肾癌临床资料回顾性分析

发布时间：2018-05-05 08:39

本文选题：肾细胞癌 + 年龄　；参考：《天津医科大学》2015年硕士论文

【摘要】：目的:调阅天津医科大学第二医院在2006年1月-2014年12月期间收治并行手术治疗的肾细胞癌病人的流行病学现状、临床特征、手术治疗方式等资料,从中进行归纳、分析、总结,进而不断提升我们对肾细胞癌的诊断及治疗能力,更好地指导临床工作,更好地为病患服务。方法:共调阅1619例肾细胞癌患者病例资料,按就诊时间、姓名、性别、年龄、首发症状、临床分期、病理类型、病理分级,手术方式,进行记录、归纳、赋值。其中将首发症状、临床分期、病理类型、病理分级等临床资料分为有临床表现组和无临床表现组进行对比分析;计量资料用表示,如:年龄;计数资料使用频数/百分比描述,如:性别、首发症状、临床分期、病理结果、手术方式等;两组计量资料比较,采用t检验。比较构成比和无序计数资料采用卡方检验。等级资料的比较采用秩和检验。以p0.05作为有统计学差异的标准。所有数据采用SPSS21.0统计软件分析。结果:1619例肾细胞癌病人中,男性为1151例(71.09%),女性为468例(28.91%),男性与女性的比例为2.46:1。病人首次就诊年龄区间为16-88岁,主要以50~和60~两个年龄段为主(2006年这两个年龄组占本年度全部病人的56.14%,2007年占65.30%,2008年占64.24%,2009年占65.30%,2010年占57.90%,2011年占63.84%,2012年占64.57%,2013年占64.56%,2014年占70.09%)。1619例肾细胞癌病人的首次就诊平均年龄为56.38±10.89岁,2006年-2014年我院肾细胞癌首次就诊年龄平均值(单位为:岁)分别为53.57±12.07、55.75±11.21、55.76±10.33、56.14±10.64、57.00±11.56、57.16±10.31、57.26±10.74、57.28±11.41、57.49±10.15,每年病人平均年龄比较有统计学差异(P0.05),显示肾细胞癌就诊病人平均年龄有逐渐增高的趋势。2006年-2014年我院肾细胞癌新发病例数(单位为:例)统计分别为:114、144、165、173、190、177、175、237、244,显示我院肾细胞癌的年收治例数逐渐增高。临床特征统计分析中,根据肾细胞癌病人首次就诊有无临床表现,分为有临床表现组(血尿、疼痛、腹部包块、发热、高血压等)与无临床表现组,进行对比分析。首次就诊有临床表现组共计632例(39.04%),每年所占构成比分别为43.76%、43.06%、41.82%、41.04%、40.53%、39.55%、37.71%、36.29%、33.20%,无临床表现组共计987例(60.96%),每年所占构成比分别为:56.24%、56.94%、58.18%、58.96%、59.47%、60.45%、62.29%、63.71%、66.80%,两组比较存在统计学差异(p0.05),显示首次就诊有临床表现的肾癌病人逐年减少,无临床表现的肾癌病人逐年增加。比较临床分期情况:有临床表现组t1期占55.06%、t2期占20.41%、t3期占16.30%、t4期占8.23%,无临床表现组t1期占83.28%、t2期占9.7%、t3期占6.99%、t4期占0%,两组比较存在统计学差异(p0.05),显示无临床表现组临床分期较有临床表现组低。在1619例肾癌患者中,最常见的是无临床表现、t1期患者,占50.77%。比较肿瘤直径情况:有临床表现组肾肿瘤直径为5.57+3.26cm,无临床表现组肾肿瘤直径为4.45+1.75cm,两组比较存在统计学差异(p0.05),显示有临床表现组肿瘤直径比无临床表现组直径大。比较病理类型情况:有临床表现组中常见病理类型占89.87%,少见类型占10.13%,无临床表现组中等常见病理类型占97.26%,少见病理类型占2.74%,两组比较存在统计学差异,(p0.05),显示有临床表现组中少见病理类型肾细胞癌比无临床表现组多,无临床表现组中常见病理类型比有临床表现组多。比较两组病理分级情况:有临床表现组中1级103例(占16.3%)、2级361例(占57.12%)、3级129例(占20.41%)、4级39例(占6.17%),无临床表现组中1级192例(占19.44%)、2级685例(占69.45%)、3级96例(占9.72%)、4级14例(占1.39%),两组比较存在统计学差异(p0.05),有临床表现组的病理分级在3级和4级的占比较多,说明有临床表现组的病理分级高于无临床表现组。手术治疗方式统计分析中,行orn者共计1148例,占总例数70.91%,表明肾细胞癌的手术方式仍以orn为主;此外,2011年-2014年我院肾细胞癌腹腔镜手术例数(单位为:例)分别为:14、69、98、110,显示近年来腹腔镜手术例数逐年增多。保留肾单位手术例数(单位为:例)分别为:27、29、49、65,显示近年来保留肾单位手术例数逐年增多。结论:1、天津医科大学第二医院收治肾癌的新发病例数呈逐年递增趋势,其发病以男性为主,发病的高峰年龄在五十至七十岁之间。现代医学的进步,也使得肾细胞癌能从健康体检中早期发现和治疗。因此提高人们健康意识,普及医院和社区的查体,对早期发现肾细胞癌、提高生存质量尤为重要。2、随着科技的进步,新的技术和各项检查设备的应用,医生可以更加客观和确切的诊断肾细胞癌,尤其是早期没有症状的肾细胞癌。肾癌的诊断主要依靠影像学检查。当前越来越多的无临床表现的肾细胞癌被及早发现.,其临床特征为临床分期较低、肿瘤直径小、病理分级较低、以透明细胞癌为主。3、目前为止早期肾细胞癌仍以外科手术治疗为主,主流手术方式包括:根治性肾切除术和保留肾单位的肾部分切除术。值得一提的是,腹腔镜手术由于创口小,解剖组织清楚,病人术后恢复快,痛苦小,已在肾细胞癌手术中占有越来越重要的地位,今后应加大腹腔镜手术在泌尿外科的应用和科研投入。
[Abstract]:Objective: To review the epidemiological status, clinical features and surgical treatment methods of renal cell carcinoma patients treated in Second Hospital Affiliated to Tianjin Medical University during the period of January 2006 -2014 December, and to improve the diagnosis and treatment ability of renal cell carcinoma. Methods: a total of 1619 cases of patients with renal cell carcinoma were reviewed, according to the time of treatment, name, sex, age, first symptom, clinical stage, pathological type, pathological classification, operation mode, record, induction, assignment. The clinical data were divided into first symptom, clinical stage, pathological type and pathological classification. The clinical presentation group and the non clinical group were compared and analyzed; the measurement data were expressed as: age, the use frequency / percentage of the counting data, such as sex, first symptom, clinical stage, pathological result, operation mode, and the comparison of the two groups of measurement data, using t test. The data were compared with the rank sum test. P0.05 was used as a standard of statistical difference. All data were analyzed by SPSS21.0 statistical software. Results: among the 1619 patients with renal cell carcinoma, 1151 cases (71.09%), 468 women (28.91%), and the male and female ratio of 2.46: 1. were 16-88 years old for the first time, mainly with 50~ and 60. The two age groups accounted for 56.14% of all patients in 2006 (56.14% of all patients in the year, 65.30% in 2007, 64.24% in 2008, 65.30% in 2009, 57.90% in 2010, 63.84% in 2011, 64.57% in 2012, 64.56% in 64.56%, 70.09%). The average age of.1619 patients with renal cell carcinoma was 56.14% years old for the first time. The average age of the first diagnosis of renal cell carcinoma in our hospital in the past 014 years was 53.57 + 12.07,55.75 + 11.21,55.76 + 10.33,56.14 + 10.64,57.00 + 11.56,57.16 + 10.31,57.26 + 11.41,57.49 + 10.15 respectively. The average age of the patients was statistically different (P0.05) every year. The average age of renal cell cancer patients was gradually increased. The rising trend of the number of new cases of renal cell carcinoma in our hospital (.2006) in -2014 was 114144165173190177175237244, showing that the number of annual cases of renal cell carcinoma in our hospital increased gradually. In the statistical analysis of clinical features, there were no clinical manifestations according to the first visit of patients with renal cell carcinoma. Urine, pain, abdominal mass, fever, hypertension, etc. were compared with those without clinical manifestation. 632 cases (39.04%) were first treated with clinical manifestation, and the proportion of each year was 43.76%, 43.06%, 41.82%, 41.04%, 40.53%, 39.55%, 37.71%, 36.29%, 33.20%, and no clinical presentation group altogether 987 cases (60.96%), the proportion of each year was respectively as follows: 56.24%, 56.94%, 58.18%, 58.96%, 59.47%, 60.45%, 62.29%, 63.71%, 66.80%, two, there were statistical differences (P0.05), which showed that the first clinical manifestation of renal cancer patients decreased year by year, and no clinical manifestation of renal cancer patients increased year by year. Compared with the clinical stage, the T1 period was 55.06%, T2 period accounted for 20.41%, T3 period accounted for 16.30%, T4 The period accounted for 8.23%, the T1 period in the non clinical group was 83.28%, the T2 period accounted for 9.7%, the T3 period was 6.99%, the T4 period was 0%. The two groups had statistical difference (P0.05), which showed that the clinical stage without clinical manifestation was lower than that of the clinical group. In 1619 cases of renal cancer, the most common is the non clinical manifestation, the T1 stage patients were compared with the tumor diameter in 50.77%.: there were clinical cases in the 50.77%. The diameter of the renal tumor in the expression group was 5.57+3.26cm and the diameter of the renal tumor was 4.45+1.75cm in the non clinical group. There was a statistical difference between the two groups (P0.05). It showed that the diameter of the tumor in the clinical group was larger than that of the non clinical group. The pathological types were compared with the common pathological