【作者】 李亚健；

【导师】 李汉忠；

【作者基本信息】 北京协和医学院 ， 临床医学， 2013， 博士

【摘要】 目的：1.对全国19家合作医院泌尿外科2007年1月-2011年12月所有肾癌患者的诊治资料进行统计,分析我国最近5年来肾癌发病情况及诊治观念的变化。2.统计北京协和医院2002年1月-2012年12月泌尿外科肾癌患者的详细诊治资料,分析我院最近10年来肾癌诊治情况,和外院资料进行对比,总结我院肾癌的诊治经验。3.建立北京协和医院肾癌数据库,为医院和科室科研搭建数字平台。方法：外院2007年1月-2011年12月的肾癌患者诊治资料收集工作由全国19家合作医院泌尿外科的临床医生完成,共录入8438例肾癌患者,回顾性分析其中具备较完整临床资料的6853例患者,分析我国最近5年来肾癌的发病情况及诊治观念的变化,比较肾癌的发病情况和病理类型是否存在地域差异；我院2002年1月-2012年12月的肾癌患者诊治资料的收集工作由我和具有临床经验的医学生完成,共录入1638例肾癌患者,回顾性分析其中具备较完整临床资料的1571例,总结我院最近10年来肾癌患者在年龄、性别、籍贯、住院天数、治疗费用、TNM分期、肿瘤位置、手术方式、手术时间、术中出血、术后并发症、术后病理结果等特征,并建立北京协和医院数据库。结果：1.外院6853例肾癌患者中,男5238例,女2641例,男女比例为1.98：1。发病年龄范围为1-99岁,平均56.0±13.3岁,高发年龄段为47-68岁。其中肾透明细胞癌3517例(51.32%),肾透明细胞癌所占比例远远低于文献报道,考虑与还有2926例患者病理报告不详细,无法进一步归类有关。2.北京协和医院1571例肾癌患者中,男1085例,女486例,男女比例为2.2：1。发病年龄范围为15-86岁,平均54.34±12.82岁,高发年龄段为45-60岁。其中肾透明细胞癌1279例(81.41%),发病年龄范围为15-86岁,高发年龄段为44-58岁。不同地区在肾癌的发病年龄和病理类型上不存在统计学差异。肾癌的发生在侧别、上/中/下极方面不存在统计学差异。3.无症状肾癌患者在发病人群中已占主要比例：北京协和医院1571例肾癌患者中,有1169例为“无症状肾癌”(74.41%),402例为症状性肾癌(25.59%),且无症状肾癌比例逐年增高。无症状。肾癌患者和症状性肾癌患者相比,在性别、年龄、肿瘤位置、吸烟史方面无显著性差异。但是无症状肾癌的肿瘤直径较小、病理分期较低,发生远处转移较少,手术时间、住院天数、治疗费用都较少(P<0.01)。因此坚持体检对于早期发现、早期诊断、早期治疗有重要意义。4.腹腔镜已取代传统开放性手术占据主导地位：北京协和医院泌尿外科自2004年起在临床开展腹腔镜治疗,2009年以后已超过传统开放性手术。和外院相比,北京协和医院腹腔镜开展最早,推广最快,应用程度最高。和传统开放性手术相比,腹腔镜手术时间短、术中出血量少、术后恢复快、住院时间短、治疗费用少,且对肾功能的影响和开放性手术无差异(P＜0.01)。5.不同医疗保险制度对住院天数和治疗费用有影响：公费医疗/商业保险的平均住院天数最长,而新农合的平均治疗费用最高。更多还原

【Abstract】 Objectives:1. By collecting RCC treatment related materials from2007to2011in urinary surgery departments of19hospitals, to analyze RCC epidemiology and changing treatment in recent5years.2. By collecting detailed treatment materials of patients in PUMC urinary surgery department from2002to2012, to analyze PUMC RCC treatment in recent10years. Then conclude our RCC treatment experience after comparing with other hospitals.3. To build up PUMC RCC database as a e-platform for scientific researches of our hospital and department.Method:RCC treatment related materials from2007to2011in other hospitals were input by doctors in their urinary surgery departments. There are8438cases in total, within which6853cases have provided integrated information for analyzing RCC epidemiology and changing treatment in recent5years, and whether any regional difference in RCC epidemiology and pathology. RCC patient treatment material collection of PUMC was done by me and other medical students with clinical experience. We have collected1638cases and1571cases are with integrated information. With those cases, I have concluded patients’characteristics by age, gender, native place, length of stay, cost, TNM stage, tumor location, operation method, vessel bleeding, complication, pathological diagnosis.Results:1. In6853patients of other hospitals, there are5238male and2641female (1.98:1). Their ages distribute from1to99, with an average of56.0±13.3. High incidence age is from47to68.3517cases (51.32%) belong to Suprarenal Epithelioma, which show much lower percentage compared with previous literature. The reason may be2926cases are without pathological diagnosis, thus cannot be classified.2. In1571patients of PUMC, there are1085male and486female (2.2:1). Their ages distribute from15to86, with an average of54.34±12.82. High incidence age is from45to60.1279cases (81.41%) belong to Suprarenal Epithelioma. And its high incidence age is44-58. There is no statistical difference between different regions in RCC incidence age and pathology. Neither is there any statistical difference between tumor locations.3. Asymptomatic patients have higher proportion, i.e.1169out of1571cases (74.41%) are asymptomatic, and other402cases (25.59%) are symptomatic. The percentage of asymptomatic patients is increasing year by year. Comparing asymptomatic with symptomatic patients, they have no significant difference in gender, age, tumor location and smoking history. But tumor diameters of asymptomatic patients are smaller, and they tend to have lower stage, shorter operation time, fewer days of stay, and lower cost (p<0.01).As a result, keep doing physical examination is very helpful for earlier discovering, diagnosing, and treating.4. Laparoscopic operation, is occupying a leading position in place of open operation. PUMC started laparoscopic operation clinically from2004, and its percentage gets higher than traditional open operation after2009. Compared with other hospitals, PUMC started earlier in laparoscopic operation. And it was spread faster and applied more. In comparison with traditional open operation, laparoscopic operation takes less time. Patients who took laparoscopic operation generally have less bleeding in operation, recover faster after operation, stay shorter time in hospital, spend less for treatment. And two ways of operation have no difference in influence to renal function (p<0.01)5. Different type of medical insurance will impact length of stay and treatment cost. Patients with state medical insurance and commercial health insurance always stay in hospital longer. And treatment cost of patients with new rural cooperative medical insurance is the highest among all.更多还原