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目的:探讨肾细胞癌边缘部CT征象与病理基础。材料与方法:搜集32例经手术病理证实的肾细胞癌,观察其术前边缘部的CT征象与术后病理改变对照。结果:(1)CT肿瘤边缘形态分3类:肿瘤边缘清楚无分叶(50%);边缘清楚伴分叶(28%);边缘不清(22%)。(2)肿瘤边缘病理分3种类型:包膜完整(48%);包膜不完整或锯齿状(33%);无包膜(19%)。(3)肿瘤平扫边缘不清者有7例,增强后病灶“缩小”或变清者占94.4%。(4)肿瘤边缘形态与癌细胞分级关系:边缘清楚无分叶或伴分叶者,癌细胞分级Ⅰ~Ⅱ级占81.8%,Ⅲ级占18.2%;边缘不清者,以Ⅲ级为主,占70%。结论:(1)CT肿瘤边缘3类形态恰与病理上肿瘤边缘3种类型相对应:即CT肿瘤边缘清楚无分叶者,病理上大多包膜完整;边缘清楚伴分叶者,病理上大多包膜不完整或锯齿状;边缘不清者,病理大多无包膜。因此,CT肿瘤边缘3类形态能较好地反映肿瘤包膜的完整程度以及肿瘤浸润情况。(2)CT平扫肿瘤边缘不清者,增强后肿瘤大多“缩小”或边缘变清,边缘不清是肿瘤周围正常肾实质内散在浸润的癌细胞所致,对于指导手术范围有一定帮助(手术应略扩大范围)。(3)CT平扫肿瘤边缘清楚无?
Objective: To explore the CT features and pathology of the margins of renal cell carcinoma. MATERIAL AND METHODS: Thirty-two cases of renal cell carcinoma confirmed by pathology were collected. The CT findings of preoperative margins and postoperative pathological changes were observed. Results: (1) The tumor margins of CT were divided into three groups: tumor-free margin (50%); margin clear with lobes (28%); marginal margin (22%). (2) There are three types of tumor marginal pathology: complete capsule (48%); incomplete or serrated coating (33%); no capsule (19%). (3) There were 7 cases of unclear margins of the tumor, 94.4% of the lesions were “narrowed” or clear. (4) Tumor marginal morphology and cancer cell grading: clear edge without leaves or leaves, cancer cells grade Ⅰ ~ Ⅱ grade accounted for 81.8%, Ⅲ grade accounted for 18.2%; marginal unclear to Ⅲ-based, accounting for 70%. Conclusions: (1) The three types of CT margins just correspond to the three types of pathological tumor margins: the CT margins of the tumor are clear without lobe, most of the pathological lesions are completely enveloped; the margins are clear with lobe, most of the pathology Envelope is not complete or jagged; unclear margins, mostly non-enveloped pathology. Therefore, three types of CT edge morphology can better reflect the complete extent of tumor capsule and tumor infiltration. (2) CT scan of the edge of the tumor is not clear, most of the tumor enhanced the “shrink” or clear edge, unclear margins surrounding the normal renal parenchyma within the scattered infiltration of cancer cells caused for the guidance of the scope of surgery has some help Surgery should be slightly expanded range). (3) CT scan clear tumor edge?