肾癌临床表现和诊治方式的时段变化

目的探讨肾细胞癌临床表现和诊治方式的变化,改进切除技术。方法对1955年至2001年收治的537例肾癌患者资料按术式演变分为3个阶段进行分析。第1阶段为1955年至1982年,以单纯肾切除术为主;第2阶段为1983年至1992年,以经腹根治性肾切除术为主;第3阶段为1993年至2001年,以经腰根治性肾切除术为主。结果第1～3阶段临床表现：血尿分别为72．4％（42／58）、62．2％（92／148）、48．6％（161／331）;腰腹痛分别为65．5％（38／58）、51．4％（76／148）、36．6％（121／331）;腹部包块分别为51．7％（30／58）、23．0％（34／148）、12．7％（42／331）;“三联征”分别为24．1％（14／58）、10．8％（16／148）、3．6％（12／331）。无症状肾癌所占比例分别为0％、6．1％（9／148）、15．7％（52／331）。3阶段肾癌的诊断分别以尿路造影、B超和CT为主。第1阶段以单纯肾切除术为主,根治性肾切除术仅占4．8％;第2阶段根治性肾切除术占76．5％,其中经腹占63．9％、经腰占36．1％,保留肾单位肾癌切除术（NSS）占1．7％;第3阶段根治性肾切除术占89．8％,其中经腰占77．4％、经腹占20．8％、经胸腹占1．8％,NSS占3．2％。第1阶段3、5年生存率分别为42．（;％、27．7％;第2阶段3、5、10年生存率分别为64．4％、48．2％、17．6％;第3阶段3、5年生存率分别为74．2％、58．6％。结论肾癌典型的临床表现率逐渐下降;无症状肾癌所占比例增加,对肾癌的诊断更趋向于早期,诊断更加准确;肾癌的手术更加标准化,保留肾单位手术应用增加;肾癌生存率有所提高。

Clinical symptoms and diagnosis and treatment changes of renal cell carcinoma during different time period

Objective To compare the difference of clinical symptoms, diagnosis, and treatments of renal cell carcinoma (RCC) during different time. Methods 537 renal carcinoma cases hospitalized from 1955 to 2001 in chronological order were reviewed and the comprehensive clinical data were analyzed by grouped into 3 time periods based on the predominant surgical procedure in each period. Results The proportion of RCC versus the total hospitalized patients in 3 periods accounted for 0. 89% , 2. 85% and 3. 04% , respectively. Clinical symptoms in each period were as following:hema turia ratio was 72. 4% , 62.2%, 48.6%, respectively;lumbar pain or bellyache was 65. 5% , 51.4%, 36.6%, respectively; the exploration rate of abdominal mass by image study was 51. 7%, 23. 0%, 12.7%, respectively; "trilogy" was 24.1%, 10.8%, 3.6%, respectively. The main diagnosis methods applied for RCC in the 3 periods were urography, ultrasonography and CT scanning. The predominant operational methods in the three periods were changed as the following: simple nephrectomy via either lumbar (90. 5%)or abdominal (9. 5%) approach in the first period, radical nephrectomy via abdominal (63. 9%)or lumbar (36. 1%) approach in the second period, in which RN was 76. 5% and NSS was 1.7%, and then the operation method turned to RN via lumbar approach mainly (77. 4%) in the third period, in which RN was 89. 8% and NSS was 3. 2%. The 3 years and 5 years survival rate were 42. 6% and 27. 7% respectively in the first period. Those survival rates were 64. 4% , 48. 1 % in the second period, and 74. 2%, 58. 6% in the third period respectively. Conclusions The ratio of typical symptoms of RCC decreased gradually. The diagnosis of RCC was achieved in the early stage and the diagnosis became to be more accurate. Clinical staging could be done in most cases. The operation method was standardized, the application of nephron sparing surgery increased, and the survival rate of RCC increased to some extent.