姜涛 王大光 胡志林 张颖 温爽 郭军 杨杨 张建荣

[摘要] 目的 探讨肾嫌色细胞癌的临床特点、诊断及治疗方法。 方法 回顾性分析2006年7月～2015年7月我院收治的16例肾嫌色细胞癌患者，其中男7例（43.75%），女9例（56.25%）；患病年龄25～76岁，中位年龄56岁；肿瘤直径2.5～9 cm，中位数4.8 cm；病理分期：T1aN0M0期6例（37.50%），pT1bN0M0期4例（25.00%），pT2aN0M0期3例（18.75%），pT2bN0M0期2例（12.50%），pT3aN0M0期1例（6.25%）。病变位于左肾9例，右肾7例。 结果 16例均行手术治疗，根治性肾切除术9例，其中腹腔镜下4例；保留肾单位手术7例，腹腔镜下3例。术中均未见肾门淋巴结肿大。Fuhrman分级：Ⅰ级1例，Ⅱ级9例，Ⅲ级4例，Ⅳ级2例，未出现复发或因肿瘤导致死亡者。均未进行化疗。 结论 肾嫌色细胞癌（CRCC）是一种低度恶性的少见的肾细胞癌，较少复发和转移，预后良好，但是确诊有赖于其典型的病理特征，治疗以手术为主，尤其后腹腔镜下肾部分切除术具有创伤小、出血少、不经腹、术后恢复快的优点，值得临床推广。

[关键词] 肾嫌色细胞癌；手术治疗；后腹腔镜；预后

[中图分类号] R737.11 [文献标识码] B [文章编号] 1673-9701（2016）09-0093-03

[Abstract] Objective To investigate the clinical characteristics， diagnosis and treatment of renal chromophobe cell carcinoma. Methods The clinical and pathological data of 16 cases of chromophobe renal cell carcinoma from July 2006 to July 2015 in our hospital were retrospective analyzed， which had 7 males（43.75%） and 9 female patients（56.25%）， were analyzed in combination with literature. The median age was 56 years from 25 to 76 years， the median tumor size was 4.8 cm from 2.5 to 9 cm. Pathological stage was T1aN0M0 in 6 cases（37.5%）， pT1bN0M0 stage in 4 cases （25.00%）， pT2aN0M0 stage in 3 cases （18.75%）， pT2bN0M0 period in 2 cases（12.50%） and pT3aN0M0 stage in 1 case （6.25%）. Lesions were located in left kidney in 9 cases， and 7 cases in the right kidney. Results 16 cases were all treated with operation with radical nephrectomy performed in nine patients-4 removed laparoscopically， and nephron-preserving partial nephrectomy in 7 cases including 3 cases of laparoscopic radical nephrectomy. No renal hilar lymph nodes were found in the operation. According to Fuhrman classification， there was a case of grade Ⅰ， 9 cases of grade Ⅱ， 4 cases of grade Ⅲ， 2 cases of grade Ⅳ， no recurrence or death due to tumor. No chemotherapy was performed. Conclusion Chromophobe renal cell carcinoma（CRCC） is a rare low-grade malignant renal cell carcinoma， with low recurrence and metastasis and good prognosis. It has a unique morphology， histoimmunochemistry and cytogenetic characteristics， with the diagnosis depends on the typical pathological characteristics， upon which the treatment methods will be based on. In particular， laparoscopic partial nephrectomy has the advantages of less trauma， less bleeding， rapid recovery and which is worthy of being encouraged for clinics.

[Key words] Chromophobe renal cell carcinoma； Therapy； Retroperitoneal laparoscopy； Prognosis

肾细胞癌占我国恶性肿瘤的3%，占泌尿系肿瘤第2位。肾嫌色细胞癌（Chromophobe renal cell carcinoma，CRCC）是一种少见病理亚型，肾细胞癌的临床特征、遗传特点、病理特征，各个亚型各不相同。肾细胞癌病理类型中约80%肾透明细胞癌，肾嫌色细胞癌约5%[1，2]。CRCC临床特征缺乏特异性，术前明确诊断有一定困难，但是复发及转移临床少见。近年来病理的诊断水平逐渐提高，CRCC逐渐得到重视[3，4]。总结我院2006年7月～2015年7月收治的16例CRCC的临床资料，对其临床病理特征、诊断及预后结合文献复习进行讨论，现报道如下。……