后腹腔镜根治性肾癌切除术

目的　评价后腹腔镜下肾癌根治术的安全性及疗效。　方法　2002年 11月至2004年7月于后腹腔镜下行肾癌根治术 46例。男 24例,女 22例。年龄 23~86岁,平均 58岁。3例因无痛性全程肉眼血尿就诊,余 43例为B超体检发现。所有患者腹部均未触及肿物。B超检查报告肿物直径1. 5~8. 0cm,平均 4. 5cm,肿瘤位于肾上极 17例,肾中部 13例,肾下极 16例。46例均行CT检查, 41例行MRI检查,报告肿物大小均与B超相符,术前临床分期:T1N0M0 3例,T2N0M0 38例,T3aN0M0 5例。　结果　本组手术时间 60~255min,平均 145min;出血量 20 ~1000ml,平均 133ml; 32例肿瘤位于肾上极、瘤体>6cm、肿瘤与肾血管关系紧密者均行肾上腺切除。3例发生手术并发症,其中1例为生殖腺静脉损伤,出血约 1000ml转开放手术; 1例用直线切割器切右肾静脉时,误将腔静脉切割封闭了一半,但未出血; 1例为直线切割器切断肾动脉后残端喷血,用钛夹止血。病理报告:肾透明细胞癌 41例,囊性肾细胞癌 2例,嫌色细胞癌 1例,错构瘤 1例,嗜酸细胞瘤 1例。随访 1~20个月,平均 9个月, 1例因肾癌肝转移,于术后 1年死亡,其余病例仍无瘤生存。　结论　后腹腔镜下肾癌根治术安全可靠,疗效良好。     

青少年肾细胞癌14例报告

目的提高青少年肾细胞癌的诊断和治疗水平。方法1992-2004年收治20岁以下青少年肾细胞癌患者14例。男8例，女6例。年龄10～20岁，平均17岁。血尿8例，腰部疼痛6例，腹部肿块5例，发热3例，消瘦2例，尿路刺激症状1例，贫血、乏力1例。14例均行B超、KUB加IVU和CT检查。肿块直径2．5～13．0cm，≤3．0cm者2例，4．0～10．0cm者10例，＞10．0cm者2例。术前Robson分期：Ⅰ期2例，Ⅱ期7例，Ⅲ期4例，Ⅳ期1例。14例均行肾癌根治术，8例术后行免疫治疗。结果病理诊断透明细胞癌11例，颗粒细胞癌2例，混合型癌1例。11例随访1～9年，术后2年内死亡2例，其中1例Robson分期Ⅲ期，肿块直径10．0cm，病理为颗粒细胞癌，另1例Robson分期Ⅳ期，肿块直径13．0cm，病理为混合型癌。余9例均无瘤存活，包括8例术后行免疫治疗者。结论对有肾癌相关症状的青少年宜尽早行影像学检查。根治术是青少年肾细胞癌的标准治疗手段，术后联合免疫治疗可提高生存率。预后与病理类型、肿瘤分期密切相关。     

450例肾细胞癌的临床回顾分析

目的:探讨肾细胞癌的临床特征、预后因素及诊治情况。方法:回顾性分析1999年1月-2005年1月期间收治的450例肾细胞癌患者临床特征、诊疗方法和预后情况。结果:450例平均年龄54.2岁。术后病理检查提示透明细胞癌375例,颗粒细胞癌40例,其他类型肾细胞癌35例。临床分期为T1N0M0期267例,T2N0M0期142例,T3期以上(含T3期)41例,其中偶发肾癌263例,有症状肾癌187例。行肾癌根治性切除术372例,保留肾单位手术78例,其中静脉癌栓取出术8例,术后行α-干扰素治疗161例。平均随访时间37个月(4-60个月)。结论:B超、CT是目前早期诊断肾癌的重要手段;早期行根治性肾切除术仍是最有效的治疗方法,保留肾单位的肾部分切除术对局限性小肾癌是一项可供选择的手术方法,尤其适合于对侧并发肾脏疾病的患者;联合生物治疗对肾细胞癌晚期患者有一定效果。     

