腹腔镜下微波消融剜除术治疗肾脏肿瘤的疗效分析

目的 探讨腹腔镜下微波消融肾肿瘤剜除术治疗肾脏肿瘤的疗效与安全性.方法 本组84例肾肿瘤患者,予以腹腔镜下辅助微波消融,尔后手术剜除肾肿瘤,记录术中出血量、手术时间,观察术中、术后并发症及疗效与安全性.结果 84例患者手术均顺利完成,术中均未阻断肾动脉,无术中大出血或中转开放手术,出血量为50~350 ml,手术时间为70~120 min.术后病理诊断为肾透明细胞癌60例,血管平滑肌脂肪瘤16例,嗜酸性细胞瘤4例,嫌色细胞癌2例,乳头状肾细胞癌2例.术中血管平滑肌脂肪瘤普遍出血较多.术后血管平滑肌脂肪瘤出血1例.全部病例随访12个月,无肿瘤复发、远处转移或死亡病例.结论 腹腔镜下微波消融肾肿瘤剜除术是一种安全有效的保留肾单位的手术方式,具有出血量少、手术时间短、术后并发症少等优点.     

腹腔镜下肾血管平滑肌脂肪瘤单纯剜除术

目的探讨后腹腔镜肾血管平滑肌脂肪瘤单纯剜除术的手术方法及临床疗效。方法2005年6月～2006年12月,采用后腹腔镜途径对11例肾血管平滑肌脂肪瘤行单纯剜除术。术中沿瘤体边缘外用电钩或超声刀切开肾包膜,肿瘤突出部分沿边缘整块取出,深部剩余部分富脂瘤体组织由吸引器吸出,再以小方纱擦拭瘤窝表面,双极电凝止血。生物蛋白胶、止血纱布及可吸收线缝合肾脏创面。结果11例手术均成功完成,无中转开放者。平均手术时间84.5min(60～110min),平均术中出血量51ml(20～100ml),平均术后住院时间8.8d(6～14d),无并发症。术后肾功能正常。随访7～23个月(平均13.4月),影像学检查无局部肿瘤组织残留或复发。结论后腹腔镜肾血管平滑肌脂肪瘤单纯剜除术具有创伤小、出血少、恢复快、住院时间短等优点。     

肾血管平滑肌脂肪瘤的保留肾单位手术

目的　评估保留肾单位手术在肾血管平滑肌脂肪瘤治疗中的作用。　方法　回顾性分析 49例行保留肾单位手术治疗的肾血管平滑肌脂肪瘤患者资料 ,观察术前及术后肾功能、手术并发症及预后等。肿瘤剜除术 3 1例 ,肾部分切除 15例 ,原位灌注肾部分切除术 3例 ;其中 3例患者术前行选择性肾动脉栓塞术。　结果　切除肿瘤平均直径 6.0cm (2 .5～ 16.0cm) ,3例原位灌注肾部分切除术肿块直径分别为 10 .5cm、12 .0cm和 15.0cm。 49例术中平均失血量 3 10ml (50～ 10 0 0ml)。无手术并发症发生。术前及术后 10d血肌酐值比较差异无显著性 [(89± 2 6)mmol/Lvs (98± 3 4 )mmol/L ,P>0 .0 5]。 45例平均随访 3 6个月 (1～ 76个月 ) ,无肿瘤复发或需血液透析治疗者。　结论　保留肾单位手术是外科治疗肾血管平滑肌脂肪瘤的首选方法     

肾血管平滑肌脂肪瘤的影像学特征与术式选择

目的：探讨肾血管平滑肌脂肪瘤(RAML)影像学特征及术式选择。方法：对71例肾肿瘤患者．均行B超和CT检查．63例诊为RAML；9例诊断肾癌不排除．其中4例另行MRI联合诊断为RAML。除1例因肿瘤巨大肾实质较少、出血较多或怀疑恶性变而行肾切除，1例行选择性肾动脉栓塞术外．其余均行保留肾单位手术。结果：70例术中及术后病理诊断为RAML；1例术前B超和CT检查诊断为RAML．病程10年．肿瘤未有明显变化，但术中肉眼和术后病理诊断为“肾透明细胞癌”。11例术中阻断肾蒂患者．术后肾功能无明显异常。患者术后B超复查无肿瘤复发和转移。结论：B超和CT是诊断肾血管平滑肌脂肪瘤的重要手段．必要时呵辅助MRI联合诊断。除极少病例需要行肾切除术，RAML患者应尽量行保留肾单位术。     

