肾脏小肿块的诊断和治疗(附80例报告)

Diagnosis and Treatment of Small Renal Mass (Report of 80 Cases)

目的:提高实性或复杂性囊性肾脏小肿块(SRM)的诊断与治疗水平。方法:回顾性分析80例经B超、CT或MRI证实为实性或复杂性囊性SRM患者的临床资料:实性SRM患者75例,BosniakⅢ级、Ⅳ级囊性SRM患者各3例和2例。良性SRM患者12例,怀疑恶性SRM患者68例,其中行开放根治性肾切除术、腹腔镜根治性肾切除术和开放性保留肾单位手术各52例、5例和11例。对12例良性SRM患者及4例术后病理检查证实为良性者每6～12个月随访1次;对术后病理检查证实为恶性者64例术后每3～6个月密切随访1次,连续3年,以后每年1次。结果:对12例良性SRM患者及4例术后病理检查证实为良性者密切随访未见肿块明显增大、复发或恶变;68例怀疑为恶性SRM患者中,术后病理检查确诊者64例,随访62例无肿瘤复发或转移,1例术后30个月出现肿瘤复发,1例术后16个月死于肿瘤转移。结论:明确SRM的良、恶性,对恶性SRM患者采取合适的治疗方法,仍然是临床处理SRM的关键。

Objective： To improve the diagnosis and treatment of small solid or complex cystic renal masses. Methods： Clinical data of 80 patients of small solid or complex cystic renal masses founded by ultrasonography, CT or MRI were reviewed. Including 75 solid masses, 3 cystic masses（Bosniak class Ⅲ）, 2 cystic masses（Bosniak class Ⅳ）. 12 cases were benign, 68 cases were considered as malignant, 52 cases were operated by open radical nephrectomy, 5 by laparoscopic radical nephrectomy, 11 by nephron sparing surgery. We follow up the benign cases every 6 to 12 months,and follow up the malignant cases every 3 to 6 months in the＇near 3 years and then once every year. Results：The renal mass wasn＇t enlargement obviously or recurrence or canceration to the 16 benign cases after close follow up. To 64 malignant cases were certified by the pathology after operation, 62 of them are alive without tumor recurrence or metastasis, one was recurrenced 30 months after operation, and one died of tumor metastasis 16 months. ＂Conclusions：The key of the clinical-management of the small renal mass involves distinguishing benign small renal masses from those likely to be malignant and determining the appropriate treatment of malignant masses.