肾上皮样血管平滑肌脂肪瘤临床特点分析

目的 探讨肾上皮样血管平滑肌脂肪瘤的临床及病理特点.方法 肾上皮样血管平滑肌脂肪瘤患者6例.单发4例,多发2例.肿瘤直径平均9(5～14)cm.有结节硬化家族史1例.CT检查发现肿瘤内含脂肪组织(CT值-30～-120 HU)3例,诊断为肾血管平滑肌脂肪瘤;3例瘤组织CT值30～55 HU,增强扫描CT值70～110 HU.行肿瘤剜除术3例,行根治性肾切除术3例.结果 3例行肿瘤剜除术者肿瘤完整剜除,2例出现肾盂破损,行肾盂修补及留置双J管.其中1例双肾肿瘤者,2个月后手术剜除对侧肿瘤.3例根治性肾切除者完整切除肾脏、肾周脂肪组织及肿大淋巴结.病理检查:镜下肿瘤以上皮样细胞为主,并出现多形、异形核,有明显的上皮样分化,浸润破坏性生长,瘤组织广泛坏死.免疫组化染色HMB45(+++),EMA、CK(-).病理诊断均为肾上皮样血管平滑肌脂肪瘤.平均随访26(10～44)个月,肿瘤无复发及转移5例;1例根治术后18个月出现双肺转移,10个月后死亡.结论 肾上皮样血管平滑肌脂肪瘤多为良性,部分缺乏脂肪组织,主要由单核或多核的上皮样细胞构成,免疫组化染色HMB45强阳性为特征表现,具有潜在恶性倾向,可发生转移;CT检查易误诊为肾癌;手术为主要治疗方法.     

成人肾母细胞瘤的诊疗及预后分析（附10例报告）

目的：探讨成人肾母细胞瘤的诊疗方法和预后。方法：回顾性分析10例成人肾母细胞瘤患者的临床资料。男8例,女2例,年龄16～62岁,平均29岁。就诊症状为单纯肉眼血尿3例、腰腹部肿块或腰腹痛4例（伴血尿2例）、无症状查体发现3例。患者均行B超、IVU、尿脱落细胞学检查,8例行CT平扫＋强化检查。影像学检查提示肾占位6例、肾盂占位3例、输尿管占位1例。CT提示肾门或腹腔淋巴结肿大4例。10例均行手术治疗,根治性肾切除6例,患肾、输尿管全段切除＋膀胱输尿管口袖口状切除4例,2例根治性肾切除患者因肿物与周围粘连严重切除部分腹膜。行腹膜后淋巴结清扫5例。结果：所有病例均于术后病理确诊为肾母细胞瘤,预后良好组织型（FH）4例,预后不良组织型（UH）6例,病理证实淋巴结转移3例。按美国国家肾母细胞瘤研究组（NWTS）分期标准,分别为Ⅰ期4例、Ⅱ期3例、Ⅲ期3例。7例患者接受术后辅助放化疗。随访9例患者1～13年,5例无瘤生存,生存时间为1．5～13年,平均4．4年。1例术后1年死于肿瘤肺转移,1例术后1年死于肿瘤脑转移,2例术后2年内局部复发,再次接受手术。结论：成人肾母细胞瘤为罕见的恶性肿瘤,预后较差,确诊主要依靠病理诊断,目前尚无公认的最佳治疗手段。手术治疗并辅以合理、及时的放疗、化疗是改善其预后的有效措施。     

用无水酒精作肾细胞癌术前血管栓塞

作者于1981～1983年对34例患者作了无水酒精血管栓塞和肾切除术。其中药物不能控制的高血压9 例,肾细胞癌25例。后者男23例,女2例。年龄35～77岁,平均64岁。在远处转移的6例中,4例进行栓塞以作姑息治疗。肿瘤局限于右肾者11例,左肾13例,双侧者1例。肿瘤最大直径大于5cm,重250～1660g(平均830g)。6例肿瘤局限于肾囊内(Ⅰ期),4例穿入肾周围脂肪但未达Gerota's筋膜(Ⅱ期),9例侵犯肾静脉及局部淋巴结(Ⅲ期),2例转移(Ⅳ期)。所有患者在血管栓塞后进行了根治性肾切除术。无水酒精血管栓塞至手术时间为几小时至57天。其中4例在栓塞后立即手术,14例手术在栓塞后1天内进行。2例患者术中解剖肿瘤供应血管时,     

