飞行人员肾癌临床诊治及医学鉴定——附病例报告六例

目的探讨分析飞行人员肾癌临床诊治经验和医学鉴定方法。方法回顾分析2002年3月至2008年12月我院收治的6例空军现役飞行人员肾癌病例资料并复习相关文献。结果患者均为男性，年龄43-54岁，平均47．3岁；左肾癌4例，右肾癌2例，肿瘤直径1．8-5．2cm，平均3．6cm；5例于年度体榆行超声检查时发现，1例因出现腰腹部疼痛伴肉眼血尿，行影像学检查发现。6例患者术前均经超声、泌尿系平片（plainfilm of kidneys，ureter and bladder，KUB）＋静脉尿路造影（intravenous urography，IVU）、CT平扫及强化等系统检查明确诊断。肾癌临床分期均为TlNoMo，均行手术治疗。其中3例行根治性肾切除术，1例行保留肾单位手术，2例行后腹腔镜肾癌根治术。6例手术均获成功，术后恢复良好，术后病理提示均为肾透明细胞癌。3例患者鉴定飞行合格，1例尚处观察期，2例术后临近退休未再飞行。术后随访2-5年，肿瘤无复发和转移。结论对于飞行人员早期局限性肾癌，手术疗效好，可帮助飞行人员重返飞行岗位。

Clinical treatment and medical evaluation of the aircrew with renal cell carcinoma-6 cases attached

Objective To explore the clinical treatment experience and medical evaluation method for the aircrew with renal cell carcinoma. Methods The medical records of 6 cases of the aircrew with renal cell carcinoma dated from Mar. 2002 to Dec. 2008 were analyzed and related literatures were reviewed. Results Six male aircrew's average age was 47.3(43-54) years.Four tumors were in left kidney and 2 in right.The mean diameter of the tumors was 3.6(1.8-5.2) cm.Five patients didn't show any symptom in annual general health checkup but ultrasound examination indicated.One patient complained flank pain and gross hematuria was observed and renal cell carcinoma was diagnosed by imaging examination. All patients received ultrasound,plain film of kidneys,ureter and bladder (KUB) + intravenous urography (IVU) and CT scan to confirm the final diagnosis.Clinical stage was T1 N0 M0 for all cases and all patients received operations. Radical nephrectomy was performed on 3 cases while nephron-sparing surgery on 1 case and laparoscopic radical nephrectomy on 2 cases.All surgeries were successful and all patients recovered well.The pathological examination showed that all cases were clear cell carcinoma.Three patients got flying qualification and 1 was still in observation.Two patients retired after surgery.By 2-5 years follow-up,no recurrence and metastasis were found. Conclusions Surgery is effective for the aircrew with pristine localized renal cell carcinoma.And it enables the aircrew with satisfied recovery and would be helpful to let them return flying.