肾嗜酸细胞瘤诊治体会（附5例报告并文献复习）

目的：探讨肾嗜酸细胞瘤早期临床诊断及治疗方法。方法：5例肾嗜酸细胞瘤患者中3例术前诊断为肾癌行肾癌根治术;1例术中冰冻切片证实诊断后行肿瘤剜除术;1例巨大肾占位术前影像学诊断为恶性间皮瘤或脂肪肉瘤,行胸腹联合切口肿瘤切除术。结果：术后随访7～34月,平均15.2月,均无瘤生存。结论：超声、CT及MRI在肾嗜酸细胞瘤的诊断中具有重要作用,对于可疑病例,须行术中快速冰冻病理检查,确诊需要免疫组化检查,宜行保留肾单位手术。     

肾良性肿瘤和瘤样病变诊治分析(附49例报告)

目的　提高肾良性肿瘤和瘤样病变的诊治水平。　方法　肾良性肿瘤和瘤样病变 4 9例 ,均行B超和CT检查 ,14例行MRI检查 ,分析临床表现、病理和影像学特点。 2 1例术前未能确诊 ,按肾癌行肾切除术 ;2 8例行保留肾单位的肿瘤切除术。　结果　各种病变临床症状无特异性。血管平滑肌脂肪瘤CT和MRI表现含脂肪组织的影像学特点。彩超检测 2例肾动脉瘤和 2例动静脉瘘有特异性表现。其他良性病变无特异性影像学表现。行保肾手术的 2 8例患者随访 1～ 9年无复发 ,肾功能正常。　结论　B超、CT、MRI和彩超等影像学检查对肾良性肿瘤和病变有重要诊断价值。有依据的保留肾单位的肿瘤切除术和术中行冰冻病理检查可减少误诊误治。     

囊性肾癌诊治体会

目的 提高囊性肾癌的诊治水平. 方法 回顾分析10例囊性肾癌患者术前影像学特点、病理特征和治疗方法.男7例,女3例.年龄38～74岁,平均56岁.患侧腰酸3例,体检偶然发现7例,有肾囊肿病史者2例.囊腔直径3.5～8.2 cm.术前B超检查诊断为肾癌6例,CT诊断为肾癌7例.8例术中行冰冻病理:肾细胞癌6例,未发现恶性倾向2例.10例均行根治性肾切除术. 结果 术后病理诊断:肾透明细胞癌9例,颗粒细胞癌1例.病理学分型:肾癌囊性坏死6例,多房囊性肾癌2例,肾囊肿恶变型2例.8例随访6个月～5年,6例无瘤存活,2例分别于术后13、20个月死于肿瘤转移. 结论 重视囊性肾癌独特的影像学特点、病理学特征,术中行冰冻病理检查,是提高囊性肾癌诊治水平的关键.     

肾脏非肿瘤实性肿块诊治分析(附12例报告)

目的:提高肾脏非肿瘤实性肿块的诊治水平。方法:回顾12例的诊治过程,分析其临床表现、病理和影像学特点。结果:除肾炎性假瘤和肾血肿有可疑或明确的病史外,其余无明确病史;全部病例行B超、CT检查,1例肾血肿CT提示“血肿不能除外”其余均诊断肾癌或肾肿瘤。手术治疗7例,4例按肾癌行肾癌根治术,1例行肾切除术;2例行术中冷冻活检1例提示黄色肉芽肿性肾盂肾炎,1例提示肾炎性假瘤。5例未手术者观察随访1～4个月后B超复查包块均消失。结论:虽然B超、CT等影像学的检查对肾肿瘤有重要的诊断价值,但是临床医生不应过高评价这些影像检查的诊断学意义。提高诊断水平,术前影像学的复查,肾穿刺活检及术中行冷冻病理检查可减少误诊误治。     

非肾癌肾实质实性占位的诊疗(附58例病例报告)

目的 总结临床诊治非肾癌肾实质实性占位的经验,提高非肾癌肾实质实性占位的诊治水平.方法 回顾性分析经临床或病理诊断为非肾癌肾实质实性占位的58例患者的临床资料.结果 根据58例非肾癌肾实质实性占位患者的病例特点,予46例患者行手术治疗.手术效果确切.结论 非肾癌肾实质实性占位常规临床实验室检查和影像学检查术前常难以做出准确诊断,术中冰冻病理结果对诊断及具体手术方案的制定很有帮助.对于诊断为错构瘤和肾嗜酸性细胞瘤的患者,可适当放宽肾脏部分切除的手术适应证,尽量减少肾切除手术.     

