医药学论文：肾细胞癌临床与病理的新特点

【摘要】 目的 分析肾细胞癌临床诊治和病理方面的新特点。方法 回顾性分析我院1991～2000年收治的269例肾细胞癌患者临床资料，随访治疗效果。结果 肾细胞癌病例就诊年龄平均47.1岁。67.3％（181/269）为体检发现。RobsonⅠ期+Ⅱ期252例，约93.7％（252/269）。肾癌根治术242例，术前病侧肾动脉栓塞57例，与非栓塞组对照：手术时间和术中出血量的差异有显著性（χ2值分别为4.3、6，P＜0.05），两组5年和10年生存率差异无显著性。肾癌5年、10年总存活率分别是86.2％（232/269）、60.7％（37/61）。39例囊肿相关性肾细胞癌中16例有肾囊肿病史（平均6.2年），5年生存率为949％（37/39）。结论 肾细胞癌发病年龄年轻化，大多数为低期意外瘤。囊肿相关性肾细胞癌有特殊临床病理特点。术前肾动脉栓塞不能提高远期生存率，应严格掌握使用指征。迟发性肾细胞癌转移无规律性，术后复查要系统全面。
【关键词】 肾细胞癌 临床 病理 特点
New clinical and pathological characteristics of renal cell carcinoma
Pan Dongliang，Li Hanzhong，Cui Quancai
Department of Urology，Peking Union Medical College Hospital，Beijing 100730.
【Abstract】 Objective To analyze the new characteristics about diagnosis and therapeutics of renal cell carcinoma (RCC) and to summarize the new clinical experience.Methods The clinical data of 269 patients with RCC were analyzed from 1991 to 2000 in our hospital，and their results were followed up.Results The average age of first hospital-in was 47.1 years old.67.3%(181/269) was discovered by healthy check-up.242 patients suffered radical nephrectomy of which 57 were given preoperative embolization of renal artery.The difference of operation time and bleeding volume in operation was significant statistically between embolization group and control group.The total survival rate of 5 and 10 years was 86.2％（232/269）and 60.7％（37/61）respectively.39 cases of cyst-associated RCC had 94.9％（37/39）of survival rate of 5 years.Conclusion The age of patients with RCC now is younger than ever.The most of them are in early stage clinically.Preoperative embolization could not improve the long-term survival rate，and its indication should be controlled strictly.The follow-up should be systematic because of the irregularity of late metastasis of RCC.The cyst-associated RCC has its particular clinical and pathological characteristics.
【Key words】 renal cell carcinoma clinic pathology characteristics
肾细胞癌是肾脏最常见的恶性肿瘤。随着经济的发展、生存环境的变化、科学技术的提高以及自我保健意识的增强，入院就诊的肾细胞癌病例呈现新的临床和病理特点，国内文献报道较少。为此，回顾性分析我院1991～2000年收治的269例肾细胞癌患者临床资料，总结如下。
1 资料与方法
1.1 一般资料 本组患者269例，其中男169例，女100例。年龄19～81岁，平均47.1岁。39例囊肿相关性肾细胞癌中16例有肾囊肿病史1～18年，平均6.2年，见表1。体检发现肿瘤者181例，以肉眼血尿就诊的67例，腰痛10例，消瘦、乏力为主诉者10例，扪及无痛性肿物的1例。体格检查：仅1例腹部双合诊扪及左上腹部实质肿物，上界不清，随呼吸上下移动，表面尚光滑，无触痛。