肾脏偶发瘤诊治体会

目的提高肾脏偶发瘤的术前诊断率和手术治愈率。方法回顾性分析66例。肾脏偶发瘤患者的术前影像学特点诊断、治疗方法及预后。患者中男40例，女26例；年龄33—67岁，平均52岁。均因体检或行临近器官检查发现肿瘤。肿瘤位于左肾36例，右肾30例。肿瘤直径1．2—4．8cm，其中〉3．0cm者4例。结果66例患者中肾癌36例，行肾癌根治术30例，肾切除术6例；肾错构瘤24例，肾囊肿6例，均行手术治疗。B超诊断肾癌26例，准确率72．2％；CT诊断32例，准确率88．9％。结论肾脏偶发瘤的术前诊断是关键，影像学检查对术前诊断的意义最大。术中可疑病例应行冰冻病理检查，以提高肿瘤的手术治愈率，偶发肾癌的术式选择应根据患者的具体情况决定。     

肾错构瘤的诊断与治疗(附13例报告)

目的探讨肾错构瘤的诊断和治疗。方法本组13例患者手术治疗,4例行肿瘤剜除术,6例行患肾部分切除术,1例患者因急腹症就诊探查确诊切除患肾,1例恶变者行肾癌根治术,1例保守治疗。结果所有手术患者术后恢复顺利,术后随访6个月~2年,未见肿瘤复发。结论通过B超、CT等检查,大部分肾错构瘤的患者都可明确诊断,少数瘤体破裂大出血而诊断未明者,宜剖腹探查。手术是治疗肾错构瘤的主要方法,特别是对于肾错构瘤体积大于4cm者应尽早手术治疗。对少数非手术治疗者,应严密观察。手术宜尽量保留有功能的肾组织,恶变者行肾癌根治术。     

多房囊性肾细胞癌手术治疗的预后特点分析

目的探讨多房囊性肾细胞癌患者手术治疗的预后特点。方法回顾性分析482例肾癌患者中22例多房囊性肾细胞癌患者资料，分析其手术治疗的预后特点。多房囊性肾细胞癌占同期肾癌病例的4．56％，男女比例为2．67：1．00，年龄32～74岁，平均47岁。结果22例患者中行肾癌根治术18例，行肾部分切除术4例。肿瘤直径1．8～11．0cm，平均4．8cm。其中透明细胞癌21例，透明细胞癌与颗粒细胞癌混合型1例；pT1N0M019例，pT2N0M02例；pT3bN0M01例；G15例，G217例。失访2例，20例获随访，随访时间9～56个月，平均27．6个月。其中1例因肝硬化、上消化道出血死亡，无瘤存活21例。结论多房囊性肾癌是肾癌的一种特殊类型，多为肾偶发癌，病理分期分级低，预后与肿瘤大小无关，手术治疗效果满意，预后佳。     

保留肾单位的肾癌切除术探讨

目的 探讨保留肾单位的肾癌切除术的适应证及术中处理。方法 肾癌患者53例。男32例，女21例。年龄21～76岁。病程1周～13个月。均经B超检查发现为单侧肾脏肿瘤，均除外对侧肾病变。肿瘤位于肾上极和下极者38例行肾部分切除术，肿瘤位于肾中部者15例行肾楔形切除术。术中肾血管全阻断，10～15min放松肾蒂钳，肾创面采用止血纱布填塞加可吸收线涤纶布外固定缝合。术后行干扰素治疗（500万U皮下注射，隔日1次，共3个月），每3个月复查。结果 肿瘤切除时间7～21min，平均12min。53例患者均经术中冰冻切片及术后病理学检查确诊为肾细胞癌，切缘阴性。肾癌最大直径6cm者1例，余均〈4cm。临床分期均为T1N0M0。术后随访6．48个月，肿瘤无复发，术侧肾脏功能良好。结论肾癌的快速切除可缩短肾血管全阻断时间，手术效果满意。对于直径〈4cm单发肿瘤或肿瘤直径〉4cm但位于肾浅表呈外凸性生长的T1肾癌，保留肾单位的肾癌切除术是值得积极尝试的治疗方式之一。     