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。     

肾嗜酸细胞瘤4例临床分析

目的:探讨肾嗜酸细胞瘤的临床、影像学及病理学特点,提高对肾嗜酸细胞瘤的诊疗水平。方法:回顾性分析4例肾嗜酸细胞瘤患者的临床资料:临床表现为右上腹痛2例,另2例体检发现。2例静脉尿路造影(IVU)检查提示占位性病变,超声、CT及肾动脉造影诊断为肾癌。4例均行肾癌根治性切除术,其中2例行腹腔镜手术,2例行开放性手术。结果:术后病理检查均诊断为肾嗜酸细胞瘤。术后B超随访6～15个月,4例均未出现复发和转移。结论:肾嗜酸细胞瘤是良性肿瘤,但临床症状、影像学表现与肾癌类似,需病理检查确诊。治疗上首选保留肾单位手术,术中冷冻切片活检可对手术提供重要信息。     

术前影像诊断肾癌的肾脏良性病变发生率及预测因素分析

目的:研究在中国患者中术前影像学诊断肾癌行肾脏部分切除手术或根治性肾切除手术的肾脏良性占位病变发生率,并分析其预测因素。方法:回顾性分析从2003年1月～2010年9月共1 531例术前影像学诊断为肾癌并行肾脏部分切除手术或根治性肾切除手术患者的临床资料,多因素回归分析术后病理检查证实为良性患者的临床病理资料。结果:在1 531例患者中,共有81例(5.3%)为良性,其中包括错构瘤52例(3.4%),嗜酸细胞腺瘤12例(0.8%),复杂性囊肿6例(0.3%),其他类型11例(0.7%)。单因素分析显示女性、肿瘤最大径较小、年龄较小、囊性占位病变为临床表现者,病理检查证实为良性的可能性大。多因素回归分析显示,女性(OR,3.13;95%CI,1.95～5.04;P<0.001)、肿瘤最大径较小(OR,0.75;95%CI,0.66～0.85;P<0.001)、年龄较小(OR,0.94;95%CI,0.92～0.96;P<0.001)是良性占位病变的独立预测因素,而囊性占位病变不是显著性预测因素。结论:在中国患者中,术前影像学检查诊断为肾癌术后病理检查证实为良性病变的发生率为5.3%,较国外同类研究明显偏低。良性占位病变中最常见的类型为错构瘤,而欧美同类研究中为嗜酸细胞腺瘤。女性、年龄较小、肿瘤最大径较小是良性占位病变的独立预测因素。     

囊性肾癌的诊治(附12例报告)

目的　提高对囊性肾癌的认识。　方法　总结 12例囊性肾癌患者的诊断、治疗、预后等资料。术前诊断为复杂性囊肿 10例 ,9例术中行病理检查 ,8例报告为恶性。 12例中行根治性肾切除 7例 ,肾切除 3例 ,部分肾切除和囊肿去顶各 1例。　结果　 12例术后病理均为囊性肾透明细胞癌 ,平均随访 39.5个月 ,无肿瘤复发和转移。　结论　对可疑囊性肾癌者 ,术中须行病理检查 ;确诊者宜行根治性肾切除或部分肾切除。囊性肾癌预后较好     

小肾癌54例诊治分析

目的 提高小肾癌的诊断水平和治疗效果。方法 对54例直径小于3cm的小肾癌的诊断与治疗进行回顾性分析。结果 54例中因体检或其他疾病检查时发现者37例（68．5％）；腰痛9例（16．7％）；血尿5例（0．9％）；腰痛伴血尿3例。行根治性肾切除术43例．行保留肾单位手术11例。术后均经病理证实。术中快速冰冻切片证实5例。结论 小肾癌多为偶然发现。其早期诊断主要依靠B超、CT、MRI和DSA等影像学检查；手术视具体情况行根治性肾切除术或保留肾单位手术；小肾癌病理分期低。肿瘤体积小．预后较好，生存率高。     