恶性嗜铬细胞瘤(附12例报告)

目的提高恶性嗜铬细胞瘤诊治水平.方法总结12例恶性嗜铬细胞瘤患者临床资料.结果12例均行手术治疗,1例术后24h死于顽固性低血压,余11例随诊2年6个月～13年,平均5年6个月.首次手术根据肿瘤浸润及局部淋巴结转移情况确诊恶性嗜铬细胞瘤5例中,1例膀胱恶性嗜铬细胞瘤行膀胱部分切除术后,出现顽固性低血压,抢救无效于术后24h死亡;余4例存活2～3年死于肿瘤复发及高血压并发症.7例首次手术病理诊断为嗜铬细胞瘤者,术后10个月～5年肿瘤复发,病程中发现肿瘤转移至肝3例,肝、肺、骨均有转移者2例,局部淋巴结转移2例.存活时间<2年者3例,3～11年者4例(包括目前存活3例).结论病理难以区别肿瘤的良恶性,现代影像学检查(CT、MRI等)可为恶性嗜铬细胞瘤的诊断提供参考依据.对直径>5cm,内部结构不均匀的复发性嗜铬细胞瘤,应果断行根治性肿瘤切除术.     

阴茎疣状癌的临床诊断和治疗

目的 探讨阴茎疣状癌的诊断和治疗. 方法 回顾性分析6例阴茎疣状癌患者的诊治资料.患者平均年龄45岁.肿瘤均为菜花状、外生型,最大径2～6 cm,局限于阴茎头4例,侵犯至冠状沟近侧2例.3例在术前经病理活检确诊,另3例为术后病检证实.2例肿瘤侵犯冠状沟近侧者和2例位于阴茎头肿瘤较大者行阴茎部分切除术,1例局限于阴茎头与冠状沟之间者给予包皮环切术,1例局限于阴茎头者行肿瘤局部切除术. 结果 病理检查见肿瘤细胞分化好,标本切缘均阴性.6例术后随访2～4年,无肿瘤复发或转移. 结论 6例阴茎疣状癌以局部侵袭性生长为主,未发生区域性淋巴结转移或远处转移,选择手术方式合理,预后良好.     

保留神经腹膜后淋巴结清除术治疗睾丸肿瘤

目的探讨保留神经腹膜后淋巴结清除术(RPLND)在低期睾丸肿瘤治疗中的作用和效果。方法1999年6月至2003年7月收治睾丸肿瘤患者13例,年龄24～41岁,平均29岁。肿瘤位于左侧9例,右侧4例,大小2cm×3cm×2cm～9cm×6cm×5cm。临床分期:Ⅰ期11例,均为非精原细胞瘤;ⅡA期1例,为畸胎瘤(CT示腹膜后转移灶1cm×2cm);ⅡC期1例,为精原细胞瘤(CT示腹膜后转移灶10cm×9cm)。12例非精原细胞瘤者根治性睾丸切除术后1～4周行保留神经RPLND,1例精原细胞瘤者根治性睾丸切除术后行3疗程BEP方案化疗后行保留神经RPLND。结果术后病理分期:Ⅰ期11例,ⅡA期2例,其中ⅡC期精原细胞瘤患者化疗后分期降为Ⅰ期。13例术后均无肠梗阻、淋巴瘘和体位性低血压。术后2周复查时血AFP和βHCG均降至正常范围。术后8～12周均恢复射精功能。随访18～64个月,平均39个月,无肿瘤复发或转移。结论对于青壮年患者,保留神经RPLND是治疗低期非精原细胞瘤和化疗后降期的精原细胞瘤的首选方法。     

胃肝样腺癌伴肝转移一例

患者,男,48岁.2009年12月因"中上腹持续性疼痛1周"就诊,行胃镜检查,活检病理提示"腺癌".术前检查:血清AFP＞ 350 ng/ml(参考值1.09 ～8.04 ng/ml),CEA66.30 ng/lm(参考值0～5ng/ml).CT检查:"胃体小弯侧胃壁增厚突人胃腔,增强后有明显强化(平扫CT值28 HU,动脉期90HU,静脉期70HU),肝表面光滑,各叶比例均匀,实质密度未见异常"(图1).评估后行胃癌根治术(远端胃切除,D2淋巴结清扫,毕Ⅰ式吻合),术后病理提示"胃肝样腺癌,肿瘤位于胃窦部,溃疡浸润型,6 cm ×2.2 cm,浸润至浆膜外,淋巴管内癌浸润(+),血管内癌浸润(+),神经周围癌浸润(一),上、下切缘(一).     