保留肾单位肾癌切除术的疗效与随访

目的 探讨保留肾单位的肾癌手术疗效。方法 26例行保留肾单位的肾癌切除术患者，男16例，女10例，平均年龄47岁。肿瘤直径1．1～4．0cm，平均2．8cm。T1 21例，T2 5例。透明细胞癌22例．颗粒细胞癌3例，囊性肾癌1例。10例有腰痛、血尿、低热等症状，无症状16例。单侧24例，双侧1例，术后孤立肾癌1例。对侧肾功能正常22例，对侧肾有病变或潜在病变4例。术后定期行腹部CT、超声及尿常规检查，复查肾功能。结果 26例手术均成功。术后平均随访41个月，除1例肾转移癌术后16个月因肺癌广泛转移死亡外，余25例肿瘤无复发，无瘤生存至今。结论 保留肾单位的肾癌剜除术安全有效。适用于对侧肾功能正常肿瘤直径≤4．0cm的局限性肾癌，对于对侧肾脏有病变或孤立肾癌是必要的选择。     

不典型肾错构瘤的诊断与治疗（附18例报告）

目的：探讨不典型肾错构瘤的误诊原因,提高其诊治水平。方法：回顾性分析18例不典型肾错构瘤的临床资料。18例均行B超检查,15例行CT扫描,8例行MRI扫描,6例行IVU检查。3例接受保守治疗;15例接受手术治疗,其中3例行肿瘤剜除术,5例行肾部分切除术,7例行肾癌根治术。结果：B超诊断肾错构瘤10例（10／18）,CT诊断肾错构瘤7例（7／15）。3例保守治疗者获得随访,肿瘤大小无明显变化,无转移。15例手术治疗者术后病理检查均为肾错构瘤,随访未见肿瘤转移或复发。结论：大部分肾错构瘤可通过B超、CT等影像学检查明确诊断;对于不典型肾错构瘤,术前应仔细分析影像学检查,结合病史尽量明确诊断,减少不必要的肾切除。     

后腹腔镜下根治性肾切除术并区域淋巴结清扫术40例报告

目的探讨后腹腔镜下肾癌根治性肾切除术并区域淋巴结清扫术的安全性和疗效。方法2002年1月至2006年7月,行后腹腔镜下肾癌根治区域淋巴结清扫术40例。男22例,女18例,年龄23～70岁,平均53岁。8例以无痛性全程肉眼血尿就诊,32例为体检时B超检查发现。B超检查肿物直径1．5～7．0 cm,平均5．0 cm;肿瘤位于肾上极16例,肾中部10例,肾下极14例。40例均行CT检查,31例行MRI检查,报告肿物大小与B超相符。术前临床分期：T1N0M09例, T2N0M025例,T3N0M06例。结果本组手术时间80～180 min,平均120 min。出血量20～300 ml,平均50 ml。无中转开放手术。术后肠道功能恢复时间（24±12）h,术后住院天数（7±2）d。术后无明显并发症。病理报告：肾透明细胞癌33例,囊性肾细胞癌4例,血管平滑肌脂肪瘤2例,嗜酸细胞瘤1例。送检清扫的淋巴结中,阳性4例,均为透明细胞癌,T21例、T23例。随访6～36个月,平均12个月,1例术后3个月局部复发,后因远处转移死亡,其余39例未发现局部复发和穿刺通道的种植性转移,未发现远处转移,均无瘤生存。结论后腹腔镜下肾癌根治性肾切除术并区域淋巴结清扫术安全可靠,疗效良好。     

Renal Cell Carcinoma in Kidney Allografts: A Case Series from a Single Center

In kidney transplant recipients, renal cell carcinoma (RCC) occurs either in the native kidney or, less frequently, in the grafted kidney. Here, we report a series of rare cases involving 5 patients from a single center who developed RCC in their grafts. The diagnosis was made serendipitously by ultrasound. The time lapse post-transplant varied from 4 to 17 years. Surgical treatment consisted of nephron-sparing surgery (NSS) in four cases and a secondary radical nephrectomy in one case. All tumors were less than 4 cm in diameter. The histopathology was clear cell type in four cases and papillary RCC in one case. Patients treated by NSS retained kidney function for 2 years or more, and none of them presented early neoplasia recurrence. In conclusion, NSS can be performed safely in grafted kidneys to treat incidental RCC. It prevents an immediate return to dialysis for patients.     

