复合式肾动脉栓塞术在肾癌治疗中价值的探讨(附19例报告)

目的：探讨复合式肾动脉栓塞术在肾癌治疗中的应用价值。方法：对19例肾癌采取复合式肾动脉栓塞术联合治疗,并对其临床资料进行总结和讨论。结果：15例行肾癌根治术,术中出血少,无严重并发症,术后3、5年生存率分别为86．7％(13／15)、60．0％(9／15)。3例晚期肾癌和1例仅手术探查活检者血尿消失,肿块缩小,生存7～19个月。结论：复合式肾动脉栓塞术能提高肾癌的手术切除率及治疗效果,对较大或巨块型及粘连严重的肾癌患者可列为手术前的常规准备,对晚期肾癌或体差、无法切除患肾者,可作为主要的有效治疗手段之     

根治性肾癌切除术前应用超选择复合式肾动脉栓塞术的体会

为了探讨根治性肾切除术前应用超选择复合式肾动脉栓塞术的临床价值,我们对47例肾癌病人均于术前5～7天给予超选择复合式肾动脉栓塞。栓塞后造影发现瘤体靶血管呈枯枝样改变,无非靶血管栓塞、术中见瘤体缩小、水肿、部分坏死,根治性切除率达95．7％,手术时间平均2．5小时。该术式可作为一种临床治疗肾癌的常规方法。     

超选择性肾动脉栓塞化疗术在肾癌治疗中作用的评价

目的：探讨肾癌根治性切除前肾动脉栓塞化疗术对肾癌的疗效。方法：将73例肾癌患者分为两组：治疗组30例，肾癌根治术前行超选择性肾动脉栓塞术；对照组43例，单纯行肾癌根治术。结果：治疗组手术时发现瘤体明显缩小，表面静脉萎缩，易于剥离，平均手术时间200min，输血量330ml；而对照组平均手术时间250min，输血600ml。术后1、3、5年的生存率治疗组为96.7%、90.0％、83.3％，对照组为100％、91.4%、81.3%，差异无显著性意义。结论：肾癌根治性切除术前行肾动脉栓塞化疗术可缩短手术时间，减少术中失血量，但不能明显提高患者的生存率。     

超选择性肾动脉灌注化疗加栓塞术在特殊肾癌中的应用

应用大剂量顺铂１５０ｍｇ／ｍ~２经超选择性肾动脉化疗加碘化油、明胶海绵或钢丝环行肾动脉栓塞术治疗肾癌８例。结果：６例肿块缩小、症状缓解，２例栓塞后完整剜出肿瘤。随访２．５～５．５年，至今存活７例，死亡１例。该法安全、有效，能最大限度保留肾组织和功能，尤其适用于孤立肾或对侧肾功能低下或丧失的肾癌患者。     

复合式肾动脉栓塞治疗肾癌

复合式肾动脉栓塞治疗肾癌许敬亭，程章玉，李建明自１９９０年以来对３８例肾癌患者采用碘化油、抗癌药、明胶海绵顺序注入肾动脉栓塞（复合式肾动脉栓塞），效果较好，报告如下。临床资料本组３８例，男２４例，女１４例。年龄２．５～７１岁，病程６～３５个月，均由Ｂ...     

超选择性肾动脉灌注化疗加栓塞术在特殊肾癌中的应用

目的：探讨超选择性肾动脉化疗加栓塞术在特殊肾癌治疗中的疗效。方法：应用大剂量顺铂150mg/m^2经超选择性肾动脉化疗加碘化油、明胶海绵或钢丝环行肾动脉栓塞术，治疗肾癌9例。结果：9例中6例肿块缩小，症状缓解，3例栓塞后完整刺出肿瘤。随访2．5—5年，至今存活8例，死亡1例。结论：该法安全、有效，能最大限度地保留肾组织和功能，尤其适用于孤立肾或对侧肾功能低下或丧失的肾癌患。     

肾动脉栓塞术在肾癌治疗中的应用(附67例报告)

目的：探讨肾动脉栓塞术在肾癌治疗中的应用价值。方法：对59例肾癌患者术前行肾动脉栓塞术，采用选择性肾动脉栓塞术姑息治疗8例晚期肾癌患者。结果：59例肾癌患术前行肾动脉栓塞术后。术中平均出血量为114ml，无一例并发症发生；8例晚期肾癌患者行栓塞术后，血尿1周后消失，1-3个月后复查肿块明显缩小。结论：在肾癌术前行肾动脉栓塞术十分有效；对晚期肾癌作肾动脉栓塞姑息治疗能有效控制症状，使肿块缩小，是一种有效的治疗方法。     