经腹腔途径单孔腹腔镜下肾切除术的临床研究

目的 探讨经腹腔途径单孔腹腔镜手术(laparoendoscopic single-site surgery,LESS)行肾切除术的可行性及安全性. 方法 2010年11月至2012年6月应用4通道单孔腹腔镜行肾切除术患者6例.年龄34～ 77岁,平均57岁.体质指数(body mass index,BMI)20.1 ～30.3 kg/m2,平均24.2kg/m2.术前诊断肾肿瘤4例,左肾盂肿瘤1例,无功能肾1例.其中肾肿瘤1例为右侧中央型4.2 cm肾肿瘤,另3例分别为左肾下极7.4 cm肿瘤、左肾中部4.5 cm肿瘤和左肾中部4.3 cm肿瘤.全麻下健侧60°卧位,经患侧脐缘切口将单孔腹腔镜通道Quadport置人腹腔,采用5 mm头部可弯腹腔镜、标准腹腔镜直器械及预弯器械实施手术.记录手术时间、估计术中出血量、术中并发症、术后第1天疼痛指数(visual analog pain scale,VAPS)、留置引流管时间、术后住院时间和术后病理等临床资料. 结果 本组6例手术均顺利完成,无中转为标准腹腔镜或开放手术者,无另加操作通道者.手术时间145.0 ～ 235.0 min,平均181.7 min;估计术中出血量20.0～150.0 ml,平均78.3 ml;VAPS1.0 ～2.0分,平均1.7分;术后留置引流管时间1.0～4.0 d,平均2.8d;术后住院时间1.0 ～10.0d,平均6.8d.术中无严重并发症,术后无继发性出血和切口感染.病理诊断为肾透明细胞癌3例,肾嫌色细胞癌1例,肾盂尿路上皮癌1例,萎缩肾1例.肿瘤患者均未发现淋巴结转移. 结论 经腹腔途径单孔腹腔镜下肾切除术临床可行性和安全性良好.     

青年型肾癌56例报告

目的探讨青年型肾癌的临床特征及诊治措施。方法青年型肾癌56例。男36例,女20例。平均发病年龄32.4岁。偶发癌20例,症状癌36例。病程2 d～4年。临床症状有肉眼血尿18例、腰腹胀痛23例、消瘦乏力2例、发热3例、可触及肿块2例,其中有2项以上症状者12例。单侧55例,双侧1例。56例患者均行B超、CT检查,11例患者行KUB加IVU检查,2例行MR检查。50例行根治性肾切除,6例行保留肾单位手术。术后随访7～108个月,平均64个月。结果B超诊断错构瘤4例,多囊肾1例,肾脏炎性肿块1例,肾肿瘤50例;B超检出率89.3%。CT诊断为错构瘤2例,肾肿瘤54例;CT检出率96.4%。行MR检查2例,诊断肾肿瘤1例,错构瘤1例。9例有症状者行KUB加IVU检查,5例示肾集合系统受压,1例未显影,1例示肾盏破坏,2例示肾外形增大;2例偶发癌者行KUB加IVU检查均未见明显异常。20例偶发癌者肿瘤直径1.8～10.0 cm,平均4.8 cm;其中T1N0M0者16例,T2N0M0者3例,T3N0M0者1例。36例有症状者肿瘤直径2.5～13.0 cm,平均8.7 cm;其中T1N0M0者20例,T2N0M0者7例,T3N0M0者4例,淋巴结阳性者5例。偶发癌组20例中仅1例(T3N0M0)行根治术者于术后19个月肾窝复发,再次手术治疗,于术后53个月死于全身转移;偶发癌组的5年存活率为92.3%。症状癌组中8例因癌死亡,4例失访,5年存活率为66.7%。2组5年存活率比较差异有统计学意义(P=0.042)。结论青年型肾癌恶性程度与普通人群肾癌相仿,根治性肾切除是主要的治疗方式,合适的患者可行保留肾单位手术。     

