囊性肾癌14例临床诊治分析

目的 探讨囊性肾癌的诊断与治疗水平.方法 总结2005年1月至2010年12月浙江大学第一附属医院收治的14例囊性肾癌患者的临床资料.其中男10例,女4例,年龄40 ～71岁.术前CT检查显示囊性病变伴钙化4例,有分隔8例.术前诊断为复杂性肾囊肿12例.术中行冰冻病理检查12例,10例报告为囊性肾癌,1例报告为肾囊肿,1例报告为多房性肾囊肿.结果 14例术后病理均为囊性肾透明细胞癌,14例中行根治性肾切除术6例,后腹腔镜下根治性肾切除术4例,后腹腔镜下肾部分切除术2例,先行后腹腔镜下肾囊肿去顶,后又行根治性肾切除术1例,先行后腹腔镜下肾上极肿块切除,后行根治性肾切除术1例.随访4个月～6年,无肿瘤复发和转移.结论 CT检查对术前诊断囊性肾癌有帮助,术中应行冰冻病理检查确诊,囊性肾癌保留肾单位手术为首选,预后良好.

Diagnosis and treatment of cystic renal cell carcinoma: a report of 14 cases

Objective To explore the diagnosis and treatment of cystic renal cell carcinoma.Methods A total of 14 cases of cystic renal cell carcinoma were reviewed and analyzed.Their age range was 40 to 71 years old.Preoperative CT(computed tomography)scan revealed renal cyst-relative masses in 14 cases.The lesions were accompanied by calcification(n =4)and with septa(n =8).The preoperative diagnosis was a complex cystic mass in all but 2.Intraoperative pathological examination was undertaken in 12 cases.The findings were malignant cystic renal clear cell carcinoma(n =10),renal cyst(n =1)and multi-cell renal cyst(n =1).The procedures included radical nephrectomy(n =6),retroperitoneal laparoscopic radical nephrectomy(n =4),retroperitoneal laparoscopic partial nephrectomy(n =2),retroperitoneal laparoscopic cyst unroofed plus radical nephrectomy(n =1)and retroperitoneal laparoscopic partial nephrectomy plus radical nephrectomy(n =1).Results All 14 cases were confirmed postoperatively as cystic renal clear cell carcinoma.All patients received a mean follow-up period of 26 months(range:4-72).Their overall results were excellent with no evidence of neoplastic recurrence or metastasis.Conclusion Preoperative CT scan may aid the diagnosis of cystic renal clear cell carcinoma.Intraoperative pathological examination should be performed in suspected cases.Nephron-sparing surgery is indicated.Its prognosis is generally favorable.