2019 年第 6 期 第 14 卷

影像诊断在肾肿瘤伴下腔静脉瘤栓中的价值

Value of imaging diagnosis in renal tumor with inferior vena cava tumor thrombus

作者：李丽伟刘茁何为张丽崔立刚王淑敏

英文作者：

单位：100192北京大学第三医院超声诊断科（李丽伟、张丽、崔立刚、王淑敏），泌尿外科（刘茁），放射科（何为）

英文单位：

关键词：肾肿瘤；下腔静脉瘤栓；病理类型；影像诊断

英文关键词：

• 摘要：

• 【摘要】目的    探讨影像在肾肿瘤伴下腔静脉瘤栓诊断中的价值。方法    回顾性选取北京大学第三医院2014年1月至2018年10月行手术治疗的肾肿瘤伴下腔静脉瘤栓患者108例，结合肾肿瘤及瘤栓的超声、CT和/或磁共振成像（MRI）影像学表现和原发肿瘤病理特征，探讨影像诊断价值。结果    结合患者影像学表现及原发肿瘤病理特征，108例患者诊断为肾透明细胞癌82例（75.9%）、乳头状肾细胞癌12例（11.1%）、肾母细胞瘤3例(2.8%)、尿路上皮癌6例(5.6%)、血管平滑肌脂肪瘤2例（1.9%）、肾脏Ewing肉瘤1例（0.9%）、TFE3易位肾细胞癌1例（0.9%）、嫌色细胞性肾细胞癌1例（0.9%）。CT/MRI检查发现，下腔静脉最大冠状径为（3.2±0.7）cm，下腔静脉瘤栓长度为（7.0±4.2）cm。下腔静脉瘤栓伴血栓35例，血栓可位于下腔静脉远心端、近心端及对侧肾静脉。结论    不同病理类型肾肿瘤伴下腔静脉瘤栓影像表现不同。结合超声、CT及MRI影像表现，分析肾肿瘤的影像特征及瘤栓长度、范围及肿瘤血供、伴血栓情况，对治疗方案及手术计划制定有重要指导意义。

• 【Abstract】Objective    To explore the value of imaging diagnosis in renal tumor with inferior vena cava tumor thrombus(IVCTT). Methods    A retrospective analysis was conducted on 108 patients who had surgery for renal carcinoma with IVCTT in Peking University Third Hospital from January 2014 to October 2018. Pathological types of renal carcinoma and imaging features of ultrasonography, CT and/or magnetic resonance imaging(MRI) manifestations were analyzed. Results    There were 82 cases(75.9%) of clear cell renal cell carcinoma, 12 cases (11.1%) of papillary renal cell carcinoma, 3 cases(2.8%) of nephroblastoma, 6 cases(5.6%) of urothelial carcinoma, 2 cases(1.9%) of angiomyolipoma, 1 case(0.9%) of Ewing sarcoma, 1 case(0.9%) of translocation of TFE3 renal cell carcinoma and 1 case(0.9%) of chromophobe renal cell carcinoma. CT/MRI showed that the maximum coronal diameter of inferior vena cava was (3.2±0.7)cm and the length of IVCTT was (7.0±4.2)cm. There were 35 cases of IVCTT with bland thrombus located at distal, proximal of inferior vena cava and contralateral renal veins. Conclusion    Ultrasonography, CT and MRI can indicate the length, range, blood supply and thrombosis of renal carcinoma with IVCTT and provide references for therapeutic choice and surgical planning.