单中心14年B超引导下经皮肾肿物穿刺活检经验

发布时间：2019-07-11 19:26

【摘要】：目的:评价B超引导下经皮肾肿物穿刺活检(renal masses biopsy,RMB)的诊断效果、安全性及在中晚期肾癌患者中的临床应用价值。方法:回顾性分析2001年4月至2014年12月在北京大学第一医院行B超引导下肾肿物穿刺活检的75例患者的临床病理资料,总结肿瘤大小、病理分型和分级、穿刺部位、穿刺针数以及诊断效果等数据,分组统计分析。结果:北京大学第一医院14年来B超引导下RMB数量呈明显增加趋势。共75例患者纳入本研究,确诊64例(85.3%),包括60例恶性肿瘤,4例良性病变;非诊断性穿刺11例(14.7%)。60例恶性肿瘤中,肾细胞癌37例(61.7%),尿路上皮癌13例(21.7%),其他肿瘤10例(16.7%)。37例肾细胞癌中明确诊断病理学亚型33例(89.2%),无法明确病理学亚型4例(10.8%)。75例患者中,集合管癌占肾癌10.8%,鳞癌占尿路上皮癌23.1%,比例均高于已报道流行病学数据(2%,9.9%)。75例患者中,13例行手术治疗并取得术后病理,穿刺活检结果与术后病理结果相比,肿物良恶性、病理学亚型及病理分级诊断的准确率分别为100%、81.8%和60.0%。75例患者中1例(1.3%)出现轻微血尿,未出现其他相关并发症。结论:B超引导下RMB可准确诊断肾癌病理学亚型,指导晚期肾癌患者靶向治疗;RMB可较准确判断恶性程度较高的集合管癌、尿路上皮鳞癌,可为制定合理的治疗方案提供参考。
[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.
【作者单位】：北京大学第一医院泌尿外科北京大学泌尿外科研究所国家泌尿男性生殖系统肿瘤研究中心泌尿生殖系疾病(男)分子诊治北京市重点实验室;首都医科大学燕京医学院附属密云医院泌尿外科;
【分类号】：R737.11

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