单中心肾门部肿瘤行肾部分切除术经验总结

目的:总结肾门部肿瘤行肾部分切除术的手术经验,探讨肾部分切除术治疗肾门部肿瘤的可行性及相关技术难点。方法:回顾性分析2014年6月～2016年6月我院行肾部分切除术的66例肾门部肿瘤患者临床资料,其中男38例,女28例,平均年龄(52.6±11.0)岁,平均肿瘤最大径为(4.0±1.8)cm,平均R.E.N.A.L.评分为(9.1±1.3),美国麻醉医师协会(ASA)评分为(1.8±0.4)分。分析手术时间、肾动脉阻断时间、术中估计出血量、手术并发症发生率、手术切缘阳性率、术后病理结果及肾功能变化等指标。结果:所有手术均成功完成,其中行开放手术12例,行腹腔镜手术18例,行机器人手术36例,无一例中转根治,无切缘阳性。患者平均手术时间为(208.8±62.0)min、平均阻断时间为(24.0±8.4)min、平均术中出血量为(147.8±97.7)ml,术后1周肾小球滤过率(eGFR)下降率11.1%。其中1例术中出血1 000ml,输血后治愈,另有3例因尿漏延长放置负压引流管放置时间。术后病理示:透明细胞癌47例、血管平滑肌脂肪瘤7例、嫌色细胞癌6例、乳头状肾细胞癌2例,嗜酸细胞腺瘤、TFE-3基因融合相关肾癌、梭形细胞癌、单纯性囊肿各1例。66例患者均获得随访,随访时间24～48个月,期间均无瘤生存。结论:对于有经验术者,行肾门部肿瘤肾部分切除术出血等并发症发生率低,围术期肾功能变化小,未见肿瘤复发转移,提示手术安全可行,但其远期疗效仍需进一步研究。     

腹腔镜保留肾脏肾肿瘤切除术

目的:探讨腹腔镜保留肾脏手术治疗肾肿瘤的临床应用价值。方法:为21例患者施行腹腔镜保留肾脏肾肿瘤切除术,其中13例经后腹腔途径,8例经腹腔途径,肿瘤直径2.5～4.0cm。术后病理为15例肾脏透明细胞癌(T1N0M0),6例肾血管平滑肌脂肪瘤。结果:21例手术均获成功,手术时间80～130min,血管阻断时间10～35min,术中失血100～400ml,术后无出血、尿漏等重要并发症发生。术后短期随访所有透明细胞癌病例5～22个月无局部复发。结论:腹腔镜保留肾脏肾肿瘤切除术治疗早期肾脏肿瘤(直径≤4cm)安全有效,患者损伤小,康复快,值得临床推广应用。     

腹腔镜下肾肿瘤保留肾单位手术体会

目的 探讨腹腔镜下肾肿瘤保留肾单位手术(NSS)的安全性和町靠性.方法 腹腔镜下NSS手术72例.男43例,女29例.平均年龄47岁.肿瘤最大径平均3.0(1.5～8.0)cm.术前CT检查诊断为肾细胞癌者64例,均为T1.手术常规建立4个通道,于肿瘤周围3 cm处清除脂肪并作切除标记,阻断肾血管后切除肿瘤,创面用钛夹或可吸收缝线缝合止血,创面填塞止血纱布条,1.0 Dixon缝线连续交叉缝合,Hem-o-lok间断固定缝线.结果 手术成功71例,中转开放1例;手术时间平均125(90～190)min;热缺血时间平均22(12～40)min;术中出血量平均110(20～600)ml,术中输血1例,术后输血4例.病理报告透明细胞癌52例、血管平滑肌脂肪瘤14例、嫌色细胞癌5例、集合管癌1例;术后切缘阳性2例,均为血管平滑肌脂肪瘤.术后发生尿瘘1例,留置双J管2周后自愈.住院时间平均7(5～12)d.术后随访72例,平均随访时间26(1～52)个月.患肾功能良好,肿瘤无复发及转移.结论 腹腔镜下NSS操作难度大,采用连续交叉缝合、间隔Hem-o-lok固定可降低手术难度,缩短肾缺血时间,减少并发症.     

