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目的探讨核素全身骨显像在肾细胞癌(简称肾癌)患者术后随访中的应用价值,分析肾癌患者术后骨转移的相关影响因素。方法回顾性分析2000年1月至2011年1月157例随访资料完整的肾癌患者术后骨显像结果,根据病理组织学结果、CT、MRI及骨显像随访结果最终确定患者是否发生骨转移,通过单因素分析和多因素Cox模型分析性别、年龄、病理分级、病理分期、骨痛与骨转移发生的关系。结果 157例肾癌患者术后行骨显像检查,共计显像652次,每例患者骨显像次数2～12次。发生骨转移者55例,男45例,女10例。其中多发转移者42例,单发转移者13例。骨显像中转移灶表现为浓聚者35例,浓聚伴缺损者15例,缺损者5例。骨转移发生部位依次为骨盆、腰椎、肋骨、股骨、胸椎、颅骨、肱骨、肩胛骨、胸骨、胫骨、跟骨。单因素及多因素分析结果均显示,患者病理分期、骨痛与骨转移的发生密切相关,而患者的性别、年龄、病理分级、病理类型与骨转移的发生无明显关系。结论骨显像在肾癌术后骨转移的诊断中有重要的应用价值,尤其是病理分期较高、有骨痛的患者,应尽早进行骨显像,以便早期发现骨转移病灶,及时采取有效的治疗。
Objective To investigate the clinical value of radionuclide bone imaging in the follow-up of patients with renal cell carcinoma (renal cell carcinoma) and to analyze the influencing factors of bone metastasis after renal cell carcinoma. Methods A retrospective analysis of 157 patients with complete follow-up data from January 2000 to January 2011 was performed. According to histopathological findings, CT, MRI and bone imaging were followed up to determine whether the patient had bone The relationship between gender, age, pathological grade, pathological stage, bone pain and bone metastasis was analyzed by univariate analysis and multivariate Cox model. Results 157 cases of renal cell carcinoma patients underwent bone imaging examination, a total of 652 times the imaging, bone imaging in each patient the number of 2 to 12 times. 55 cases of bone metastases, 45 males and 10 females. 42 cases of multiple metastasis, single metastasis in 13 cases. Bone metastasis imaging showed the concentration of 35 cases, concentrated with defects in 15 cases, defects in 5 cases. Bone metastases occurred in order pelvis, lumbar spine, ribs, femur, thoracic spine, skull, humerus, scapula, sternum, tibia, calcaneus. The results of univariate and multivariate analysis showed that the pathological staging and bone pain were closely related to the occurrence of bone metastasis. However, the gender, age, pathological grade and pathological type had no significant correlation with the occurrence of bone metastasis. Conclusions Bone imaging has important value in the diagnosis of postoperative renal metastases, especially in patients with high pathological grade and bone pain. Bone imaging should be performed as soon as possible in order to detect early bone metastases and to take timely and effective Treatment.