肾癌患者治疗方法的选择

目的:探讨肾细胞癌的不同手术方式、术前肾动脉栓塞及免疫治疗的临床应用价值。方法:回顾性分析179例肾细胞癌患者的临床资料。对患者的临床资料分组进行对比,并对治疗效果和随访结果作进一步统计学分析。结果:小肾癌行肾癌根治术与保留肾组织手术效果比较,在手术时间、术后住院时间、术后5年生存率上差异均无统计学意义(P>0.05);78例术前行选择性肾动脉栓塞者,手术证实栓塞效果满意。结论:保肾单位手术是治疗局限性小肾癌的有效手段;较大的肾癌术前进行肾动脉栓塞术便于手术切除病灶,提高了肿瘤的切除率;免疫治疗是继手术治疗之后的又一种主要临床治疗方式,尤其肿瘤疫苗的出现,对于晚期肾癌及转移癌效果明显。     

肾动脉栓塞术的临床应用（附57例报告）

报告肾动脉栓塞术５７例均栓塞成功。以明胶海绵、钢丝圈采用整体式栓塞用于肾恶性肿瘤５０例，７ｃｍ以上的肿瘤４８例，占９６％。根治性肾切除者平均出血量１１５ｍｌ；５例栓塞前未能切除或放弃手术而栓塞后得以切除。以自家凝血块，明胶海绵超选择性栓塞用于肾出血７例，均获立即止血。栓塞后患者可有程度不等的腰痛，发热。栓塞后４８小时以内手术者４０例（８７．５％）。本组未见合并症。认为肾动脉栓塞术迅速、安全、有效，可用于肾癌术前的辅助治疗及肾癌晚期的姑息治疗和各种出血性疾病。     

肾动脉灌注化疗联合栓塞与免疫治疗巨大肾癌32例

目的 探讨巨大肾癌动脉灌注化疗联合栓塞免疫治疗的疗效。方法 1990年4月～2003年4月，我院对32例巨大肾癌行动脉灌注栓塞术，灌注抗癌药物为表阿霉素30～40mg、丝裂霉素20～30mg、5-FU 500mg；应用无水酒精、5％鱼肝油酸钠、40％碘油加明胶海绵颗粒施行肾动脉栓塞；干扰素和白介素-2辅助治疗。结果 32例均成功施行动脉灌注栓塞术。8例栓塞术后l～3个月实施手术切除，术中见肿瘤血供基本中断，病理见肿瘤细胞坏死明显，周边有少许炎性淋巴细胞及不同程度纤维增生，毛细血管栓塞。总有效率为87．5％（28／32），6个月及1、2、3年生存率分别为78．1％（25／32）、68．8％（22／32）、46．9％（15／32）、31．2％（10／32），平均生存期41．5月。结论 肾动脉灌注化疗联合栓塞与免疫治疗巨大肾癌，临床疗效较好。     

Continuous renal replacement therapy improves renal recovery from acute renal failure

BACKGROUND: Acute renal failure (ARF) occurs in up to 10% of critically ill patients, with significant associated morbidity and mortality. The optimal mode of renal replacement therapy (RRT) remains controversial. This retrospective study compared continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) for RRT in terms of intensive care unit (ICU) and hospital mortality, and renal recovery. METHODS: We reviewed the records of all patients undergoing RRT for the treatment of ARF over a 12-month period. Patients were compared according to mode of RRT, demographics, physiologic characteristics, and outcomes of ICU and hospital mortality and renal recovery using the Chi square, Student's t test, and multiple logistic regression as appropriate. RESULTS: 116 patients with renal insufficiency underwent RRT during the study period. Of these, 93 had ARF. The severity of illness of CRRT patients was similar to that of IHD patients using APACHE II (25.1 vs 23.5, P = 0.37), but they required significantly more intensive nursing (therapeutic intervention scale 47.8 vs 37.6, P = 0.0001). Mortality was associated with lower pH at presentation (P = 0.003) and increasing age (P = 0.03). Renal recovery was significantly more frequent among patients initially treated with CRRT (21/24 vs 5/14, P = 0.0003). Further investigation to define optimal timing, dose, and duration of RRT may be beneficial. CONCLUSIONS: Although further study is needed, this study suggests that renal recovery may be better after CRRT than IHD for ARF. Mortality was not affected significantly by RRT mode.     