肾血管平滑肌脂肪瘤自发破裂出血的急诊处理(附24例报告)

目的 探讨肾血管平滑肌脂肪瘤自发破裂出血的急诊处理.方法 对24例肾血管平滑肌脂肪瘤自发破裂出血患者的临床资料及随访结果进行回顾性分析.术前均行B超和CT检查,22例诊断为肾血管平滑肌脂肪瘤自发破裂出血,2例未能排除肾癌出血.3例保守治疗,4例行选择性肾动脉栓塞术,17例急诊手术.结果 3例保守治疗患者中1例病情稳定,2例改行手术治疗.4例行肾动脉栓塞术患者栓塞成功,出血停止.4例行肾切除术,13例行保留肾单位手术,其中5例行后腹腔镜手术.术后病理诊断为肾血管平滑肌脂肪瘤并出血.随访3个月～6年,肿瘤无复发或转移.结论 B超和CT是诊断肾血管平滑肌脂肪瘤出血的重要手段.治疗可以选择保守治疗、肾动脉栓塞或者急诊手术.     

后腹腔镜肾部分切除术在治疗肾肿瘤的临床应用

目的探讨后腹腔镜保留肾单位的肾部分切除术治疗肾肿瘤的临床应用价值。方法 11例患者施行后腹腔镜保留肾单位的肾部分切除术的临床资料,其中男8例,女3例,年龄平均51.2岁,肿瘤直径3～4cm回顾性分析。结果所有手术均获成功,手术时间70～120min,血管阻断时间20～40min,术中失血100～300ml,术后无出血、尿漏等并发症。术后病理9例肾脏透明细胞癌(T1N0M0),2例肾血管平滑肌脂肪瘤,随访3～15个月无局部复发。结论后腹腔镜下保留肾单位的肾部分切除术治疗早期肾脏肿瘤,安全、有效,兼有创伤小,康复快等优点,近期疗效满意,远期疗效有待进一步观察。     

肾血管平滑肌脂肪瘤18例报告

目的 探讨肾血管平滑肌脂肪瘤的诊断及治疗。方法 回顾性分析近10年来收治的肾血管平滑肌脂肪瘤18例的临床资料。结果 18例术前行B超检查．16例行CT检查。手术治疗16例．其中行肾切除术2例．肿瘤剜除术14例，术后均病理检查证实；定期随访2例．随访2～5年，无肿瘤恶变及复发。结论 对肾血管平滑肌脂肪瘤直径大于4cm．可手术治疗；对肿瘤直径小于4cm，可观察。     

Simple enucleation for the treatment of PT1a renal cell carcinoma: our 20-year experience

OBJECTIVES: To evaluate the safety and efficacy of simple enucleation as a conservative treatment for pT1a RCC, and to report on the incidence of major complications, local recurrence, and progression-free and disease-specific survival rates. METHODS: We retrospectively reviewed the data of 232 patients who had nephron-sparing surgery (NSS) by simple enucleation between 1986 and 2004 for sporadic, unilateral, pathologically confirmed pT1a RCC. The patients' status was evaluated last in September 2005. The mean (median, range) follow-up was 76 (61, 12-225) months. RESULTS: The mean (SD, median, range) tumor greatest dimension was 2.8 (0.78, 2.85, 0.6-4) cm. The histopathologic review according to the International Union Against Cancer and American Joint Commission for Cancer (1997) classification revealed 198 clear cell (85.3%), 18 papillary (7.8%), 15 chromophobe (6.5%) and one (0.4%) collecting duct RCCs. There were no major complications, such as prolonged acute tubular necrosis/chronic renal insufficiency and bleeding requiring open reoperation. One patient developed postoperative late retroperitoneal fluid collection consistent with urinoma, which required aspiration, drainage position and JJ stenting for 3 weeks. The 5- and 10-year cancer-specific survival were 96.7% and 94.7%, respectively. The 5- and 10-year progression-free survival were 96% and 94%, respectively. Overall, 13 (6.4%) patients had disease progression, three of whom had local recurrences alone (1.5%) elsewhere in the kidney; none had local recurrence at the level of the enucleation bed. CONCLUSIONS: Simple tumor enucleation is a safe and acceptable nephron-sparing treatment that provides excellent long-term local control and cancer-specific survival rates.     

