【摘要】：目的： 后腎腺瘤（Metanephric adenoma,MA）臨床罕見，其臨床表現(xiàn)及影像學(xué)表現(xiàn)缺乏特異性。本研究通過對4例后腎腺瘤病例分析，對該病臨床表現(xiàn)、影像學(xué)及病理特征等方面進(jìn)行探討，旨在提高臨床醫(yī)師對后腎腺瘤的認(rèn)識，并且在一定程度上，提高對本病的診斷與治療水平。 方法： 收集鄭州大學(xué)第二附屬醫(yī)院泌尿外科2008年～2013年收治的4例后腎腺瘤患者的臨床及病理資料，回顧性分析并復(fù)習(xí)相關(guān)文獻(xiàn)，對該病的臨床表現(xiàn)，影像學(xué)特征、病理學(xué)特點(diǎn)、鑒別診斷和治療方法進(jìn)行總結(jié)分析。 結(jié)果： 本組共4例患者，其中男性1例，女性3例。年齡在38～71歲之間，平均年齡為55歲。其中腫瘤位于左腎者3例，右腎者1例，4例腫瘤均系單側(cè)、單發(fā)。1例患者因腰部酸痛不適就診，余3例患者均為體檢或偶然發(fā)現(xiàn)。4例患者術(shù)前均行超聲、CT等檢查，證實腎臟實性占位病變存在。2例患者因腫瘤體積較小，術(shù)中行快速冰凍病理證實為后腎腺瘤，并行后腹腔鏡下保留腎單位腎腫瘤切除術(shù)；1例行后腹腔鏡下腎癌根治術(shù)；1例行開放腎癌根治術(shù)，手術(shù)過程順利，術(shù)后病理均證實為后腎腺瘤。術(shù)后4例患者均獲隨訪，，隨訪時間為8～22個月，均未見腫瘤復(fù)發(fā)或轉(zhuǎn)移。 結(jié)論： 后腎腺瘤是近年來剛被認(rèn)識的一種特殊類型良性腎上皮腫瘤，其臨床表現(xiàn)及實驗室檢查缺乏特異性，影像學(xué)檢查對該腫瘤的檢出提供重要的依據(jù)，但對其性質(zhì)鑒別意義有限。本病的最終確診需要依靠術(shù)后病理，必要時尚需聯(lián)合免疫組化（Immunohistochemistry，IHC）分析進(jìn)行鑒別診斷。治療上以手術(shù)為主，首選手術(shù)方式為“保留腎單位的腫瘤切除術(shù)”。但由于該腫瘤生物學(xué)行為尚存在爭議性，因此術(shù)后仍需要定期隨訪。
[Abstract]:Objective: posterior renal adenoma (Metanephric adenoma,MA) is rare in clinical practice, and its clinical and imaging manifestations are not specific. Through the analysis of 4 cases of posterior renal adenoma, the clinical manifestations, imaging and pathological features of the disease were discussed in order to improve the clinician's understanding of posterior renal adenoma, and to a certain extent, Improve the diagnosis and treatment of the disease. Methods: the clinical and pathological data of 4 patients with posterior renal adenoma admitted to the Department of Urology, the second affiliated Hospital of Zhengzhou University from 2008 to 2013 were collected. The related literature was analyzed and reviewed retrospectively. the clinical manifestations and imaging features of the disease were analyzed. Pathological features, differential diagnosis and treatment were summarized and analyzed. Results: there were 4 patients, including 1 male and 3 female. The age is between 38 and 71 years old, with an average age of 55 years. Among them, 3 cases were located in the left kidney, 1 case in the right kidney, 4 cases were unilateral and single. 1 case was ill due to low back pain, and the other 3 cases were examined by physical examination or accidental discovery. All 4 cases were examined by ultrasound and CT before operation. It was confirmed that the solid space occupying lesion of kidney existed. Because of the small tumor volume, 2 patients were confirmed as posterior renal adenoma by rapid frozen pathology, and the renal unit renal tumor was resected under retrolaparoscopy. Retrolaparoscopic radical resection of renal carcinoma was performed in 1 case and open radical resection of renal cell carcinoma was performed in 1 case. The operation was smooth and proved to be posterior renal adenoma by pathology. All the 4 patients were followed up for 8 to 22 months. No tumor recurrence or metastasis was found. Conclusion: posterior renal adenoma is a special type of benign renal epithelial tumor which has just been recognized in recent years. Its clinical manifestation and laboratory examination are lack of specificity. Imaging examination provides an important basis for the detection of this tumor. However, the significance of distinguishing its properties is limited. The final diagnosis of this disease needs to rely on postoperative pathology, the necessary fashion needs to be combined with immunohistochemical (Immunohistochemistry,IHC) analysis for differential diagnosis. Surgery is the main treatment, and the first choice is "tumor resection with preservation of renal unit". However, because the biological behavior of the tumor is still controversial, it still needs to be followed up regularly after operation.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.11

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