后肾腺瘤4例诊治分析并文献复习

发布时间：2019-05-20 02:57

【摘要】：目的：后肾腺瘤（Metanephric adenoma,MA）临床罕见，其临床表现及影像学表现缺乏特异性。本研究通过对4例后肾腺瘤病例分析，对该病临床表现、影像学及病理特征等方面进行探讨，旨在提高临床医师对后肾腺瘤的认识，并且在一定程度上，提高对本病的诊断与治疗水平。方法：收集郑州大学第二附属医院泌尿外科2008年～2013年收治的4例后肾腺瘤患者的临床及病理资料，回顾性分析并复习相关文献，对该病的临床表现，影像学特征、病理学特点、鉴别诊断和治疗方法进行总结分析。结果：本组共4例患者，其中男性1例，女性3例。年龄在38～71岁之间，平均年龄为55岁。其中肿瘤位于左肾者3例，右肾者1例，4例肿瘤均系单侧、单发。1例患者因腰部酸痛不适就诊，余3例患者均为体检或偶然发现。4例患者术前均行超声、CT等检查，证实肾脏实性占位病变存在。2例患者因肿瘤体积较小，术中行快速冰冻病理证实为后肾腺瘤，并行后腹腔镜下保留肾单位肾肿瘤切除术；1例行后腹腔镜下肾癌根治术；1例行开放肾癌根治术，手术过程顺利，术后病理均证实为后肾腺瘤。术后4例患者均获随访，，随访时间为8～22个月，均未见肿瘤复发或转移。结论：后肾腺瘤是近年来刚被认识的一种特殊类型良性肾上皮肿瘤，其临床表现及实验室检查缺乏特异性，影像学检查对该肿瘤的检出提供重要的依据，但对其性质鉴别意义有限。本病的最终确诊需要依靠术后病理，必要时尚需联合免疫组化（Immunohistochemistry，IHC）分析进行鉴别诊断。治疗上以手术为主，首选手术方式为“保留肾单位的肿瘤切除术”。但由于该肿瘤生物学行为尚存在争议性，因此术后仍需要定期随访。
[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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.11

【参考文献】