肾癌诊断192例的临床经验

Diagnosis of renal cancer:clinical experience with 192 cases

目的 :探讨肾癌的临床诊断方法。方法 :对我院 1993年 1月～ 2 0 0 0年 12月收治的 192例肾癌临床资料进行回顾性分析。结果 :男性发病为女性的 2 4倍 ;多单侧发生 ,双侧肾癌的发生率为 1 0 4%(2 /192 ) ;好发年龄为 5 0～ 70岁 ,占5 3 1%(10 2 /192 ) ;有抽烟史者占 2 9 2 %(5 6 /192 )。典型肾癌“三联征”的发生率为 2 1%(4 /192 ) ;肾癌偶发瘤占 44 7%(86 /192 ) ,近 5年内占 47 4 %(6 4/135 ) ;“肾外表现”中 :贫血 41 1%(79/192 ) ,消瘦 14 5 8%(2 8/192 ) ,发热 12 5 %(2 4/192 ) ,高血压10 94%(2 1/192 ) ,其它少见 ;病程 <3个月者占 71 9%(138/192 )。辅助检查仍以B超、CT为主。结论 :随着人们平均寿命的延长和医学影像的快速发展 ,肾癌的发病率比以前增加 ,越来越多的肾癌患者被早期发现 ,临床上无任何表现而体检偶发的肾癌日渐增多 ,而典型的肾癌“三联征”在临床上已少见。综合分析患者的病史、体检 ,结合辅助检查 ,有助于肾癌的早期诊断。

Objective:To discuss the diagnostic experience of clinical renal cell carcinoma (RCC).Methods:192 cases of renal cell carcinoma treated in our hospital from Jan. 1993 to Dec. 2000 were analysed retrospectively. Results:Male-to-female ratio was 2.4∶1. Unilateral RCC was common. The incidence of bilateral RCC was 1.04%(2/192). RCC occured most commonly from 50 to 70 years old (53.1%). The mean age was 56.9 years old. 56 cases (29.2%) had a smoking history. The classically described triad of gross hematuria, flank pain, and a palpable mass occured in only 2.1(4/192). The rate of RCC detected incidentally was 44.7(86/192), and it was 47.4%(64/135) in recent 5 years. So-called paraneoplastic syndromes included anemia (41.1%), thin(14.58%), fever(12.5%). Uncommon syndromes included erythrocytosis, hypercalcemia, varicocele and so on. The course of 138 cases was less than 3 months (71.9%). The assistant examinations gave priority to ultrasonography and CT scanning. Conclusion:With the development of medical imaging and the increase of mean natural life, more and more patients were diagnosed early, the incidence of RCC was higher than before, the classical triad became shorter and shorter while thd serendipitous RCC became more and more. Synthetical analysis of symptoms, physical examination and assistant check-up helped to early detection of RCC.