者B超检查均提示囊性占位。18例共有高密度肾囊肿20个,平均直径为3.5cm;平扫CT平均值42Hu(22-87Hu),增强CT有5个囊肿CT值升高,平均升高22Hu。该5例因囊肿强化接受手术治疗,余13例定期随访。结果5例手术患者中2例肾癌分别随访2年、4年,未见复发和转移;3例为单纯性高密度肾囊肿,B超随访1-6年未见囊肿复发。非手术治疗13例中8例随访2-8年,其中3例患者囊肿直径逐渐增加,5例患者囊肿未有明显变化。5例失访。结论高密度肾囊肿容易与肾脏实质性占位相混淆,CT检查是鉴别其性质的有效手段,但需要结合B超和MR的检查结果。当囊肿可以被增强并在延迟期有明显衰减,应该考虑实质性占位或囊性肾癌可能,积极手术治疗。

Objective To discuss the treatment and diagnosis of high density renal cyst. Methods Eighteen cases of 12 males and 6 females with high density renal cyst from 1996 - 2003 were analyzed. The age of 18 cases ranged from 33 - 67 years old with a mean age 49 years. There were no symptom in 14 cases with hematuria in 2 cases and indisposition in 4 cases. All patients underwent B ultrasoun- der examination and were found renal cyst with average diameter about 3.5cm. The average Hu unit was 42 in plain scan and elevated about 22 Hu after enhanced in 5 cases who underwent operation. Results Thirteen cases were followed up including 5 patients who received operation. Two cases of renal cell carcinoma were followed for 2 and 4 years with no recurrence and the other 3 cases with simple renal cyst had no recurrence for 1 - 6 years. The other 8 cases were followed up with B ultrasounder. The diameter of cyst increased in 3 cases and no changes were found in the other 5 cases. Conclusions CT is useful in the diagnosis of high density renal cyst which could be confused with renal cell carcinoma easily. The operation must be performed in the cases when the renal cyst was enhanced and attenuated easily.