肾腺瘤的临床诊治分析(附9例报告并文献复习)

Diagnosis and treatment of renal ademoma(Report of 9 cases and literature review)

目的:探讨肾腺瘤的临床及病理特点,提高对肾腺瘤的诊疗水平。方法:回顾性分析9例肾腺瘤患者的临床资料,复习相关文献并对本病的临床、病理特点及诊疗方式进行讨论。结果:所有病例均行超声、IVP、CT检查,其中IVP仅4例提示占位性病变,而超声、CT均误诊为肾癌,仅2例CT提示不除外肾腺瘤可能。临床表现2例有腰痛,1例有肉眼血尿,余6例为体检发现。9例均行肾癌根治性切除术,术后病理诊断均为肾腺瘤。其中7例镜下胞质内有大量红染嗜酸性颗粒诊断为嗜酸细胞腺瘤;1例镜下见肿瘤由密集小管(或腺泡)构成,瘤细胞小而一致,并可见肾小球样结构,诊断为后肾腺瘤;1例镜下可见乳头状腺样结构诊断为乳头状腺瘤。7例获随访,随访时间为6个月-5年,均未出现复发和转移,无瘤生存至今。结论:肾腺瘤分为乳头状腺瘤、嗜酸细胞腺瘤、后肾腺瘤3种类型。临床症状和体征、影像学表现均与肾癌相似,术前难定性,易误诊,临床上应提高认识,综合临床及影像学表现进行诊断。手术为首选治疗方法,保留肾单位手术应优先考虑,其预后良好,但应密切随访。

Objective：To investigate the diagnostic and therapeutic feature of renal adenoma.Methods： Clinical datas of 9 case of renal adenoma were retrospectively analyzed and review relative literature.Results：Ultrasound-B,IVP and CT scan were performed in all cases.Only 4 cases were diagnosed as renal tumor on IVP,all cases were misdiagnosed as renal carcinoma.On Ultrasound-B and CT,2 cases were suggested adenoma.Clinical feature was hematuria（1 case）,lumbago（2 cases）,others were found accidentally during physical examination with no symptoms.All cases were underwent radical nephrectomy,and proved to be renal adenoma by postoperative pathology.7 cases were oncocytoma,1 case was papillary adenoma,1 case was metanephric adenoma.All cases were followed up from 6 months to 5 years,and 9 cases survived without recurrence and metastasis.Conclusion： Renal adenomas were classified as 3 types,the papillary adenoma,oncocytoma,and metanephric adenoma.Renal adenoma is similar to renal cell carcinoma in clinical and image feature and often misdiagnosed before operation,so aggregate analysis should be given with imaging display（CT,IVP,Ultrasound） and clinical feature.Surgery is the optimal treatment,nephron-sparing surgery（NSS） should be first choice.The prognosis of renal adenoma is well and regular follow-up should be taken.