家族性脑血管母细胞瘤10例分析

背景与目的：家族性脑血管母细胞瘤是一种特殊的脑血管母细胞瘤，临床对其认识不足，发现率较低。本文探讨家族性脑血管母细胞瘤的临床特点和适宜的外科处置。方法：采用同顾方法对10例经手术和病理证实的家族性血管母细胞瘤进行临床分析一结果：本组病例占同期血管母细胞瘤8.92％（10／112），家族性血管母细胞瘤产生新病灶率（40％）明显高于散发性血管母细胞瘤（3．92％）；肿瘤伞切除18枚（其中囊结节肿瘤13枚，实质性肿瘤5枚），手术死亡1例，出院9例中5例复发．复发问隔4～127个月．平均42个月一恢复劳动或丁作6例，生活自理2例，仍需他人照料1例。结论：家族性脑血管母细胞瘤较散发性血管母细胞瘤易产生新病灶和复发，预后较差，应终身随访；临床应加强对家族性脑血管母细胞瘤的认识．VHL基因诊断是现今可取的诊断手段，并改变患者及家族成员的处置过程。     

颅内血管母细胞瘤的临床研究

目的 探讨颅内血管母细胞瘤（HB）的临床特点及次全切除术后的综合疗效。方法 采用回顾性分析方法，对经手术完全切除的38例（手术组）及手术切除有残灶、术后辅以放疗的25例（综合治疗组）颅内血管母细胞瘤进行临床分析和疗效总结。主要临床症状为颅内压增高（35例）、小脑机能障碍（20例）及颅神经损害（8例）。52例病灶位于小脑，肿瘤病理组织学特点由毛细血管网和间质细胞构成。结果 综合治疗组5例复发，4例死于复发，22例非脑干区术后残留肿瘤照射剂量50～55Gy；其5、10和15年生存率分别为100％、92％和89％。手术组6例复发，3例死于复发；其5、10、15年生存率分别为97％、85％、79％。结论 颅内血管母细胞瘤好发于成人小脑部位，术后有残留者辅以放疗可能会减少复发。     

毛细胞型星形细胞瘤的临床特点和外科治疗

背景和目的：毛细胞型星形细胞瘤是一特殊病理类型的星形细胞瘤，本文结合我们的临床病例，探讨毛细胞型星形细胞瘤的临床特点、病理学和影像学特点以及治疗方法。方法：回顾性分析我院近7年来18例经手术病理证实的毛细胞型星形细胞瘤临床资料。结果：18例患者平均发病年龄20岁，大多位于小脑，临床表现主要为颅内压增高症和共济失调，CT和MRI可分为囊性伴囊壁结节、假囊性伴囊壁结节、实质性3种影像学表现。病理以镜下见到大量Rosenthal氏纤维为特征性改变。预后与手术切除程度有关，全切组(11例)无肿瘤复发；部分残留组(6例)肿瘤易复发(2例)和恶性变(1例)，未放疗组1例肿瘤复发，为次全切除组。结论：毛细胞型星形细胞瘤好发于年轻人和小脑，有较典型的影像学和病理学特点，应争取外科全切除。对未全切病例术后应行放疗，化疗可作为预防肿瘤复发的一种辅助治疗方法。     

保留肾单位手术治疗双肾细胞癌十例临床分析

目的:观察保留肾单位手术治疗双侧肾细胞癌的疗效.方法:回顾性分析10例双侧肾细胞癌患者的临床资料.7例同时性肾癌中,1例行双侧Ⅰ期手术,6例行分期手术.其中3例行双肾肿瘤剜除术,1例行双肾部分切除及右肾上腺切除术,2例行一侧肾癌根治性切除术及对侧肾肿瘤剜除术,1例行一侧肾癌根治性切除术、下腔静脉切开取癌栓术及对侧肾肿瘤剜除术.3例异时性肾癌均分期手术,其中2例行双肾肿瘤剜除术,1例行一侧肾癌根治性切除术,对侧肾肿瘤剜除术.所有患者术后均行生物学治疗3个月.10例获随访3个月～8年,平均19个月.结果:7例未见肿瘤复发和转移.1例术后6个月出现肺转移,已带瘤生存3个月;1例术后1年出现残肾肿瘤复发,经生物学治疗,已带瘤生存3个月;1例术后3个月后死于肾衰竭.异时性肾癌者的先发一侧行肾癌根治术,对侧肾出现肿瘤的时间分别为9个月、2年和6年.结论:保留肾单位的肾切除术是目前双侧肾癌较为理想的治疗方法,它对肾功能的影响较少.双侧肾癌的预后和单侧肾癌一样,与肿瘤的分期和分级有关,而与肿瘤是否多发无关.     

