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目的为进一步提高肾转移性恶性肿瘤的诊治水平提供参考。方法回顾性分析6例肾转移性恶性肿瘤患者的诊断和治疗情况,男4例,女2例,年龄43~65岁,平均年龄为(53±10)岁。原发肿瘤分别为支气管肺鳞癌3例、胃腺癌1例、急性粒细胞性白血病1例和肝癌1例,分别于原发病手术治疗后5~41个月内经B超检查偶然发现肾脏转移性病灶,病程中患者均无肉眼血尿和其他不适症状。6例患者均行根治性肾切除术,术前均经B超、CT或磁共振(MRI)检查,均未行细针穿刺活组织检查(FNAB)。肿瘤大小为3.5cm×4.2cm至6.0cm×8.5cm。其中1例患者B超检查示肾脏实性低回声占位;CT检查示肾脏等密度影,增强期明显强化,可见假包膜影;术前诊断为肾癌。5例患者B超检查示肾脏区边界不清楚的团块,呈低回声,内部回声不均匀;CT检查示肾脏肿块多数呈少或无外凸,弥漫浸润生长,密度不均,边界不清,增强后出现轻度强化,并与周围肾脏组织边界不清,无包膜,有“毛刺样”改变;术前诊断为肾转移性鳞癌。结果手术过程均顺利,术中出血量50~800mL,平均出血量为(250±173)mL,均未输血。6例患者术后均诊断为肾转移性恶性肿瘤,均无手术并发症发生,于术后7~10d出院。除1例肝癌患者外,其余5例患者均根据原发病行相应的化疗。随访2~36个月,1例急性粒细胞性白血病肾转移患者失访,3例支气管肺鳞癌和1例胃腺癌患者均死亡(术后存活时间为7~15个月),1例肝癌肾转移患者术后2个月尚在随访中。结论虽然恶性肿瘤患者一旦出现肾转移,其生存期相当有限,但对于原发性肿瘤的转移仅局限于肾脏的患者,采取根治性肾切除术治疗并进一步明确肾脏肿瘤的性质还是具有一定意义的。
Objective To provide reference for further improving the diagnosis and treatment of renal metastatic malignancies. Methods The diagnosis and treatment of 6 patients with renal metastatic malignancies were retrospectively analyzed. There were 4 males and 2 females, aged from 43 to 65 years with a mean age of (53 ± 10) years. The primary tumors were 3 cases of bronchial squamous cell carcinoma, 1 case of gastric adenocarcinoma, 1 case of acute myeloid leukemia and 1 case of hepatocellular carcinoma, respectively. Kidney metastases were found by B-ultrasound within 5 to 41 months after the primary disease was treated Sexual lesions, the course of patients with no gross hematuria and other symptoms. All 6 patients underwent radical nephrectomy. All patients underwent B-mode ultrasound, CT or magnetic resonance imaging (MRI) before operation. No fine needle aspiration biopsy (FNAB) was performed. Tumor sizes ranged from 3.5 cm x 4.2 cm to 6.0 cm x 8.5 cm. One case of B-ultrasound showed renal solid hypoechoic lesions; CT examination showed renal density, enhanced significantly enhanced, showing pseudocapsule; preoperative diagnosis of renal cell carcinoma. Five patients with B-ultrasound showed unclear clumps in the renal border area, showing hypoechoic, internal echo uneven; CT showed renal masses were mostly less or no convex, diffuse infiltration of growth, uneven density, the border is not clear, Enhanced mild enhancement, and the surrounding renal tissue with unclear borders, no capsule, there is “burr-like” change; preoperative diagnosis of renal metastatic squamous cell carcinoma. Results The operation procedure was smooth. The blood loss was 50 ~ 800mL and the average bleeding amount was (250 ± 173) mL. No blood transfusion was given. Six patients were diagnosed as renal metastases after surgery, no complications occurred in 7 to 10 days after discharge. In addition to a liver cancer patients, the remaining 5 patients were treated according to the corresponding primary chemotherapy. All cases were followed up for 2 to 36 months. One patient with metastatic renal cell carcinoma was lost to follow-up. Three patients with bronchogenic carcinoma of the lung and one patient with gastric adenocarcinoma died (survival time 7 to 15 months) and one patient with liver cancer Patients with renal metastases were still followed up 2 months after surgery. Conclusions Although renal metastases in patients with malignant tumors have relatively limited survival, patients with metastatic neoplasms whose nephropathy is limited to the kidney may be of some value by radical nephrectomy and further clarification of the nature of renal tumors .