Xp11.2易位/TFE3基因融合相关性肾癌8例报告并文献复习

目的:探讨Xp11.2易位/TFE3基因融合相关性肾癌(Xp11.2肾癌)成人患者的诊断及治疗经验。方法:回顾性分析我院2012年10月~2016年11月行手术治疗的8例Xp11.2肾癌成人患者的临床资料。其中男4例,女4例;年龄21~70岁,平均27.7岁。病灶位于左肾者3例,右肾者5例。3例行后腹腔镜保留肾单位手术(NSS),肿瘤最大径为2~4cm,平均3.2cm;5例行后腹腔镜肾癌根治性切除术(RN),肿瘤最大径为4~6cm,平均4.9cm,1例患者同时行肾静脉瘤栓取出术。结果:8例术后病理均为透明细胞癌,免疫组化示TFE3强阳性。病理分期:T_(1a)4例,T_(1a)伴肾门淋巴转移1例,T_(1b)期1例,T_2期伴淋巴转移1例,T_(3a)期1例。术后随访时间6~33个月,RN组有1例患者在术后6个月出现肺转移,术后11个月死亡。其他均无复发或转移。所有患者均未行化疗或靶向药物等辅助治疗。结论:Xp11.2肾癌是一种罕见的肾癌亚型,免疫组化检测TFE3表达水平是目前最常用的诊断措施。Xp11.2肾癌常会引起局部淋巴结或远处器官转移,预后较差,RN是治疗该病最常用的手术方式,必要时应同时行淋巴结清扫术。     

小切口后腹腔镜下根治性肾切除术17例报告

目的总结小切口后腹腔镜下根治性肾切除术的治疗经验。方法采用第12肋尖部向前下方5—6cm切口后腹腔镜下根治性肾切除术治疗肾及肾盂输尿管肿瘤患者17例。男10例，女7例，平均年龄56岁。5例因无痛性肉眼血尿就诊，余12例为B超体检发现，腹部均未扪及肿块。左侧5例，右侧12例。肾肿瘤13例直径3～10cm，平均5cm。UICC临床分期；T1N0M0 10例，T2N0M0 2例，T3aN0M0 1例；分级：G1 1例、G3 12例。肾盂输尿管肿瘤4例：T1N0M0和T2N0M0各2例，G2 3例、G3 1例．结果17例手术均顺利，其中1例肿瘤直径10cm者扩大手术切口取出标本。手术时间平均111min，平均出血90ml。未出现并发症。病理报告：肾透明细胞癌10例，嗜色细胞癌2例，血管平滑肌脂肪瘤1例；肾盂移行细胞癌3例，原发性输尿管移行细胞癌1例。17例随访2—21个月，平均12．8个月，均健在，未见肿瘤复发。结论该手术具有手术时间短，安全可靠，患者恢复快，操作简单等优点，是一种实用的手术方法。     

内镜下钬激光治疗早期上尿路上皮肿瘤特殊病例1O例报告

目的探讨内镜下钬激光治疗特殊早期上尿路上皮肿瘤的安全性及有效性。方法2002年4月～2010年5月,对10例不适合行根治性。肾输尿管切除术的早期上尿路上皮肿瘤患者行内镜下钬激光治疗,其中输尿管肿瘤7例（1例合并膀胱肿瘤）,肾盂肿瘤3例。单发7例,多发3例。术前肿瘤分期cTa～cT1。3例对侧已行肾输尿管全长切除,2例孤立肾,3例肾功能不全,1例2～3级心功能不全,1例肿瘤小（〈1cm,位于。肾盂,单发且表浅）。输尿管硬镜治疗7例,软镜1例,微通道经皮肾镜2例。术后行丝裂霉素上尿路及膀胱灌注化疗。结果10例术后随访2年,无肿瘤死亡。1例术后6个月输尿管狭窄,其余均未出现大出血、严重感染、周围脏器损伤及全身肿瘤转移。复发4例,其中1例输尿管合并膀胱肿瘤者膀胱内复发,1例为肾盂内单发肿瘤复发,2例为输尿管单发肿瘤复发。该4例随访5年,1例未见肿瘤复发与转移,3例复发3—4次,且为尿路多处复发,行肾盂输尿管癌根治术,其中2例术后血液透析1年内肿瘤转移死亡。结论对不适合行根治性肾输尿管切除术的早期上尿路上皮肿瘤,内镜下钬激光治疗短期内是安全有效的。     

