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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。
Objective: To evaluate the diagnostic value, safety and clinical value of B-ultrasonography guided renal masses biopsy (RMB) in the diagnosis of advanced renal cell carcinoma. Methods: The clinical and pathological data of 75 patients with renal tumor biopsy under the guidance of B-ultrasound from April 2001 to December 2014 in Peking University First Hospital were retrospectively analyzed. The tumor size, pathological classification and grading, puncture Site, the number of punctures and diagnostic results and other data, group statistical analysis. Results: The number of RMB showed a significant increase under the guidance of B-ultrasound in Peking University First Hospital over the past 14 years. A total of 75 patients were enrolled in this study. 64 cases (85.3%) were diagnosed, including 60 malignant tumors and 4 benign lesions. Non-diagnostic puncture was performed in 11 patients (14.7%). Of 60 malignant tumors, 37 (61.7%) had renal cell carcinoma, 13 (21.7%) had urothelial carcinoma, and 10 (16.7%) had other tumors. Thirty-three cases (89.2%) were diagnosed as pathological subtypes in 37 cases of renal cell carcinoma, and 4 cases (10.8%) were unable to confirm the pathological subtypes. Of the 75 patients, 10.8% were tubal cancer and 23.1% squamous cell carcinoma was urothelial carcinoma, both of which were higher than the reported epidemiological data (2%, 9.9%). Of the 75 patients, 13 were surgically treated and achieved postoperative pathology. The results of biopsy and biopsy results were 100% and 81.8%, respectively, for the diagnosis of benign and malignant tumors, pathological subtypes and pathological grade. And 60.0%. One of the 75 patients (1.3%) had mild hematuria and no other related complications. Conclusion: B-guided ultrasonography can accurately diagnose the pathological subtype of renal cell carcinoma and guide the targeted treatment of patients with advanced renal cell carcinoma. RMB can be more accurate to determine the malignant carcinoma of the collection tube, urothelial carcinoma, Treatment program to provide a reference.