术前怀疑恶性的复杂肾囊肿临床诊治分析

Diagnostic and therapeutic characteristics of the preoperatively misclassified complicated renal cysts

目的 对术前怀疑恶性而行手术切除、术后病理却为肾囊肿的患者临床特点进行分析,并探讨其治疗选择与原因.方法 回顾性分析2008年1月至2014年12月在我院泌尿外科接受肾部分切除或肾根治性切除术、但术后病理结果为肾囊肿的患者临床资料.记录患者年龄、性别、肿瘤侧别、肿瘤最大直径、手术类型等数据,并进行亚组分析;对手术效果进行随访,收集随访结果.结果 共有31例患者纳入本研究,术前诊断为BosniakⅡ型囊肿4例,BosniakⅡF型囊肿7例,BosniakⅢ型囊肿7例,BosniakⅣ型囊肿3例,考虑为肾脏实性肿物者10例.肿物最大直径平均值为（3.34±2.45） （0.8-14.3）cm,其中4 cm以下的占83.87％ （26/31）.本研究病例中行开放肾部分切除术18例,腹腔镜手术13例（肾部分切除术10例,腹腔镜肾根治性切除术3例）,开放手术的比例为58.06％（18/31）.结论 相当数量的肾脏良性囊肿患者接受了不必要的手术治疗,甚至是肾脏根治性切除术;小体积的高密度肾囊肿病变不仅在B超和平扫CT上表现为实性肿物,还会在增强CT上出现假强化现象,易导致其被误诊为肾实性肿瘤.

Objective To explore the clinical features and treatment options of patients undergoing surgical masses excision for preoperatively misclassified complicated renal cysts.Methods Retrospective analysis was performed on clinical records of patients who received partial or radical nephrectomy at Department of Urology of Peking Union Medical College Hospital with postoperatively pathological examination as benign renal cysts from January 2008 to December 2014.Results There were a total of 31 patients meeting the inclusion criteria for analysis.Among them 4 patients were classified as Bosniak Ⅱ renal cysts by preoperative ultrasonography and/or computed tomography （CT）,7 patients as Bosniak Ⅱ F and Ⅲ respectively,3 patients as Bosniak Ⅳ,as well as 10 patients as renal solid masses.The average max diameter of the lesions was 3.34 ±2.45 cm （ranging from 0.8 cm to 14.3 cm）,with 83.87% lesions less than 4 cm.Eighteen patients （58.06%） received open partial nephrectomy,while 13 patients underwent laparoscopic partial or radical nephrectomy.Conclusions A considerable number of patients received unnecessary partial or even radical nephrectomy for misclassified benign renal cysts.Small highdensity renal cysts could not only mimic solid renal masses on ultrasonography and plain CT,but also present pseudoenhancement on enhanced CT,thus easily leading to a misdiagnosis as solid renal tumors.