纵隔炎性肌纤维母细胞瘤1例报告并文献复习

目的:探讨纵隔炎性肌纤维母细胞瘤(inflammatory myofibroblastic tumor,IMT)的临床、病理、组织化学特性和诊断方法及预后.方法:总结1例纵隔炎性肌纤维母细胞瘤病人的临床资料,并复习国内外文献,分析和归纳炎性肌纤维母细胞瘤的临床表现、诊断和治疗.结果:患者女性,21岁,在我院全麻下行纵隔肿物切除术,术后病理示:"左中后纵隔"考虑炎性肌纤维母细胞瘤.术后2年,患者再次因"出现左侧胸背部疼痛1月"入院,在全麻下行左后纵隔占位切除术,术后病理示:恶性肌纤维母细胞瘤.术后疼痛短暂缓解,3个月后因局部疼痛,行胸部CT提示再次复发,肿瘤生长速度较前明显加快,遂给予放射治疗,纵隔肿块直线加速器适形照射DT 54Gy/28fx/46d,治疗期间及治疗后3个月,复查胸部CT,提示病灶稳定,患者带瘤生存.结论:纵隔炎性肌纤维母细胞瘤依据病理学检查,应与血管源性肿瘤、神经源性肿瘤等鉴别,治疗以手术切除为主,对于手术控制不好的少数病例,可以考虑放射治疗.     

胰腺头部实性假乳头状瘤的手术治疗

目的:观察手术切除术治疗胰腺头部实性假乳头状瘤的临床疗效。方法:回顾性分析2008年11月至2014年7月间,盛京医院普通外科14例因患胰腺头部实性假乳头状瘤而行手术治疗的患者临床资料,女性12例,男性2例,平均年龄36.2岁。8例行胰十二指肠切除术,2例行保留幽门的胰十二指肠切除术,2例行胰腺部分切除术,1例行胰十二指肠切除术联合门静脉切除术,1例行胰腺部分切除术联合胰体尾空肠Roux-en-Y吻合术。评价手术效果,分析影像特点,并随访远期效果。结果:肿瘤平均7.1cm×6.1cm,所有患者术后病理及免疫组化证实胰腺实性假乳头状瘤,平均住院时间26天,有5例发生术后胰瘘,发病率35.7%,无死亡病例。术后随访8~82个月,中位随访时间27.5个月,有 1例于术后66个月复发,其余13例均无复发。结论:手术治疗胰腺头部实性假乳头状瘤是安全的,完整切除肿物远期疗效确切。     

74例神经外科肿瘤显微手术的临床体会

目的探讨应用显微手术治疗神经外科肿瘤的疗效和体会。方法选择2007年6月至2012年6月收治用显微手术进行切除治疗的肿瘤患者74例，分析手术方法，总结手术效果。结果74例患者共切除肿瘤79枚，平均误差（1．5±0．2）mm；全切68例73枚，次全切6例6枚；手术时间（306．4±25．4）min。神经纤维瘤16枚、脑膜瘤11枚，髓母细胞瘤7枚、侵袭性垂体腺瘤9枚、神经鞘瘤6枚，血管母细胞瘤4枚、血管网状细胞瘤5枚、室管膜瘤5枚、星形细胞瘤2枚、海绵状血管瘤1枚，胆脂瘤3枚、畸胎瘤2枚、脉络丛乳头状瘤5枚、蛛网膜囊肿3枚。术后66例患者症状改善；8例有并发症，其中6例经治疗后好转，2例死亡。结论通过显微技术对神经外科肿瘤的患者进行手术治疗，可最大限度的保护患者的神经功能不被破坏，提高患者的生命质量。     

子宫静脉内平滑肌瘤九例临床分析

目的:探讨子宫静脉内平滑肌瘤病(IVL)的临床特点.方法:回顾性分析2004-04-2008-05诊治的9例子宫IVL的临床和病理资料.结果:9例IVL患者中,7例患者主诉盆腔包块,1例经期延长、经量增多,1例腹痛; 7例盆腔包块超过妊娠12周子宫大小,最大者达妊娠20周大小,子宫全切术后和子宫肌瘤剔出术后各1例;超声检查提示子宫肌瘤8例,盆腔实性肿瘤1例,5例子宫肌瘤血流丰富,其中2例血流呈树枝状,术前无一确诊为IVL.全部患者均接受手术治疗,4例行全子宫+双侧附件切除术,4例行全子宫切除术,1例行盆腔肿瘤切除术.1例患者子宫+双附件切除术后1年复发,瘤栓转移至右心房及右心室再次术后2年无复发.结论: 子宫IVL是具有恶性肿瘤生物学特性的良性病变,提高术中确诊率、彻底切除原发和转移病灶以及术后全面随诊有利于改善预后.     

