超声诊断无症状肾细胞癌和小肾细胞癌91例临床分析

Asymptomatic and small renal cell carcinoma detected by real-time ultrasound:an analysis of ninety-one cases

目的 评价实时超声在早期发现无症状性肾细胞癌 (RCC)和小RCC(直径≤ 3cm )中的作用。方法 将 91例经手术和病理证实的住院患者进行分析并分为两组。A组 :5 5例无症状RCC ,由超声普查首先发现 ;B组 :36例症状性RCC ,首先由门诊超声检查发现。CT、MR、血管造影、尿路造影等进一步检查均在超声检查之后进行。结果 ①无症状性RCC多于症状性RCC ,分别占 6 0 .4%和 39.6 % (P <0 .0 1)。②小RCC仅有 19例 ,A组中占 15例 ,B组中 4例。但小RCC术后预后好 ,无 1例转移。 19例全部生存至今 ,平均 5 .6年 (1～ 13年 )。A组无症状性肾癌的转移发生率 (7.5 % )低于B组 (2 1.8% ) ,病死率分别为 5 .3 %和 2 5 .0 % (P <0 .0 1)。2例小RCC超声误诊为血管平滑肌脂肪瘤 ,CT检查给予及时纠正。结论 实时超声是筛查早期无症状性肾癌 ,包括小RCC的较有效方法。超声联合CT等其他影像检查有助于对RCC进一步诊断。RCC超声普查技术的改进尚有待于进一步研究。

Objective To evaluate the role of real time ultrasound (US) in earlier detection of asymptomatic renal cell carcinoma (RCC) and small RCC (≤3 cm). Methods Ninety one consecutive patients with RCC confirmed by surgery and pathology were analyzed retrospectively. Of them, 55 patients detected first by US in mass screening were asymptomatic(group A), and 36 patients detected first by US in our clinic were symptomatic(group B). Other examinations such as CT, MR, angiography and/or urography (IVP) were performed for further diagnosis after US.Results The asymptomatic patients with RCC (55,groupA) were more than symptomatic ones,the former was 60.4% and the latter was 39.6% respectively in total patients (P< 0.01 ). The small RCC(≤3 cm) were only 19 cases (15 in group A, 4 in group B). However, their prognosis was extremely good after surgery and none of them (0/19) had metastasis either in group A or B. All the 19 patients were alive to date and the mean survival time was 5.6 years ranging from 1 to 13 years.The small RCC metastasis occurred less frequently in group A ( 7.5% ) than in group B ( 21.8% ). The mortality of group A and B were 5.3% (3/43) and 25.0% (8/32) respectively (P< 0.01 ). There were only 2 small RCCS mis diagnosed as echogenic angiomyolipomas by US and corrected by CT and the other imaging modalities.Conclusions Real time ultrasound can be used as a very useful screening tool in earlier detection of asymptomatic RCC. Combination of CT or other imaging modalities for further diagnosis should be essential. More work is needed for further improvement of sonographic screening .