Simple Enucleation for the Treatment of PT1a Renal Cell Carcinoma: Our 20-Year Experience

Objectives

To evaluate the safety and efficacy of simple enucleation as a conservative treatment for pT1a RCC, and to report on the incidence of major complications, local recurrence, and progression-free and disease-specific survival rates.

Methods

We retrospectively reviewed the data of 232 patients who had nephron-sparing surgery (NSS) by simple enucleation between 1986 and 2004 for sporadic, unilateral, pathologically confirmed pT1a RCC. The patients’ status was evaluated last in September 2005. The mean (median, range) follow-up was 76 (61, 12–225) months.

Results

The mean (SD, median, range) tumor greatest dimension was 2.8 (0.78, 2.85, 0.6–4) cm. The histopathologic review according to the International Union Against Cancer and American Joint Commission for Cancer (1997) classification revealed 198 clear cell (85.3%), 18 papillary (7.8%), 15 chromophobe (6.5%) and one (0.4%) collecting duct RCCs. There were no major complications, such as prolonged acute tubular necrosis/chronic renal insufficiency and bleeding requiring open reoperation. One patient developed postoperative late retroperitoneal fluid collection consistent with urinoma, which required aspiration, drainage position and JJ stenting for 3 weeks. The 5- and 10-year cancer-specific survival were 96.7% and 94.7%, respectively. The 5- and 10-year progression-free survival were 96% and 94%, respectively. Overall, 13 (6.4%) patients had disease progression, three of whom had local recurrences alone (1.5%) elsewhere in the kidney; none had local recurrence at the level of the enucleation bed.

Conclusions

Simple tumor enucleation is a safe and acceptable nephron-sparing treatment that provides excellent long-term local control and cancer-specific survival rates.     

Simple enucleation for the treatment of renal angiomyolipoma

OBJECTIVES: To report on the role of simple enucleation for treating renal angiomyolipoma (AML) in a series of patients treated in our department. PATIENTS AND METHODS: We retrospectively reviewed the data of all 37 patients with a histopathological diagnosis of renal AML who had either radical nephrectomy (three) or nephron-sparing surgery by simple enucleation (34) between January 1986 and December 2005. Indications for intervention included either symptomatic AML or a tumour of >4 cm, regardless to the presence of symptoms or renal masses suspicious of malignancy. The patients' status was evaluated last in October 2006. RESULTS: The mean (sd, median, range) pathological tumour size was 5.2 (3.4, 4.8, 1.5-15) cm; five patients (15%) were affected by tuberous sclerosis. Simple enucleation was successful in all patients but in three (9%) a sharp dissection a few millimetres from the tumour was used during critical steps of the procedure where it seemed difficult to define the right plane of enucleation. Warm ischaemia was used in 79% of patients, with a mean ischaemic time of 11.2 min. Two patients (6%) required renal hypothermia. A simple parenchymal compression was used in five cases (15%). The mean (range) intraoperative blood loss was 170 (70-650) mL. None of the patients had postoperative bleeding requiring re-intervention but one (3%) required two units of blood after surgery. There were no major complications, e.g. prolonged acute tubular necrosis/chronic renal insufficiency and urinary leakage/urinoma, but two patients had urosepsis not associated with perirenal fluid collection and that required targeted antibiotic therapy. At a mean (median, range) follow-up of 56 (50.5, 10-120) months none of the patients had local tumour recurrence. Two patients had a small AML elsewhere in the operated kidney, detected 18 and 36 months after surgery, with a kidney recurrence rate of 6%. CONCLUSIONS: Our data confirm the optimum results of simple enucleation for renal AMLs; this technique provides excellent long-term local control and no patient had urinary leakage/fistula afterward.     