CT引导下微波消融对肝癌术后复发应用价值及术后复发危险因素分析

目的:探讨CT引导下微波消融对肝癌术后复发应用价值以及术后复发危险因素分析。方法:选取2015年1月至2017年1月在我院接受肝癌切除术术后复发患者30例（复发组），同时选取肝癌切除术术后未复发患者30例作为对照组，复发组患者给予CT引导下微波消融，观察治疗效果。同时比较复发组和对照组患者临床病理资料差异。结果:30例患者经消融治疗后1个月复查，CR患者25例；总不良反应发生率为26.67%，主要为疼痛伴低热、乏力等；中位总体生存时间为15个月，1年、2年总体生存率分别为70.00%和22.70%；治疗后CD4+水平为（40.03±6.22）%，明显高于治疗前（P<0.05）；治疗后CD8+和α-L-岩藻糖苷酶分别为（25.59±4.12）%和（25.20±5.11） U/L，明显低于治疗前（P<0.05）；复发组首次手术肿瘤数量＞1个、邻近大血管比例，明显高于对照组（P<0.05）；Logistic回归分析显示首次手术肿瘤数量＞1个、邻近大血管是肝癌切除术术后复发的危险因素（OR=2.330和3.357，P<0.05）。结论:CT引导下微波消融治疗肝癌术后复发有较好的效果；肝癌切除术术后复发的危险因素包括肿瘤数量，是否邻近大血管。     

20例胰腺囊性肿瘤的诊断和治疗

[目的]探讨胰腺囊性肿瘤的诊断和治疗。[方法]总结1996年10月～2006年10月诊治的20例胰腺囊性肿瘤的临床资料。[结果]20例行B超检查：7例囊腺瘤，影像表现为囊性、内部回声不均匀的低回声光团；13例囊腺癌。影像表现为多发囊性或囊性与实性共存、单发囊性。16例行CT检查：5例囊腺瘤。影像表现为囊性呈多层状、不均匀的低密度影：11例囊腺癌，影像表现为多发囊性或囊性和实性共存、单发囊肿。20例均行手术治疗，其中2例行探查术，2例行姑息性切除，16例行治愈性切除。良性肿瘤中1例囊壁空肠吻合者3年后发生恶变。2例恶性肿瘤分别于术后6和16个月死于肿瘤复发，恶性肿瘤有5年存活者7例。[结论]B超和CT是诊断胰腺囊性肿瘤的有效方法。胰腺囊性肿瘤生长缓慢，应尽快切除。     

颅内血管母细胞瘤34例临床分析

目的:探讨颅内血管母细胞瘤的临床特点和诊治方法。方法:回顾性分析我院自1988~2005年间经手术和病理证实的34例颅内血管母细胞瘤患者的临床资料并复习相关文献。结果:本病的好发年龄在20~40岁,男性多于女性,绝大多数发生在小脑,多为囊结节型。本组所有患者的囊壁瘤结节和实质型肿瘤被完全切除。结论:颅内血管母细胞瘤是良性肿瘤,其诊断主要依靠CT和MRI检查。MRI对囊性血管母细胞瘤的诊断具有特异性。手术切除肿瘤是最佳选择,彻底切除肿瘤可获治愈。     