types in the clinical group, which accounted for 89.87% of the common pathological types, and the rare types were 10.13%. The common pathological types in the bed group were 97.26%, the rare pathological types accounted for 2.74%. There were statistical differences between the two groups, (P0.05). It showed that there were more rare pathological types of renal cell carcinoma in the clinical manifestation group than those without clinical manifestations. The common pathological types in the clinical group were more than those in the clinical manifestation group. The pathological classification of the two groups was compared with the clinical manifestations. There were 103 cases (16.3%), 361 cases (57.12%), 129 cases (20.41%), 4, 4, 4, 39 (6.17%), there were no significant differences (P0.05), and there were statistical differences (P0.05) in the group of clinical manifestations. The pathological classification of the clinical manifestation group was higher than that of the non clinical group. In the statistical analysis of the surgical treatment, 1148 cases of ORN were performed, accounting for 70.91% of the total number, indicating that the operation mode of renal cell carcinoma was still mainly Orn. In addition, the number of laparoscopy cases of renal cell carcinoma in our hospital in 2011 (unit: case) was 14,69,98110, respectively. The number of cases of laparoscopic surgery in recent years has increased year by year. The number of cases of unit preservation of kidney unit (unit as: 27,29,49,65), respectively, shows that the number of cases of renal unit operation in recent years increased year by year. Conclusion: 1, the number of new cases of renal cancer in Second Hospital Affiliated to Tianjin Medical University is increasing year by year, the incidence of which is mainly male and the peak of the disease. The progress of modern medicine has also led to the early discovery and treatment of renal cell cancer from healthy physical examination. Therefore, it is important to raise people's health awareness and popularize the physical examination of hospitals and communities. It is particularly important for the early detection of renal cell cancer and the improvement of the quality of life.2, with the progress of science and technology, new technology and various inspection equipment. The doctor can be more objective and accurate in the diagnosis of renal cell carcinoma, especially in the early non symptomatic renal cell carcinoma. The diagnosis of renal cell carcinoma is mainly based on imaging examination. More and more non clinical manifestations of renal cell carcinoma are found early. The clinical features are low clinical stage, small tumor diameter and low pathological grade. At present, the main.3 is clear cell carcinoma. At present, the early renal cell carcinoma is still mainly treated with surgical treatment. The main main surgical methods include radical nephrectomy and partial nephrectomy with preserved kidney unit. It is worth mentioning that the laparoscopic surgery has been performed in renal cell cancer surgery because of small wound, clear anatomical structure, quick recovery and little pain. It is becoming more and more important. In future, laparoscopic surgery should be applied and applied in Department of urology.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.11

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