肾细胞癌271例临床分析

Clinical analysis of renal cell carcinoma： report of 271 cases

目的探讨肾细胞癌的诊治方法。方法1993年1月至2000年12月共收治肾细胞癌患者271例，对诊断方法、治疗手段、随访及预后进行回顾性分析。结果B超、CT仍为主要的诊断方法。手术治疗234例患者，其中行根治性肾切除术197例（72．6％），保留肾单位手术19例；转移瘤切除术6例；其他手术12例。病理结果：透明细胞癌137例，占61．4％（137／223）、颗粒细胞癌18例（8．1％）、混合细胞癌32例（14．3％）、乳头状腺癌23例（10．3％），其他13例。210例患者（77．5％）获得随访。1、3、5、10年生存率分别为95．3％（182／191）、88．7％（107／122）、74．7％（56／75）和32．1％（10／31）。结论B超是检测肾细胞癌的首选检查方法，CT为最有价值诊断方法。提高肾细胞癌远期生存率最关键的因素是早期发现、早期行肾癌根治术或保留肾单位的肾癌切除术。

Objective To study the diagnosis and treatment of renal cell carcinoma. Method From January 1993 to December 2000 the data of 271 cases of renal cell carcinoma were reviewed. Results Uhrasonography and CT scanning were still the main diagnostic methods. Surgical operation was performed on 234 patients. Radical nephrectomy was performed on 197 patients （72.6%）; Nephron sparing surgery was performed on 19 patients; Metastatic tumor rectomy was performed on 6 patients and other procedures for 12. The pathological results showed that 137 cases （61.4%） were clear cell carcinoma, 18 cases （8. 1% ） of granular cell carcinoma, 32 cases （14. 3% ） being combination of the above two varieties, 23 cases （10. 3% ） of renal papillary adenocarcinoma, 13 cases being renal cell of other types. And 210 cases （77.5%） had been successfully followed up. The I, 3, 5 and 10 year survival rates were 95.3% （ 182/ 191）, 88.7% （107/122）, 74.7% （56/75） and 32. 1% （10/31） respectively. Conclusions Uhrasonography is the first select examination method of detecting of renal cell carcinoma, and CT scanning is the most valuable diagnostic mean. Early diagnosis and prompt radical nephrectomy or nephron sparing nephrectomy are the critical points for achieving long-term survivals of patients with renal cell carcinoma.