转移性肾上腺癌的临床治疗（附15例报告）

目的:分析我院收治的15例肾上腺转移性恶性肿瘤的临床资料，结合文献复习，总结临床诊治体会。方法:回顾性分析我院2011年1月至2019年5月收治的15例肾上腺转移性恶性肿瘤患者的临床资料。男12例，女3例；平均年龄为63岁(53～73岁)。肾上腺转移瘤的最大径中位值为4.4 cm（2.0~9.8 cm），左侧11例，右侧3例，双侧1例。原发恶性肿瘤来源:肺7例，肝3例，肾2例，子宫1例，胰腺1例，腹膜后肿物1例。本研究中15例肾上腺转移恶性肿瘤为原发肿瘤确诊后诊断，距离原发肿瘤诊断的中位时间为15.6个月(5~28个月)。15例患者均行手术切除治疗。结果:术后病理细胞类型:腺癌4例，肝细胞癌3例，透明细胞癌2例，弥漫性大B细胞瘤2例，神经内分泌癌1例，癌肉瘤1例，肺小细胞癌1例，肺大细胞癌1例。术后定期随访患者，15例患者生存4~78个月。患者最终死于肿瘤广泛转移。结论:我院肾上腺转移性恶性肿瘤的原发肿瘤以肺癌最为常见，多数转移瘤在定期复查中无意发现。我院肾上腺转移瘤以左侧多见。肾上腺转移瘤治疗方式有手术治疗、介入治疗、经皮肿瘤消融、免疫治疗、放疗和化疗等。     

Rosette-forming glioneuronal tumor of the fourth ventricle in an elderly patient

Rosette-forming glioneuronal tumor of the fourth ventricle (RGNT) is a rare condition, which previously has been described predominantly in middle-aged patients. There is limited experience with this kind of tumor in the elderly. Clinical, neuroimaging, and histological features of an example in a 70-year-old male who presented initially with vertigo are detailed and compared with published cases. Neuroimaging studies demonstrated a 4-cm cystic lesion in posterior fossa containing a 1-cm contrast-enhancing nodule on its lateral margin. The lesion was confined to the fourth ventricle and initially thought to be a hemangioblastoma until angiography clarified the minimal tumor vascularization. Gross total resection was achieved. Pathological examination showed a rosette-forming low grade tumor with a cell proliferation rate of 2% being consistent with RGNT. The postoperative course was uneventful and clinical symptoms resolved completely. There was no tumor recurrence after 2 years follow-up. We confirm that the rare and only recently characterized tumor entity of RGNT can also be found in elderly patients; furthermore, it can be associated with a benign course. The main differential diagnosis of RGNT resulting from CNS-imaging modalities in elderly patients are pilocytic astrocytoma and hemangioblastoma of the posterior fossa, which after metastasis are the most common primary adult intra-axial posterior fossa tumors. Therefore, a subtle preoperative radiological diagnosis is warranted and surgery should be performed by experienced hands to avoid neurological deterioration.     

The Microscopic Surgical Treatment for Tumor of Posterior Cranial Fossa in Children

OBIECTIVE To analyze and discuss about the clinical characteristics,pathological types,surgical modalities and techniques,and postoperative complications in children with tumor of posterior cranial fossa.METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa,admitted and treated in our hospital during the period of January 1996 to January 2007.All patients underwent microscopic surgical treatment.Fiftyeight were male and 44 cases were female.The age ranged from 9months to 14 years old,with an average of 6.1±0.5 of age.Cranial CT or MRI examination was conducted before and after the surgery on all patients.RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia.Postoperative pathological diagnoses showed:46 cases of medulloblastoma,43cases of astrocytoma,11 cases of ependymoma(including 1 case of degenerative ependymoma),1 case of dermoid cvst,and 1 case of teratoma.In this group of the patients,radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases,while surgical removal of large Section was performed on 3 cases.There were no deaths from surgery reported.Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions,while 11 cases showed either no improvement or more severely affected afterward.For 6 cases,postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery.Sixty-three patients gained follow-up for 3 to 60 months in duration.Thirty-nine patients regained normal life and were able to learn well,while there were 7 patients who could not live normally on their own.During the follow-up period,there were 17 cases of recurrence and 7 cases of death.In 23 cases of medulloblastoma in children with age of 3 Years old or above,2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord.Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of C:armustine.CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa,right followed by ependymoma,and dermoid cysts and teratomas were rare.Early correct diagnosis,proper selection of appropriate surgical modality and the surgical margin,proper treatment of postoperative complications,and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with turrtor of posterior cranial fossa.     

