核素肾动态显像在肾脏恶性肿瘤中的应用价值

选择120例病理诊断为肾脏恶性肿瘤患者,在术前对其行核素肾动态显像,观察血流相及功能相肾脏病灶的血供情况与病理、病灶大小之间的关系;观察随诊85例患者术后6个月肾功能与术前健侧肾小球滤过率(GFR)的相关性,以探讨放射性核素肾动态显像在肾脏恶性肿瘤诊断及预后评价方面的价值。结果显示:120个病灶中79个有早期血供,其中80.2%的肾透明细胞癌、27.8%的乳头状肾细胞癌、36.4%的肾盂移行细胞癌有早期血供。有早期血供的病灶平均直径与早期血供不丰富的病灶平均直径间差异有显著性,t=3.74,P0.01。病灶平均直径6 cm的病灶早期血供明显丰富于平均直径≥6 cm的病灶,χ2=6.84,P0.01。术前健侧肾GFR≥25 mL/min者,术后肾功能均接近正常;术前健侧肾GFR25 mL/min者,术后多会出现肾功能不全。因此,核素肾动态显像病灶早期血供丰富能对肾脏肿瘤诊断提供佐证;健侧肾术前GFR能对术后肾功能做出预测。

Application Value of Nuclear Dynamic Imaging in Renal Malignant Tumor

To observe the evaluation of 99Tcm-DTPA renoscintigraphy in diagnosis of malignant renal tumor and making prognosis,120 patients with pathology approved malignant renal tumor underwent nuclear dynamic renography before surgery.The results showed that 79 of 120 focus had early blood supply including 80.2% of renal clear-cell carcinoma,27.8% of papillary renal cell carcinoma and 36.4% of transitional cell carcinoma.There was significant difference in diameter of foci with early blood supply and without（t=3.74,P0.01）.The foci with mean diameter less than 6 cm had more early blood supply than foci with diameter more than 6 cm（χ2=6.84,P0.01）.Patients with GFR more than 25 mL/min of the uninjured kidney had better renal function after surgery,while some of the patients with GFR lower than 25 mL/min in the uninjured side occured renal inadequacy.So early blood supply appearing in nuclear renography may be help for making diagnosis of renal malignant tumor.GFR of uninjured kidney before surgery may anticipate the prognosis after operation.