Adrenalectomy: defining its role in the surgical treatment of renal cell carcinoma

OBJECTIVES: With the recent widespread use of modern imaging techniques, the frequency of small low-stage renal cell carcinomas (RCC) has grown considerably, giving rise to more conservative surgical approaches. We evaluated the characteristics of adrenal involvement and the accuracy of computerized tomography (CT) in the diagnosis of RCC, defining the real need for adrenalectomy during surgical treatment. METHODS: The medical records of 201 patients undergoing radical nephrectomy and ipsilateral adrenalectomy for localized or advanced RCC, from 1996 to 2002, were analyzed, retrospectively. We considered 76 with stage T1-2 disease and 125 with T3-4N0-1M0-1 disease. In all cases a blinded review of the preoperative abdominal CT was performed. Histopathology records of the surgical specimens were examined to determine the accuracy of the CT in identifying adrenal involvement by RCC. RESULTS: The overall incidence of adrenal metastasis was 4.4%. The mean renal tumor size in patients with adrenal involvement was 7.8 cm. The tumor stage correlated with a probability of adrenal spread (p < 0.05), with T1-2 tumors accounting for 1.3% of cases only. The adrenal gland was diagnosed as abnormal on preoperative CT in 21 patients (10.4%). CT scan demonstrated 88.8% sensitivity, 92.1% specificity, 99.4% negative predictive value and 34.7% positive predictive value for adrenal involvement by RCC. CONCLUSIONS: Adrenal involvement is not likely in patients with localized early stage RCC and adrenalectomy can be omitted in such cases, particularly when CT is negative. However, in selected patients with large high-risk tumors, radical nephrectomy, including removal of the ipsilateral adrenal gland, should be performed.     

多房性囊性肾癌八例报告

目的 提高对多房性囊性肾癌(MCRCC)临床、影像学和病理特点的认识及诊治水平.方法 2004年至2006年共收治符合2004 WHO诊断标准的MCRCC患者8例,其中男5例,女3例,平均年龄49岁.以肉眼血尿就诊1例,查体发现5例,初诊肾囊肿、随访发现影像学改变确诊2例.8例术前均行B超、CT检查.二维超声表现为分隔型囊性结构4例,囊实性占位3例,1例诊断为肾囊肿.CT平扫或强化后7例可见囊壁或分隔不规则增厚,但无明显的肿块及结节,1例因肿瘤较小分隔不明显.8例患者中行开放根治性肾切除术4例,肾部分切除术1例;后腹腔镜下根治性肾切除术2例,肾部分切除术1例. 结果 术后病理证实8例均为MCRCC,肿瘤最大直径2.5～10.0 cm,平均5.6 cm.镜下主要表现为纤维组织间隔被覆单层或多层透明细胞,细胞异型性小,核分裂象少.病理分级G17例,G2 1例.TNM分期均为T1 N0 M0期.7例随访6～18个月,平均8个月,均无瘤生存,未见复发转移.1例失访. 结论 MCRCC为肾癌的一种少见类型,术前诊断主要依赖于影像学检查,与其他类型肾癌相比,恶性程度低,预后良好,手术以保留肾单位的肾部分切除术为宜.     