多房性囊性肾癌的诊治体会

目的:提高对多房性囊性肾癌(MCRCC)的诊治水平。方法:2006年1月～2011年3月我院共收治MCRCC患者12例,男8例,女4例,平均年龄50岁。该组患者均于体检时发现。术前均行B超、CT检查,其中有3例又行MRI检查,术前诊断囊实性占位10例,诊断肾囊肿2例,4例行根治性肾切除,6例行肾部分切除,1例术中病理为良性,行去顶减压术,术后病理为恶性而二次行肾切除术。1例患者术中取病理回报为恶性而行肾切除。结果:该组患者术后病理均证实为MCRCC,肿瘤最大直径为2.5～8.0cm,平均4.0cm。TNM分期均为T1N0M0期。病理分级G110例,G22例。随访3～62个月,平均36个月,均无瘤生存。结论:MCRCC恶性度低,预后好。术前诊断主要依赖于影像学检查,但影像学检查无特异性,不易与多房性肾囊肿鉴别,肾部分切除术是治疗的最佳选择。     

结石肾并肾癌的诊断和治疗

目的 探讨结石肾合并肾癌的诊断与治疗策略.方法 回顾分析9例结石肾合并肾癌患者的病例资料及诊治经过.结果 9例患者中2例术前检查已发现结石肾合并肾占位病变行根治性肾切除;另7例中4例因结石手术术中发现可疑病灶行快速冰冻切片病检证实为肾细胞癌而行根治性肾切除,3例因结石肾积水合并感染形成脓肾行患肾切除,术后病理证实为肾癌...     

Image-guided biopsy-diagnosed renal cell carcinoma: critical appraisal of technique and long-term follow-up

OBJECTIVES: To critically appraise and determine the impact of image-guided biopsy on the management of indeterminate renal masses. A comparison of long-term follow-up of renal cell carcinoma (RCC) diagnosed by image-guided biopsy and radiologically obvious RCC was also carried out. PATIENTS AND METHODS: Data were collected for all the consecutive patients requiring renal core biopsies for the diagnosis of indeterminate renal masses between January 1996 and January 2006. The long-term outcome of diagnostic and nondiagnostic renal biopsies was assessed. Furthermore, the long-term outcome of RCC diagnosed following biopsies was compared with nonbiopsy radical nephrectomy done during the same time period. RESULTS: Of the 70 biopsy procedures performed, 9 were nondiagnostic and 61 were diagnostic on histopathologic examinations (17 benign and 44 malignant). The histopathology of all radical nephrectomies was identical to the pathology of biopsy specimens. Of the nine nondiagnostic cases, one patient had a repeat biopsy that was confirmed as RCC. Six patients including the case diagnosed to have RCC on repeat biopsy underwent radical nephrectomy in the nondiagnostic group. The histopathology revealed RCC in four, and angiomyelolipoma and pyelonephritis in one each. The remaining three nondiagnostic cases are under follow-up; there has been no change in the size of the lesions in a mean follow-up of 32 mo (range: 12-52). There has been no change in the size of benign lesions at a mean follow-up of 29 mo (range: 3-72). The procedure-related complication in the form of bleeding following biopsy was observed in one patient, which settled conservatively. There was no statistically significant difference (chi-square=1.134 and p value equal to 0.379) in the recurrence rate and metastases between the biopsy radical nephrectomy and nonbiopsy radical nephrectomy groups for the same stage of disease during the same period. CONCLUSIONS: Image-guided biopsy is safe and accurately characterises indeterminate renal masses. A repeat biopsy protocol is useful in case of a nondiagnostic first biopsy. The long-term outcome following radical nephrectomy of biopsy-diagnosed RCC does not differ from the radiologically obvious RCC.     