小脑血管母细胞瘤2例临床病理分析

目的:探讨小脑血管母细胞瘤（HB)临床影像学表现、病理学特征及免疫组化特点，为鉴别诊断的准确率提供依据。方法:回顾性分析2015年10月至2017年4月诊治的2例HB患者临床资料、影像学表现、病理学特征及免疫组化特点并复习相关文献。结果:2例HB患者均以头痛为首发症状，影像学检查提示小脑半球囊实性和实质性占位，镜下肿瘤主要以大间质细胞和丰富的毛细血管网构成，并根据间质细胞的丰富程度分为细胞亚型，其肿瘤组织内含大量的间质细胞，细胞呈圆形或多角形，胞浆丰满呈空泡状；网状亚型，肿瘤组织内含大量的毛细血管，网织染色示有丰富的网状纤维。HB间质细胞中Vimentin、S-100蛋白、Inhibin-a、CD56表达均阳性且NSE、VEGF高表达，EMA、CD34、CD31、GFAP、EGFR均呈阴性。血管内皮细胞均表达内皮细胞标记物CD34、CD31及FⅧAg。Ki-67增殖指数标记阳性率＜5％。结论:HB是临床较为少见的中枢神经系统良性肿瘤（WHO Ⅰ级)，影像学表现具有一定的特异性，结合病理学特征及免疫组化特点，有助于提高诊断的准确率。     

5例胰腺韧带样瘤的临床诊治分析

目的:总结胰腺韧带样瘤的临床特点及其诊断、治疗、预后。方法:回顾性分析我院2009年1月至2017年1月5例胰腺韧带样瘤患者的临床资料,研究其诊治特点和效果。结果:5例患者都进行手术治疗,所有手术均顺利完成,其中行胰十二指肠切除术3例,胰体尾脾切除术2例,术后出现胰瘘患者2例,随访时间内,失访1人,随访4人,无复发无转移及死亡病例。结论:胰腺韧带样瘤是一种罕见的纤维组织肿瘤,低度恶性,局部侵袭易复发,无转移,手术切除为首选治疗方法,术后辅以放疗可降低复发几率,术后需密切随访。     

原发性十二指肠恶性肿瘤的诊治及预后分析

目的:探讨原发性十二指肠恶性肿瘤的诊治及预后。方法:采用回顾性分析的方法,选取2008年1月至2013年2月我院收治的原发性十二指肠恶性肿瘤患者90例,收集患者的临床资料并进行比较分析。对比患者的诊断方法、外科治疗情况、预后以及影响预后的因素。结果:90例患者中,腺癌57例（63.33%）、恶性间质瘤20例（22.22%）、类癌7例（7.78%）、其他肿瘤6例（6.67%）;术前B超检出率为24.39%（10/41）,腹部增强CT检出率为53.33%（48/90）,十二指肠低张造影检出率为84.00%（21/25）,十二指肠镜检出率为90.36%（75/83）;90例患者均接受了手术治疗,其中60例行胰十二指肠切除术,9例行十二指肠节段性切除,3例行胃大部分切除术并十二指肠球部肿瘤切除术,18例行姑息短路手术。90例原发性十二指肠恶性肿瘤患者的1、3、5年生存率分别为81.11%（73/90）、55.56%（50/90）、31.11%（28/90）。单因素回归分析显示,患者术后的生存率与手术方式、肿瘤分化程度、肿瘤浸润深度以及淋巴转移情况有关（P<0.05）;多因素Cox回归分析显示,手术方式、肿瘤浸润深度以及淋巴转移均为影响患者预后的独立危险因素（P<0.05）。结论:原发性十二指肠恶性肿瘤具有多样的临床表现,十二指肠镜检查以及低张造影均为其有效的诊断方法。手术切除是原发性十二指肠恶性肿瘤的主要治疗方法,手术方式、肿瘤浸润深度以及淋巴转移均为影响患者预后的独立危险因素。     

The microscopic surgical treatment for tumor of posterior cranial fossa in children

