彩色多普勒超声诊断肾细胞癌及其 TNM分期的临床研究

Clinical study of the color Doppler ultrasonic and TNM staging of renal cell carcinoma

目的：探讨彩色多普勒超声（CDU）诊断肾细胞癌（RCC）及其 TNM分期的临床应用价值。方法回顾性分析经手术病理证实的265例 RCC 患者的临床资料。根据2004年 WHO 病理类型的分类和2003年美国癌症联合会（AJCC）《癌症分期手册（第六版）》肾癌分期标准，采用 CDU 对 RCC 进行 TNM分期，并与手术病理诊断结果对比分析。结果该组265例 RCC 中，右肾136例（51．32％），左肾129例（48．68％）；肿瘤直径1．5～12．8 cm；组织病理学诊断肾透明细胞癌226例（85．28％），肾乳头状细胞癌28例（10．57％），肾嫌色细胞癌5例（1．89％），多房囊性肾细胞癌4例（1．51％），Bellini 集合管癌2例（0．75％）。CDU 与病理诊断结果符合250例（94．34％），CDU 漏、误诊15例（5．66％）。CDU 显示肾脏内低回声或等高回声以及混合回声的肿块，并向周围组织或脏器浸润性生长；各型血流信号均以肾透明细胞癌为主。CDU 与手术病理 TNM分期符合率为90．40％（226／250），T1 N0-1 M0、T2 N0-1 M0、T3 N0-2 M0-1和 T4 N0-2 M0-1符合率分别为92．12％（152／165）、85．71％（36／42）、82．14％（23／28）和100．00％（15／15）。结论CDU 可作为临床诊断RCC 的首选方法，对 TNM分期可提供重要信息。

Objective To explore clinical value of the color Doppler ultrasonic（CDU）and TNM staging of renal cell carcinoma.Methods 265 cases of renal cell carcinoma（RCC）confirmed by surgical pathology were retro-spectively analyzed.According to the WHO 2004 pathological types of classification standards and the American Joint Committee on Cancer（AJCC）cancer staging manual/6th TNMstaging criteria.The analyzed application of a CDFI to TNMstaging of renal cell carcinoma,and surgical pathology results werecompared.Results 265 cases of RCC and right kidney in 136 cases,129 cases of left kidney;Diameter of 1.5 -12.8cm;Pathological diagnosis of renal clear cell carcinoma in 226 cases（85.28%）,28 cases of papillary renal cell carcinoma（10.57%）,renal too color cell car-cinoma in 5 cases（1.89%）,4 cases of multilocular cystic renal cell carcinoma（1.51%）,Bellini duct carcinoma in 2 cases（0.75%）.Diagnosis results of CDU and pathological in 250 cases（94.34%）,CDU misdiagnosis leakage 15 cases（5.66%）.Within the kidney showed low echo or high echo,and mixed echo lumps,and invasive growth to the surrounding tissues or organs sign for it.CDU showed the various blood flow signals were given priority to with renal clear cell carcinoma;CDU and surgical pathology TNMstaging coincidence rate was 90.40%（226 /250）,inclu-ding T1 N0 -1 M0 ,T2 N0 -1 M0 ,T3 N0 -2 M0 -1 and T4 N0 -2 M0 -1 of coincidence rate were 92.12%（152 /165）,85.71%（36 /42）,82.14%（23 /28）and 100.00%（15 /15）.Conclusion CDU can be used as the preferred method of diag-nosis and evaluation of renal cell carcinoma,which can can provide valuable information for TNMstaging.