肾癌与血管平滑肌脂肪瘤的谐波超声造影研究

目的 分析肾癌与血管平滑肌脂肪瘤谐波超声造影的强化形式和时间一强度曲线参数特征. 方法 前瞻性分析.肾癌47例(47个)、血管平滑肌脂肪瘤10例(11个)的谐波超声造影表现及时间强度曲线参数,比较2组强化形式及强化参数差异. 结果 ①27例(57.4%)肾癌高回声,39例(83.0%)彩色多普勒超声显示周边环绕血流或周边向内穿入血流与环绕血流混合;血管平滑肌脂肪瘤为高回声6例(54.5%),3例(27.3%)显示周边环绕血流或周边向内穿入血流与环绕血流混合.②39例(83.0%)肾癌谐波超声造影为高或等增强;血管半滑肌脂肪瘤9例(81.8%))为低增强,2组比较差异有统计学意义(P<0.01).③肾癌峰值强化时间(PT)、廓清时间(WT)、强化程度(△A,峰值强化与基础回声强度之差)、相对强化倍数(△AT/R,肿瘤强化程度与肾皮质强化程度之比)、时间一强度曲线的斜率(k)、相对血流最(△A·k,强化程度与斜率的乘积)分别为(22.65±8.78)s,(206.16±65.94)s,(14.94±6.14)dB,(1.28±0.64)dB,0.29±0.14,4.36±2.62;血管平滑肌脂肪瘤分别为(35.87±16.16)s,(150.03±61.08)s,(8.94±7.87)dB,(0.61±0.37)dB,0.17±0.07,2.06±1.02.2组参数比较差异均有统计学意义,P值均<0.05. 结论 谐波超声造影对肾癌与血管平滑肌脂肪瘤的鉴别有临床应用价值,前者以高或等增强为主,后者以低增强为主;时间一强度曲线参数也有助于二者的鉴别.     

肾肿瘤剜除和改良肾部分切除术21例临床效果观察

目的评估单纯肿瘤剜除术和改良肾部分切除术治疗早期肾癌的临床效果。方法回顾性分析2006年2月至2009年4月间21例早期肾癌患者的临床资料,其中14例接受单纯肿瘤剜除术,7例改良肾部分切除术。结杲所有手术顺利完成,无1例出现严重并发症。平均热缺血时间（21土2）（17～28）min。所有切除标本都有完整的包膜,2例肿瘤〉4cm者包膜有灶状浸润,但未穿透包膜,切除的肿瘤周围肾实质内未见癌细胞。平均随访2．7年,所有患者存活,无局部复发和远处转移。1例出现肿瘤复发,但非原来手术部位,其余均无肿瘤复发。结论单纯肿瘤剜除术和改良肾部分切除术是治疗早期肾癌的安全、有效方法,能够有效保留肾单位和功能,防止肾功不全。     

Partial nephrectomy for renal tumours: the Singapore General Hospital experience.

From January 1991 to August 1998, 220 radical nephrectomies were performed for renal cell carcinoma (RCC). During the same period, 27 patients underwent partial nephrectomy for their renal tumours. These included 19 male and 8 female (mean age, 54; range, 35-75). Their clinical presentation, diagnostic modalities and surgical outcome were evaluated. The lesions included 18 RCCs, 7 angiomyolipomas (AMLs), 1 oncocytoma and 1 dysoncogenetic renal tumour. Only 8 patients had specific urological symptoms. Computerised tomography (CT) scan was diagnostic in 78% of cases. Tumour size ranged from 15-50 mm for RCC and 30-190 mm for AML, respectively. Operative time averaged 92 minutes (range: 35-145). The hospital stay ranged from 3 to 25 days (mean 11). Complications occurred in four cases (14.8%); there was one death (3.7%). No tumour recurrence was detected during a mean follow up of 20 months. None of the patients developed significant renal impairment. Partial nephrectomy is feasible in small RCC and some large AML, and can be offered in selected patients.     

