泌尿肿瘤.ppt

泌尿系肿瘤 泌尿外科 于芹超 肾癌 肾癌（renal carcinoma）又称肾细胞癌、肾腺癌等，占原发性肾恶性肿瘤的85%左右。肾癌的组织病理多种多样，透明细胞，还可见有颗粒细胞和梭形细胞。 临床表现 血尿、疼痛和肿块。 发热、高血压、血沉快等。 转移症状 临床上约有10%的病人因转移症状，如病理骨折、咯血、神经麻痹及转移部位出现疼痛等就医。 查体发现 诊断 B超：常表现为不均质的中低回声实性肿块，体积小的肾癌有时表现为高回声，需结合CT或MI诊断。 X线检查：泌尿系统平片（KUB）静脉尿路造影（IVU),价值不高。 诊断 CT:表现为肾实质内不均质肿块，平扫CT值略低于或与肾实质相似，增强扫描后，肿瘤不如正常肾实质增强明显。 MRI CT CT CT CT 病理 CT CT CT 治疗 根治性肾切除术是肾癌最主要的治疗方法。切除范围包括患肾、肾周脂肪及肾周筋膜、区域肿大淋巴结。 肾部分切除术 手术方式:开放手术或腹腔镜 应用生物制剂白细胞介素-2（IL-2）、干扰素-α（INF-α）等免疫治疗，对预防转移癌有一定疗效。肾癌具有多药物耐药基因，对放射治疗及化学治疗不敏感。 Postoperative Surveillance after Radical Nephrectomy for Localized Renal Cell Carcinoma 统计数据 3% B/L RCC 3% local recurrence after radical nephrectomy 10% local recurrence after NSS 5-10% IVC involvement at presentation 30% with METs at presentation 26% metastasize after nephrectomy TNM Primary tumor (T) TX - Primary tumor cannot be assessed T0 - No evidence of primary tumor T1 - Tumor 7 cm or smaller in greatest dimension, limited to the kidney T2 - Tumor larger than 7 cm in greatest dimension, limited to the kidney T3 - Tumor extends into major veins or invades adrenal gland or perinephric tissues but not beyond the Gerota fascia T3a - Tumor invades adrenal gland or perinephric tissues but not beyond the Gerota fascia T3b - Tumor grossly extends into the renal vein(s) or vena cava below the diaphragm T3c - Tumor grossly extends into the renal vein(s) or vena cava above the diaphragm T4 - Tumor invading beyond the Gerota fascia Regional lymph nodes (N) - Laterality does not affect the N classification NX - Regional lymph nodes cannot be assessed N0 - No regional lymph node metastasis N1 - Metastasis in a single regional lymph node N2 - Metastasis in more than 1 regional lymph node Distant metastasis (M) MX - Distant metastasis cannot be assessed M0 - No distant metastasis M1 - Distant metastasis STAGE TNM staging system Stage I 7cm or less and confined to the kidney Stage II 7cm but still