OBJECTIVE To analyze and discuss about the clinical characteristics, pathological types, surgical modalities and techniques, and postoperative complications in children with tumor of posterior cranial fossa.
METHODS Retrospective study was conducted on 102 cases of pediatric tumor of posterior cranial fossa, admitted and treated in our hospital during the period of January 1996 to January 2007. All patients underwent microscopic surgical treatment. Fiftyeight were male and 44 cases were female. The age ranged from 9 months to 14 years old, with an average of 6.1 ± 0.5 of age. Cranial CT or MRI examination was conducted before and after the surgery on all patients. RESULTS The primary manifestations for this group of patients were increased intracranial pressure and/or ataxia. Postoperative pathological diagnoses showed： 46 cases of medulloblastoma, 43 cases of astrocytoma, 11 cases of ependymoma （including 1 case of degenerative ependymoma）, 1 case of dermoid cyst, and 1 case of teratoma. In this group of the patients, radical surgery was used in 68 cases and subtotal surgical removal used in 31 cases, while surgical removal of large section was performed on 3 cases. There were no deaths from surgery reported. Ninety-one cases showed significant symptomatic improvement when compared with preoperative conditions, while 11 cases showed either no improvement or more severely affected afterward. For 6 cases, postoperative ventriculoperitoneal shunt was performed within 7 days to 2 months after the surgery. Sixty-three patients gained follow-up for 3 to 60 months in duration. Thirty-nine patients regained normal life and were able to learn well, while there were 7 patients who could not live normally on their own. During the follow-up period, there were 17 cases of recurrence and 7 cases of death. In 23 cases of medulloblastoma in children with age of 3 years old or above, 2 cases who underwent surgical removal of intracranial ependymoma received small dosage of postoperative X-ray radiotherapy on the the brain and spinal cord. Nine cases of medulloblastoma in children under age of 3 and 17 cases of astrocytoma diagnosed after the surgery received chemotherapy of Carmustine.
CONCLUSION Medulloblastomas and astrocytomas were the most common types of pediatric tumor of posterior cranial fossa, right followed by ependymoma, and dermoid cysts and teratomas were rare. Early correct diagnosis, proper selection of appropriate surgical modality and the surgical margin, proper treatment of postoperative complications, and the selecting right radiotherapy or chemotherapy were the key factors in influencing the prognostic outcome of children with tumor of posterior cranial fossa.     

非同步处理肾蒂血管技术在后腹腔镜复杂性肾癌肾盂癌根治术中的应用探讨

目的:探讨经后腹腔入路行腹腔镜复杂性肾癌肾盂癌根治术肾蒂血管非同步处理技巧。方法:2010年1月至2018 年 4月就诊于我科的109例肾癌、肾盂癌患者接受腹膜后入路腹腔镜根治性肾切除术。根据肾蒂血管处理方式的差异分别纳入非同步组和同步组。非同步组患者61例，其中肾癌43例，肾盂癌18例；同步组患者48例，其中肾癌33例，肾盂癌15例；均采用3套管技术，从腹膜后入路，显露肾蒂，非同步组优先处理肾动脉，游离肾脏，最后结扎肾静脉。同步组先游离出肾动脉及肾静脉予以结扎，最后游离肾脏。分别对两组患者的手术时间、术中失血量进行统计分析。结果:非同步组1例男性患者因左肾肉瘤浸润腰大肌、腹膜及结肠，粘连严重转为开放手术，予以排除，两组其余患者均顺利完成手术。非同步组与同步组手术时间分别为:肾癌（94.3±28.1）min vs （113.3±40.3）min，肾盂癌（135.2±43.3）min vs （168.2±37.2）min；术中出血量分别为:肾癌（68.4±56.8）ml vs （100.7±93.1）ml，肾盂癌（105.4±37.3）ml vs （131.3±36.3）ml。比较两组患者病种间手术时间及术中出血量均有统计学差异（P<0.05）。结论:肾蒂血管的处理是复杂性肾癌、肾盂癌经后腹腔镜根治切除的关键，术中灵活的肾血管处理应对尤为重要，非同步肾蒂血管处理技巧有助于减少术中出血量，缩短手术时间，增加手术安全性。     

Recurrent Glioependymal Cyst of the Posterior Fossa: An Unusual Entity Containing Mixed Glial Elements. Case report

Reports of glioependymal cysts in the posterior fossa are uncommon. There are only a few documented cases of posterior fossa glioependymal cysts and, to our knowledge, this is the first documented case of a recurrent posterior fossa glioependymal cyst. We discuss the clinical presentation, pathological features, and treatment options for this lesion. A 55-year-old woman with a 10-year history of a recurrent cytic lesion in the left cerebellar hemisphere, which required two operations, presented with diplopia, dizziness, and ataxia. Magnetic resonance imaging revealed a multiloculted cytic lesion in the left cerebellar hemisphere. Resection, through a suboccipital craniectomy, resulted in improvement of the patient's neurologic status. Microscopic examination of a surgical specimen revealed complex cysts lined by a single layer of ependyma-like cells and underlying gliotic parenchyma with florid reactive changes. Glioependymal cysts of the posterior fossa may present with symptoms of increased intracranial pressure and compression of local structures. Recurrence in this case may be partly explained by subtotal resection in the previous two operations and may also be associated with a florid, proliferative ependymal element. Definitive diagnosis is by microscopic examination of surgically resected specimens. Total extirpation of these cystic lesions is recommended.