长期血透患者获得性囊性肾病合并肾癌8例报告并文献复习

目的:学习长期血透患者获得性囊性肾病合并肾癌的筛查和诊治方法。方法:回顾性分析我院维持性血透获得性囊性肾病合并肾癌患者8例,均为B超和CT诊断为双肾多发性囊肿合并肾实质性占位,并行后腹腔镜下根治性肾切除术,术后维持规律性血透,并严密随访。结果:长期血透患者226例,获得性囊性肾病105例(46.5%),获得性囊性肾病合并肾癌8例(3.5%),在获得性囊性肾病中发生率为7.6%(8/105),其中男5例,女3例,年龄(58.6±16.4)岁,血透(12.2±6.9)年。8例患者(9次)行后腹腔镜下根治性肾切除术,手术均成功,出血(45.2±20.3)ml,手术时间(72.5±20.3)min,无严重手术并发症,术后病理3例为透明细胞癌和6例为乳头状癌。住院天数为(7.5±2.4)d。随访12～63个月,无瘤存活5例。结论:肾癌在获得性囊性肾病患者中发病率高,随着血透患者寿命的延长,血透3年后需重视和建立肾癌筛查机制,腹腔镜下根治性肾切除术安全有效、恢复快,并注重患者心脑血管疾病及糖尿病等并发症的积极治疗,有助于进一步延长血透患者寿命。     

Robotic nephrectomy for central renal tumors with intraoperative evaluation of tumor histology

Patients undergoing nephrectomy for central renal tumors suspicious for renal cell carcinoma (RCC) may carry a small risk of having transitional cell carcinoma (TCC) on final pathology, even in the absence of filling defects or abnormal cytology. We describe outcomes in such patients undergoing robotic nephrectomy for suspected RCC, with intraoperative specimen assessment to guide completion ureterectomy if TCC is present. Between September 2010 and August 2015, ten patients had central renal masses suspicious for RCC, which were not amenable to nephron-sparing surgery. Patients underwent a four-arm robotic nephrectomy technique using a GelPOINT^® access port. Following hilar ligation, the ureter was divided between adjacent hem-o-lok clips, placed in an endocatch bag, and extracted through the GelPOINT incision for the frozen section analysis. If intraoperative assessment confirmed TCC, a robotic completion ureterectomy and a bladder cuff excision were performed. Of the ten patients with central tumors who underwent robotic nephrectomy for suspected RCC, four (40 %) had TCC on the frozen section analysis and underwent completion ureterectomy. Five patients had RCC, and one patient had an oncocytoma. Mean age was 63.1 years (49–76) and mean tumor size was 4.0 cm (1.9–7.6). Mean operating time was 246 min (135–328). All patients had negative margins. Mean length of stay was 2.5 days. No recurrences were documented at median 8.5 months follow-up. For patients undergoing robotic nephrectomy for central renal tumors, intraoperative specimen evaluation can help determine the need for minimally invasive completion ureterectomy.     

肾脏交织状血管瘤的影像学表现：附2例报告并文献复习

目的探讨肾脏交织状血管瘤的临床特点及影像学表现,提高对该病的诊断及治疗水平。方法回顾性分析2例原发于肾脏的交织状血管瘤患者的临床资料,2例患者术前接受CT 或 MRI 检查均诊断为肾脏肿瘤性病变,均接受腹腔镜下根治性肾脏切除术。结果肿块在CT 上呈类圆形,边界尚清,凸向肾窦,增强呈不均匀性延迟强化特点;T2 WI 上呈不均匀的稍高信号,DWI 呈等或稍高信号,PWI 上强化方式与增强 CT 相似,呈向心性充填。术后病检肿块呈灰褐色,与周围组织境界清,无包膜;显微镜下,肿块具有松散的小叶结构,肿瘤细胞无异型性;免疫组化示 CD31(＋)、CD34(＋)。术后患者恢复良好,未出现明显复发或转移迹象。结论交织状血管瘤是肾脏的良性血管瘤性疾病,临床少见,影像学上有一定的特点,但术前诊断困难。此类病变应与肾脏恶性肿瘤,特别是血管肉瘤相鉴别。治疗上以手术治疗为主。     

肾脏嗜酸细胞腺瘤6例报告

目的：探讨肾脏嗜酸细胞腺瘤的临床特征。方法：报告6例本病患者的临床资料，5例无临床表现，经B超体检偶然发现“肾脏占位”；1例腰痛、腰部不适、触及腹部包块。CT、IVU等影像学检查均有阳性发现。行肾脏部分切除术2例，根治性肾脏切除术4例。术中快速冷冻病理检查确诊。结果：6例术后均痊愈。随访13～96个月，平均78．6个月，2例随访时间未满5年，4例已超过5年（60个月），均未见肿瘤复发和转移。结论：肾脏嗜酸细胞腺瘤是一种少见的良性肿瘤，多无临床表现；影像学检查均有阳性发现；确诊有赖于病理检查，术中快速冷冻病理检查对确定术式有帮助。