Influences of renal stone surgeries on renal function--evaluation of renal function with 99mTc-DMSA renal scintigraphy]

From 1984 to 1990, 99mTc-DMSA renal scintigraphy was performed before and after nephrolithotomy (15 cases), pyelolithotomy (15 cases), percutaneous nephrolithotripsy (PNL: 15 cases) and extracorporeal shock wave lithotripsy (ESWL: 16 cases, 17 kidneys) in order to evaluate of influences of renal stone surgeries on split renal function. DMSA renal uptake change ratio of treated kidneys of nephrolithotomy (-24.94 +/- 5.60%) was significantly lower than that of PNL (-0.06 +/- 3.92%), pyelolithotomy (-4.08 +/- 4.79%) (p less than 0.01) and ESWL (-7.72 +/- 3.87%) (p less than 0.05). The average change ratios of contralateral kidneys were as follows: PNL 4.80 +/- 4.21% nephrolithotomy 4.67 +/- 4.73%, pyelolithotomy -1.46 +/- 5.39% and ESWL -2.02 +/- 4.44%. One to 3 weeks after PNL, the cold area on the renal image was found in 10 (66.7%) of 15 cases. In cases of ESWL, DMSA renal uptake decreased even 4-10 weeks (mean 7 weeks) after treatment. In conclusion, possivility of deterioration of renal function after ESWL was suggested.     

Transplantation of renal primordia: renal organogenesis

Dialysis and allotransplantation of human kidneys represent effective therapies to replace kidney function, but the former replaces only a small component of renal function, and the latter is limited by lack of organ availability. Xenotransplantation of whole kidneys from nonprimate donors is complicated by humoral and severe cellular rejection. The use of individual cells or groups of cells to repair damaged tissue (cellular therapies) offers an alternative for renal tissue replacement. However, recapitulation of complex functions such glomerular filtration and reabsorption and secretion of solutes that are dependent on a three-dimensionally integrated kidney structure are beyond the scope of most cellular replacement therapies. The use of nonvascularized embryonic renal primordia for transplantation circumvents humoral rejection of xenogeneic tissue and ameliorates cellular rejection. Renal primordia are preprogrammed to attract a vasculature and differentiate into a kidney and in this manner undergo organogenesis after transplantation into the mesentery of hosts. Here we review a decade’s progress in renal organogenesis.     

The renal medulla in acute renal allograft rejection: comparison with renal cortex

A retrospective cohort study was undertaken to evaluate thediagnostic value of the renal medulla in acute renal allograftrejection (ARAR). One hundred and ninety-five biopsies from98 patients were randomly selected out of 565 transplant biopsies.Biopsies were graded blindly from Grade 0 (no rejection) toGrade 3 (severe rejection) using standard criteria; ARAR wasconfirmed by a fall in all cases of mean serum creatinine concentrationfrom 0.331 ± 0.182 to 0.184 ± 0.079 mmol/l, withanti-rejection therapy. In the 43 biopsies which contained bothcortex and medulla, the ARAR grades and the intensities of mononuclearcell, plasma cell, polymorphonuclear cell and eosinophil infiltrates,and of interstitial oedema and haemorrhage, were similar incortex and medulla (Spearman's Rank Correlation r=0.55–0.81,P < 0.001 ). The sensitivity, specificity and overall accuracyof medullary changes in predicting ARAR changes in the cortexwere 77%, 100% and 38%, respectively. Acute vascular rejectionchanges could not be compared between renal cortex and renalmedulla because of the anatomical differences between cortexand medulla. Further evaluation of ARAR in the all 195 biopsies,of which 188 had cortical tissue and 50 had medullary tissue,showed no significant differences in histological features (P> 0.05), except for more cortical biopsies with plasma cells(29%) than medullary biopsies with plasma cells (10%; P <0.02). It is concluded that: (1) ARAR histological changes aresimilar in cortex and medulla; (2) the predictive value of ARARmedullary changes for cortical rejection changes has low sensitivity(77%) and high specificity (100%). It is suggested that a predominantlynormal medullary renal biopsy in suspected rejection shouldbe repeated to obtain cortical tissue.     

Extensive renal involvement by renal cell carcinoma

Experience with the management of 3 cases of bilateral renal adenocarcinoma and 1 case of unilateral carcinoma in the solitary kidney is presented. Two patients died of metastases six and thirteen months postoperatively, while one is alive with metastases at fourteen months and another is alive without metastases at four months. The literature is reviewed, and the various treatments are discussed.     

Reversible renal hypertension due to renal hygroma

A hygroma of the left kidney was found at surgery in a thirty-five-year-old woman, who presented with anemia, hypertension, and a left abdominal mass. There was a very high sedimentation rate and fine needle aspiration yielded bizarre cells which raised the possibility of malignancy. Compression of the kidney by the cystic structure probably interfered with renal blood flow and was responsible for the elevated blood pressure which receded to normal after removal of the cyst and the left kidney.