乳头状肾细胞癌13例诊治体会

The diagnosis and treatment of 13 cases of papillary renal cell carcinoma

目的探讨乳头状肾细胞癌的临床特点，提高对其诊断、治疗及预后的认识。方法回顾性分析2001年1月至2009年1月收治的13例乳头状肾细胞癌患者的临床资料。所有患者均行超声、CT及静脉尿路造影（IVU）检查，4例行MRI检查。肿瘤直径2．6～11．0cm，平均（6．8±2．7）cm。10例行根治性肾切除术，3例行保留肾单位手术，术后均辅以免疫治疗。结果术后经病理证实均为乳头状肾细胞癌。13例患者均获得随访，随访时间4—42个月，平均26个月，1例于术后9个月死于脑血管意外，1例保留肾单位手术者于术后12个月局部复发，行根治性肾切除术，余均存活良好。结论乳头状肾细胞癌是一种特殊类型的肾细胞癌，临床表现和其他类型肾癌类似，影像学和病理学方面与其他类型肾癌有所不同。早期根治性肾切除术是首选的治疗方法，预后较好。

Objective To discuss the clinical feature of papillary renal cell carcinoma（PRCC） and improve the recognition of diagnosis,treatment and prognosis of PRCC. Methods The clinical data of 13 patients with PRCC who were treated from January 2001 to January 2009 were reviewed retrospectively. All patients were examined by ultrasound, CT and IVU, 4 cases were examined by MRI. The mean diameter of tumor was （6.8 ± 2.7） cm （2.6-11.0 cm）. Ten patients were performed radical nephrectomy, and 3 patients were performed nephron sparing surgery. All patients were performed adjuvant therapy of immunotherapy. Results Thirteen cases were proved to be PRCC by pathology. Alt cases were followed up for 4-42 months, mean 26 months, 1 died of cerebrovascular accident at 9 months after operation, 1 suffered from local recurrence at 12 mouths after operation and was performed radical nephrectomy, others tumor-free survived. Conclusions PRCC has unique clinicopathological features, which is a distinct entity. PRCC is similar to other renal cell carcinoma in clinical manifestation, but differs from other renal cell carcinoma in pathological morphology and biological behavior. Early radical surgery is the preferring treatment of PRCC. It has a better prognosis.