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目的提高肾脏偶发小肿瘤的诊治效果。方法对192例肾脏偶发小肿瘤进行回顾性研究,探讨其影像学检查特点和治疗方法。结果诊断为肾脏透明细胞癌160例,血管平滑肌脂肪瘤18例,后肾腺瘤14例。术中冰冻病理报告为后肾腺瘤、术后病理报告为透明细胞癌3例,术前诊断肾癌行根治性肾脏切除术、术后病理检查结果为肾血管平滑肌脂肪瘤2例。肾癌、后肾腺瘤超声表现为低回声为主58.1%(93/160),肾血管平滑肌脂肪瘤超声表现为高回声为主44.4%(8/18)。CT扫描肾癌增强扫描CT值略高于后肾腺瘤和肾血管平滑肌脂肪瘤。肾血管平滑肌脂肪瘤位于肾脏边缘突向肾外部分大于肿瘤1/2者占83.3%。肾癌行根治性肾切除术生存率与保留肾单位术后生存率无显著差异,而且保留肾单位手术后仅1例再发肾癌。结论影像学检查难以准确判断肾脏偶发小肿瘤的性质,肿瘤位于肾脏边缘突向肾外部分大于肿瘤1/2者可能为肾血管平滑肌脂肪瘤。肾脏偶发小肿瘤应该采取保留肾单位手术。
Objective To improve the diagnosis and treatment of occasional small kidney tumors. Methods A retrospective study of 192 cases of small adrenal tumors of the kidney was performed to investigate the imaging features and treatment methods. The results were diagnosed as renal clear cell carcinoma in 160 cases, angiomyolipoma in 18 cases, 14 cases of renal adenoma. Intraoperative frozen pathology report for the posterior renal adenoma, postoperative pathology report of 3 cases of clear cell carcinoma, preoperative diagnosis of renal cell carcinoma underwent radical nephrectomy, postoperative pathological examination results for 2 cases of renal angiomyolipoma. Renal and retroperitoneal adenomas mainly showed low echo (58.1%, 93/160) and high echo (44.4%, 8/18) in renal angiomyolipoma. CT scan enhanced renal CT scan CT value slightly higher than that of renal adenoma and renal angiomyolipoma. Renal vascular smooth muscle lipoma located in the edge of the kidney to the renal part of the tumor more than 1/3 accounted for 83.3%. There was no significant difference between the survival rate of radical nephrectomy and the survival rate of nephron after nephrectomy. Only one case of recurrent nephropathy was retained after nephron surgery. Conclusions Radiographic examination is difficult to accurately determine the nature of small renal tumors, the tumor located in the edge of the kidney to the renal part of the larger than the tumor may be renal angiomyolipoma. Occasionally small renal neoplasms should be taken to retain nephron surgery.