Clinical study on incidental renal cell carcinoma]

Of 93 patients with renal cell carcinoma treated at our hospital between January 1974 and December 1990, thirty-two cases with incidentally detected cancer were evaluated clinically and pathologically. The average age of the patients was 61 years old ranging from 39 to 84 years. There were 25 men and 7 women with a sex ratio of 3.6:1. Fourteen tumors had developed in the right kidney and 17 in the left kidney. One patient had bilateral tumors synchronously and was treated by radical nephrectomy with contralateral enucleation of the tumor. The proportion of incidental renal carcinoma has been increasing steadily; 87.5% of the cases was found by either abdominal ultrasonography or CT scan. Nineteen patients (59.4%) had a tumor smaller than 5 cm in diameter. There were 29 cases with G1 or G2 renal cancer and twenty with pT2. The five-year survival rate in the incidental cases was 52.2% with significantly better survival than in cases when metastasis was initially suspected, but there was no significant difference in survival between the incidentally found cases and the cases of symptomatic renal cancer.     

Incidentally diagnosed renal cell carcinoma.

We analyzed the incidence, sex and age distribution, diagnostic methods and survival rate of incidentally detected renal cell carcinomas (RCCs) and compared these factors with those of symptomatic RCCs. Of 141 patients with RCC treated between 1980 and 1989, 44 cases (31.4%) were incidentally detected. Thirty-one of these 44 cases were diagnosed by abdominal ultrasonography. The age of the incidental cases was significantly higher than that of the symptomatic ones (p = 0.045), particularly in male patients (p = 0.049). The tumor size in incidental cases was smaller and tumor stage earlier (p less than 0.0001). Moreover, the grade of malignancy was significantly lower, and clear cell type tumors were more frequently detected in the incidental cases. No difference was observed between the survival rates of incidental and symptomatic cases with stage 1 or 2 tumors. Of the incidental cases with stage 1 or 2, however, no patient with a tumor 3 cm or less in diameter has died. In conclusion, abdominal ultrasonography is a useful tool to detect RCC at an early stage, and patients with a relatively small tumor tend to have a good prognosis.     

A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma

OBJECTIVES: This study compared the complications and the cancer control of elective nephron-sparing surgery (NSS) and radical nephrectomy (RN) in patients with a small (相似文献   

保留肾单位的肾癌手术(附66例报告)

目的 探讨保留肾单位的肾癌手术治疗方法 和疗效.方法 66例行保留肾单位的肾癌切除手术,肿瘤直径2.0～6.5 cm,平均4.1cm;肿瘤位于肾上极19例,肾中部17例,肾下极30例.TNM分期:T1a NOMO42例,T1b NOMO23例,T3NOMO1例.透明细胞癌59例,颗粒细胞癌6例,乳头状肾细胞癌1例.结果...     

偶发性肾癌的临床分析

目的　探讨偶发性肾癌的临床特征、诊治方法和影响预后的因素。　方法　回顾性分析近 2 0年来收治的 10 9例偶发性肾癌患者的临床资料 ,并与 2 4 7例同期治疗的非偶发性肾癌进行对比。　结果　偶发性肾癌组和非偶发肾癌组在发病年龄、性别、单双侧和病理类型等方面差异无显著意义 ;偶发性肾癌平均直径 (4 1± 1 7)cm ,非偶发肾癌平均直径 (6 4± 3 2 )cm ,差异有显著意义 (t=6 72 ,P <0 0 1) ;偶发性肾癌的病理分期明显低于非偶发肾癌 (χ2 =2 10 .5 2 ,P <0 0 1) ;术后 3年(84 1% )和 5年 (6 8 5 % )生存率高于非偶发肾癌 (χ2 =7.5 1,P <0 0 1)。 1990～ 1999年检出偶发性肾癌 92例 (84 4 % )明显高于 1980～ 1989年的 17例 (15 6 % ,χ2 =19.4 7,P <0 0 1)。B超和CT能明显提高偶发肾癌的检出率 (χ2 =16 6 4 ,P <0 0 1) ;偶发肾癌手术疗效明显优于非偶发肾癌 (χ2 =14 5 4 ,P <0 0 1)。　结论　偶发性肾癌是肾癌未出现临床表现的一发展阶段 ,并非肾癌的另一类型。B超和CT是发现偶发性肾癌的主要诊断方法。此类型的病理分期低、瘤体小、早期发现和尽早根治性肾切除术是偶发性肾癌预后较好的重要因素