21例囊性肾癌的诊治和随访结果分析

Diagnosis and treatment of cystic renal cell carcinoma:a study of 21 cases with long-term followup

目的：增加对囊性。肾癌真实发病率和生物学行为的认识，提高术前诊断准确性。方法：回顾性分析1997年5月～2007年5月收治的所有。肾癌中存在囊性成分病例的临床特点、影像学表现、手术治疗方式的选择、病理特点以及随访的情况。结果：以囊性成分所占体积不少于肿瘤总体的75％为入选标准，筛选出21例囊性肾癌（22个病灶，其中病例17为双侧病变），占所有肾癌总数（312例）的6．7％，患者平均年龄为47．3岁（30岁到77岁）．4处病灶行。肾部分切除术（18．2％）．18处病灶行肾癌根治术（81．8％）；按病理分期T1期16例（76．2％），T2期5例（23．8％），T3期1例（4．8％）；按Bosniak分类，Ⅱ类4例（18．2％），Ⅲ类12例（54．5％），IV类6例（27．3％）。术后随访平均39．0个月（2～110个月，中位数33个月），除1例因术后心脏合并症死亡外，余20例（95．2％）均生存，没有肿瘤复发和转移。结论：囊性肾癌是一种少见的临床病理亚型，Bosniak分类能在一定程度上提高术前诊断的准确性，手术切除特别是保留肾单位手术能有效地治疗囊性肾癌，临床预后很好。

Objective： The true incidence of cystic renal cell carcinoma and its biologic behavior is not well known. To prompt accuracy of cystic renal cell carcinoma before operations. Methods：We reviewed all files of renal cell carcinoma with a cystic component in our hospital from May 1997 to May 2007,and analyzing their conditions of clinical characteristics, imaging characteristics, operative choices, histopathologic characteristics and followup. Results：We identified 21 cases of cystic renal cell carcinoma （22 lesions,case 17 with bilateral leslons）with 75% or greater involvement by cyst comprising 6.70% of all renal cell carcinoma cases resected in our hospital from 1997 to 2007. Main patients age was 47.3 years （range 30 to 77 ）. 4 focuses （18.2%） were taken nephron spar- ing surgery. 18 lesions （81.8%）were taken radical nephrectomy. According to TNM staging system, there were 16 cases （76.2%） in Tl, 5 cases in T2 and 1 case in T3. According to Bosniak classification, there were 4 cases （18.20%） in category lI ,12 cases （54.5%） in category Ⅲ and 6 cases （27.3%） in category IV. Mean followup was 39.0 months （range2 to 110,median 33）. All patients was survived with no evidence of cancer （95.2%） except 1 patient died due to cardiac complication. Conclusions：Cystic renal cell carcinoma is uncommon subtype and has a well prognosis. Bosniak classification can be useful to prompt the accuracy of diagnosis before operations. These patients may be cured by resection especially nephron sparing surgery.