本文選題：T2期腎細(xì)胞癌 + 胸部CT掃描　； 參考：《北京協(xié)和醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的探討T2期腎細(xì)胞癌肺轉(zhuǎn)移的術(shù)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(xì)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(shù)前均接受胸部X線正側(cè)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(shù)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(xué)科學(xué)院腫瘤醫(yī)院行根治性腎切除術(shù),3例未行手術(shù)治療,在B超引導(dǎo)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(zhuǎn)移灶手術(shù)切除,病理證實來源于腎的轉(zhuǎn)移性透明細(xì)胞性腎細(xì)胞癌。根據(jù)統(tǒng)計學(xué)分析,計算出Kappa值。結(jié)果70例患者均經(jīng)中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院病理科診斷,病理提示：透明細(xì)胞性腎細(xì)胞癌64例,乳頭狀腎細(xì)胞癌3例,嫌色細(xì)胞癌3例。70例患者中,經(jīng)胸部X線正側(cè)位片和胸部CT掃描檢查診斷肺轉(zhuǎn)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(shù)前的胸部X線正側(cè)位片和胸部CT掃描檢查的結(jié)果是一致的,其中49例的兩項檢查均未發(fā)現(xiàn)肺轉(zhuǎn)移灶；另外10例兩項檢查均發(fā)現(xiàn)肺轉(zhuǎn)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(zhuǎn)移灶。其余11例患者兩項檢查結(jié)果不一致,即胸部X線正側(cè)位片檢查未發(fā)現(xiàn)肺轉(zhuǎn)移灶,而胸部CT掃描檢查提示肺結(jié)節(jié)影,診斷肺轉(zhuǎn)移瘤,11例均為T2aN0期。70例患者中沒有胸部X線正側(cè)位片檢查發(fā)現(xiàn)肺轉(zhuǎn)移灶,而胸部CT掃描檢查未發(fā)現(xiàn)肺轉(zhuǎn)移灶的病例。術(shù)前胸部X線正側(cè)位片檢查正常,而胸部CT掃描檢查發(fā)現(xiàn)異常,檢出肺轉(zhuǎn)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(dá)到中度一致性。在59例T2aN0期患者中,術(shù)前胸部X線正側(cè)位片檢查正常,胸部CT掃描檢出肺轉(zhuǎn)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(zhuǎn)移的患者,原發(fā)灶病理均為透明細(xì)胞性腎細(xì)胞癌。結(jié)論 胸部CT掃描檢查較胸部X線正側(cè)位片檢查,能夠明顯提高肺轉(zhuǎn)移瘤的檢出率和診斷準(zhǔn)確率。有必要通過胸部CT掃描判斷有無肺轉(zhuǎn)移,以明確T2N0期腎癌術(shù)前分期。推薦胸部CT掃描作為T2N0期腎癌的術(shù)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(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R737.11;R730.44
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本文編號：2039270