肾细胞癌剜除术远期疗效评价

目的:评价肾细胞癌剜除术的远期疗效.方法:回顾分析23例肾细胞癌患者行肿瘤剜除术的临床资料.结果:1例术中发现一侧肿瘤旁脂肪组织有癌细胞,当即作肾及周围脂肪囊切除;22例剜除术成功.其中,生存15年以上2例,10年以上3例,5年以上6例,2年以上11例.1例术后4年在其肾上极新生长一肿瘤;1例术后5年余,原剜除部肿瘤复发做了肾切除;其余20例皆良好.结论:临床I期CT或MRI肿瘤边缘清晰的肾细胞癌作单纯肿瘤剜除术治疗是可取的,但术中务必做周围组织活检.     

Von Hippel—Lindau病肾癌的临床特征分析

目的 探讨Von Hippel-Lindau（VHL）病肾癌的临床特点。方法回顾分析28例VHL病肾癌患者的临床资料。就初诊年龄、肿瘤部位、同时或异时癌、肿瘤的组织病理等与散发性肾癌进行比较。结果VHL肾癌初诊年龄44．6岁，双肾癌15例、多灶性肾癌16例、伴双侧多发肾囊肿20例。共切除87个实性肿瘤。术后病理：透明细胞癌86个，Fuhrman分级Ⅰ级73个、Ⅱ级12个、Ⅲ级1个；钙化结节1个。TNM分期ⅠA期、ⅠB期、Ⅱ期、Ⅲ期分别为8例、7例、8例和1例。与散发性肾癌组相比，VHL病肾癌组患者发病年龄早（P〈0．05），双肾多灶性肾癌及伴双侧多发肾囊肿比例高（P〈O．001），高级别肿瘤比例低（P〈O．05）。结论VHL病肾癌不同于散发性肾癌，有其独特的临床病理特征，这对该病诊断治疗具有一定指导价值。     

Epstein-Barr virus infection in sarcomatoid renal cell carcinoma tissues

OBJECTIVE: To determine whether Epstein-Barr virus (EBV) infection is related to renal cell carcinoma (RCC) tissues. MATERIALS AND METHODS: We investigated EBV infection and its genotypes in 73 cases of different types of RCC and 18 of non-neoplastic kidney. EBV infection and its genotypes were determined by EBV-encoded RNAs in situ hybridization (EBER-ISH) and polymerase chain reactions for EBV-encoded nuclear antigen 1 (EBNA-1) and EBNA-3C. The immunophenotype and EBV status of the EBV-infected cells were examined by double-labelling of EBER-ISH and/or immunohistochemistry for lymphoid cell markers, EBV proteins, and CD21. RESULTS: EBER-ISH signals were detected in five of 73 RCC tissues (6.8%), but in none of 18 non-neoplastic kidneys. Interestingly, EBER-ISH was positive only in five of the 10 sarcomatoid RCCs, and of these, four also showed amplification of EBNA-1. EBV was located exclusively in the tumour-infiltrating B lymphocytes of sarcomatoid RCCs. The genotype of EBV was determined as type 1. A few EBV-infected B cells expressed BZLF1 (an EBV immediate-early gene product) while none expressed EBNA-2 or latent membrane protein 1. This indicates that the B cells are of EBV latency type I, often replicating EBV. EBV infection did not affect the survival rates of patients with sarcomatoid RCC (P = 0.635, Kaplan-Meier analysis, log-rank test). CONCLUSION: EBV is present only in tumour-infiltrating B lymphocytes of sarcomatoid RCCs. The present study suggests that sarcomatoid RCC modulates a function of EBV-specific T cells controlling EBV replication, or stimulates differentiation of memory B cells into plasma cells.     

细胞粘附分子CD44的变异表达与肾癌的关系

目的探讨变异型细胞粘附分子（ＣＤ４４ｖ）表达与肾细胞癌临床行为的关系。方法采用逆转录聚合酶链反应（ＲＴＰＣＲ）方法分析了ＣＤ４４ｖ在３１例肾癌及１８例正常肾组织标本中的表达情况。结果３１例肾癌中有１８例ＣＤ４４ｖ表达阳性,作为对照的１８例正常肾组织中无一例呈阳性表达（Ｐ＜０００１）。进一步结合病理资料,发现在有转移或病理分期较高的肾癌中ＣＤ４４ｖ的表达率亦较高。结论ＣＤ４４ｖ的表达与肾癌的恶性表型及浸润转移密切相关,可能作为评价肾癌临床行为的一个新的指标