本文選題：T2期腎細胞癌 + 胸部CT掃描�。� 參考：《北京協(xié)和醫(yī)學院》2013年碩士論文

【摘要】：目的探討T2期腎細胞癌肺轉移的術前診斷方法,以提高患者的生存率。方法 回顧性分析70例T2N0期原發(fā)性腎細胞癌患者的臨床資料�；颊吣挲g20～75歲,平均年齡55歲；男54例,女16例；全部患者術前均接受胸部X線正側位片及胸部CT掃描檢查。按照2009年UICC/AJCC提出的新TNM分期系統(tǒng),術前診斷均歸為T2期,其中T2aN0期59例,T2bN0期11例。67例患者均在中國醫(yī)學科學院腫瘤醫(yī)院行根治性腎切除術,3例未行手術治療,在B超引導下行腎腫瘤穿刺活檢,70例患者均獲得病理。2例患者后續(xù)治療行肺轉移灶手術切除,病理證實來源于腎的轉移性透明細胞性腎細胞癌。根據(jù)統(tǒng)計學分析,計算出Kappa值。結果70例患者均經(jīng)中國醫(yī)學科學院腫瘤醫(yī)院病理科診斷,病理提示：透明細胞性腎細胞癌64例,乳頭狀腎細胞癌3例,嫌色細胞癌3例。70例患者中,經(jīng)胸部X線正側位片和胸部CT掃描檢查診斷肺轉移患者21例,占總病例數(shù)的30%(21/70),其中T2aN0期患者19例,占T2aN0期病例數(shù)的32.2%(19/59),T2bN0期患者2例,占T2bN0期病例數(shù)的18.2%(2/11)。59例術前的胸部X線正側位片和胸部CT掃描檢查的結果是一致的,其中49例的兩項檢查均未發(fā)現(xiàn)肺轉移灶；另外10例兩項檢查均發(fā)現(xiàn)肺轉移灶,其中T2aN0期8例,T2bN0期2例,即胸片和CT掃描均發(fā)現(xiàn)肺轉移灶。其余11例患者兩項檢查結果不一致,即胸部X線正側位片檢查未發(fā)現(xiàn)肺轉移灶,而胸部CT掃描檢查提示肺結節(jié)影,診斷肺轉移瘤,11例均為T2aN0期。70例患者中沒有胸部X線正側位片檢查發(fā)現(xiàn)肺轉移灶,而胸部CT掃描檢查未發(fā)現(xiàn)肺轉移灶的病例。術前胸部X線正側位片檢查正常,而胸部CT掃描檢查發(fā)現(xiàn)異常,檢出肺轉移瘤的病例數(shù),占所有病例數(shù)的比例,約為15.7%。計算出Kappa值為0.56,達到中度一致性。在59例T2aN0期患者中,術前胸部X線正側位片檢查正常,胸部CT掃描檢出肺轉移瘤的病例數(shù)為11例,占T2aN0期病例數(shù)的比例,約為18.6%。所有21例經(jīng)胸部CT掃描確診肺轉移的患者,原發(fā)灶病理均為透明細胞性腎細胞癌。結論 胸部CT掃描檢查較胸部X線正側位片檢查,能夠明顯提高肺轉移瘤的檢出率和診斷準確率。有必要通過胸部CT掃描判斷有無肺轉移,以明確T2N0期腎癌術前分期。推薦胸部CT掃描作為T2N0期腎癌的術前常規(guī)檢查。
[Abstract]:Objective to investigate the preoperative diagnosis of lung metastasis in stage T 2 renal cell carcinoma (RCC) and to improve the survival rate. Methods the clinical data of 70 patients with T 2 N 0 primary renal cell carcinoma were retrospectively analyzed. The age of the patients was 20 to 75 years with an average age of 55 years, 54 males and 16 females. All the patients were examined by chest radiography and CT before operation. According to the new TNM staging system proposed by UICC / AJCC in 2009, the preoperative diagnosis was classified as T2 stage. Among them, 59 patients with T2aN0 stage T2bN0, 11 patients with T2bN0 stage and 67 patients with T2bN0 stage, all underwent radical nephrectomy (3 patients without surgery) in the Oncology Hospital of the Chinese Academy of Medical Sciences. Renal tumor biopsy guided by B-ultrasound was performed in 70 patients, all of whom were treated with pathology. 2 cases were treated with lung metastases, which were confirmed by pathology as metastatic clear cell renal cell carcinoma (RCC). According to statistical analysis, the Kappa value was calculated. Results all the 70 patients were diagnosed by the Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences. Pathological findings showed that 64 cases of clear cell renal cell carcinoma, 3 cases of papillary renal cell carcinoma, 3 cases of chromophobe cell carcinoma. 21 cases of pulmonary metastasis were diagnosed by chest X-ray and CT scan, accounting for 3021 / 70% of the total cases. Among them, 19 cases were in stage T2aN0, 2 cases were in stage T2aN0, and 2 cases were in stage T2bN0 of T2aN0. The results of chest radiographs and chest CT scans in 59 patients with T _ 2bN _ 0 were consistent with those of chest X-ray and CT scans. In 49 cases, lung metastasis was not found in two examinations, while in 10 cases, lung metastases were found in both examinations. There were 8 cases of T _ 2a N _ 0 stage and 2 cases of T _ 2b N _ 0, both chest radiographs and CT scans showed pulmonary metastases. In the other 11 patients, the results of two examinations were not consistent, that is, the positive and lateral chest radiography showed no metastasis of the lung, and the CT scan of the chest showed the pulmonary nodule shadow. In 11 cases of pulmonary metastases, there were no positive and lateral chest radiographs in all the patients with T _ 2a N _ 0 stage and no lung metastases were found by chest CT scan. The positive and lateral chest X-ray examination was normal before operation, but the chest CT scan was abnormal, and the number of cases of lung metastasis was 15.7% of all cases. The Kappa value was 0.56, which reached moderate consistency. In 59 patients with stage T _ 2a N _ 0, the positive and lateral chest radiographs were normal before operation, and 11 cases of lung metastases were detected by chest CT scanning, accounting for 18.6% of the cases in stage T _ 2a _ N _ 0. All 21 cases of lung metastasis confirmed by chest CT scan, the primary lesions were clear cell renal cell carcinoma. Conclusion chest CT scan can significantly improve the detection rate and diagnostic accuracy of pulmonary metastases. It is necessary to determine the lung metastasis by chest CT scan in order to determine the preoperative staging of stage T 2 N 0 renal cell carcinoma. Chest CT scan is recommended as preoperative routine examination of T 2 N 0 renal cell carcinoma.
【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R737.11;R730.44
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本文編號：2039270