【摘要】：目的:評價B超引導(dǎo)下經(jīng)皮腎腫物穿刺活檢(renal masses biopsy,RMB)的診斷效果、安全性及在中晚期腎癌患者中的臨床應(yīng)用價值。方法:回顧性分析2001年4月至2014年12月在北京大學(xué)第一醫(yī)院行B超引導(dǎo)下腎腫物穿刺活檢的75例患者的臨床病理資料,總結(jié)腫瘤大小、病理分型和分級、穿刺部位、穿刺針數(shù)以及診斷效果等數(shù)據(jù),分組統(tǒng)計分析。結(jié)果:北京大學(xué)第一醫(yī)院14年來B超引導(dǎo)下RMB數(shù)量呈明顯增加趨勢。共75例患者納入本研究,確診64例(85.3%),包括60例惡性腫瘤,4例良性病變;非診斷性穿刺11例(14.7%)。60例惡性腫瘤中,腎細胞癌37例(61.7%),尿路上皮癌13例(21.7%),其他腫瘤10例(16.7%)。37例腎細胞癌中明確診斷病理學(xué)亞型33例(89.2%),無法明確病理學(xué)亞型4例(10.8%)。75例患者中,集合管癌占腎癌10.8%,鱗癌占尿路上皮癌23.1%,比例均高于已報道流行病學(xué)數(shù)據(jù)(2%,9.9%)。75例患者中,13例行手術(shù)治療并取得術(shù)后病理,穿刺活檢結(jié)果與術(shù)后病理結(jié)果相比,腫物良惡性、病理學(xué)亞型及病理分級診斷的準確率分別為100%、81.8%和60.0%。75例患者中1例(1.3%)出現(xiàn)輕微血尿,未出現(xiàn)其他相關(guān)并發(fā)癥。結(jié)論:B超引導(dǎo)下RMB可準確診斷腎癌病理學(xué)亞型,指導(dǎo)晚期腎癌患者靶向治療;RMB可較準確判斷惡性程度較高的集合管癌、尿路上皮鱗癌,可為制定合理的治療方案提供參考。
[Abstract]:Objective: to evaluate the diagnostic effect and safety of (renal masses biopsy,RMB guided by B-ultrasound and its clinical value in patients with advanced renal cell carcinoma (RCC). Methods: the clinicopathological data of 75 patients with renal masses guided by B-ultrasound in the first Hospital of Peking University from April 2001 to December 2014 were analyzed retrospectively. the data of tumor size, pathological classification and grade, puncture site, number of puncture needles and diagnostic effect were summarized and analyzed statistically. Results: the number of RMB guided by B ultrasound in the first Hospital of Peking University increased significantly in the past 14 years. A total of 75 patients were included in this study. 64 cases (85.3%) were diagnosed, including 60 cases of malignant tumors and 4 cases of benign lesions. There were 11 cases (14.7%) of non-diagnostic puncture. Among 60 cases of malignant tumors, 37 cases (61.7%) were renal cell carcinoma, 13 cases (21.7%) were urinary epithelial carcinoma and 10 cases (16.7%) were other tumors. 33 cases (89.2%) of 37 cases of renal cell carcinoma were diagnosed as pathological subtypes, 4 cases (10.8%) could not be identified. Squamous cell carcinoma accounted for 23.1% of urothelial carcinoma, which was higher than the reported epidemiological data (2%, 9.9%). Among 75 patients, 13 patients were treated surgically and obtained postoperative pathology. Compared with the postoperative pathological results, the accuracy of diagnosis of benign and malignant masses, pathological subtypes and pathological grades was 100%, 81.8% and 60.0%, respectively. 1 of 75 patients (1.3%) had mild hematuria. No other related complications occurred. Conclusion: RMB under the guidance of B-ultrasound can accurately diagnose the pathological subtypes of renal cell carcinoma and guide the targeted treatment of patients with advanced renal cell carcinoma, and RMB can accurately judge the malignant grade of collecting carcinoma and urinary epithelial squamous cell carcinoma, which can provide a reference for the formulation of reasonable treatment plan.
【作者單位】： 北京大學(xué)第一醫(yī)院泌尿外科北京大學(xué)泌尿外科研究所國家泌尿男性生殖系統(tǒng)腫瘤研究中心泌尿生殖系疾病(男)分子診治北京市重點實驗室;首都醫(yī)科大學(xué)燕京醫(yī)學(xué)院附屬密云醫(yī)院泌尿外科;
【分類號】：R737.11

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