肾盂鳞状细胞癌临床特点分析

目的 探讨肾盂鳞状细胞癌的诊治特点.方法 回顾性分析1991年10月至2009年5月收治8例肾盂鳞状细胞癌患者资料.临床表现血尿8例,腰痛7例,腹部包块1例.B超检查8例,IVU检查8例,CT检查4例.术前诊断为肿瘤3例,诊断为肾结石5例,结石术中发现肿瘤并经冰冻病理确诊2例.8例患者均经手术治疗,行根治性肾输尿管切除4例、单纯性肾切除3例、姑息性切除术1例.结果 8例病理诊断均为鳞状细胞癌.中分化6例,高分化和低分化各1例;pT1 1例,pT2 1例,pT3 3例,pT4 3例;淋巴结转移2例.获随访7例,失访1例.术后生存时间2～42个月,中位时间6个月,患者均死于肿瘤复发及转移.结论 肾盂鳞状细胞癌恶性程度高,常合并结石,术前诊断困难,确诊时多为中晚期,术后短期内易复发转移,预后极差.

Abstract：

Objective To review the diagnosis and treatment of squamous cell carcinoma of renal pelvis. Methods The clinical data from October 1991 to May 2009 of eight cases of squamous cell carcinoma of renal pelvis were reviewed and analyzed retrospectively. The symptoms of the patients were hematuria (eight cases), pain (seven cases) and abdominal mass (one case). All patients underwent B-ultrasound and IVU examination and four cases underwent CT scan. Three cases were diagnosed as having a tumor before surgery. Five cases were diagnosed as renal calculus, two of the five cases were diagnosed by intraoperative frozen section. Radical nephroureterectomy were performed in four cases, nephrectomy in three cases and palliative resection in one case. Results Histological classification revealed that six cases were moderately differentiated, one case was well differentiated and one case was poorly differentiated. Two cases had stage pT1/pT2 and six cases had stage pT3/pT4. 2 cases had regional lymph nodes metastasis. Seven cases were followed-up. All patients died of tumor recurrence or metastasis. The median tumor specific survive time was six months (range from two months to 42 months). Conclusions Squamous cell carcinoma of renal pelvis is often occurs concurrently with urolithiasis which could lead to difficulty in diagnose before operation. As the most of the patients were diagnosed with advanced stage disease, squamous cell carcinoma of renal pelvis tended to early recurrence and metastasis and the prognosis was very poor.     

A clinico-pathological study of small renal cell carcinoma

Between 1960 and 1989, 50 patients with small renal cell carcinoma measuring below 3 cm in diameter were examined. Among them, 31 patients were nephrectomized, but in 19 patients, the renal cell carcinoma was found first at autopsy. The average tumor diameter of the unrecognized ones was smaller than that of nephrectomized patients with the minimum of 0.4 cm. Forty-one patients had clear cell carcinoma, 9 granular cell carcinoma, 40 grade 1 tumor, and 10 grade 2 tumor. The grade 3 tumor was not found in our study. Three out of the 50 patients had distant metastasis at the time of operation or autopsy. Six patients had microscopic tumor thrombi just close to the tumor pseudo-capsule. Two patients had apparent tumor thrombi in the main renal vein. The smallest tumor that showed microscopic tumor thrombi measured 1.5 cm in diameter. The incidence of tumor thrombi was correlated with tumor diameter. The step sections by 4 mm thick of nephrectomized specimens were examined on 16 patients. The daughter tumor was found in two patients. The tumor thrombi had close relationships with the presence of distant metastasis (p less than 0.001) and/or the daughter tumor (p less than 0.01). In conclusion, small renal carcinoma measuring less than 1.5 cm in diameter was considered to be treated by conservative surgery.     

双侧肾癌的诊治与预后（附6例报告）

目的：探讨双侧肾癌（Bilateral renal cell carcinoma,BRCC）患者的诊治与预后。方法：1999年1月～2006年1月我院共诊治BRCC患者6例,平均发病年龄53（35～74）岁。其中双侧同时性肾癌3例,异时性肾癌3例。肿瘤位于肾上极6枚,中极7枚,下极1枚;左肾6枚,右肾8枚;肿瘤平均直径4．6（3～7）cm。3例同时性肾癌患者,2例行双侧同期手术,1例行分期手术。其中2例行一侧肾癌根治术,对侧保留肾单位手术（NSS）;1例一侧先行NSS,2周后再行对侧肾癌根治术。3例异时性肾癌患者均行分期手术治疗,均行一侧肾癌根治术,对侧NSS术。结果：6例随访12～156个月,平均84．5个月。肿瘤转移2例,分别死于肺转移和骨转移;肿瘤局部复发2例;无瘤生存2例。结论：NSS是目前较为理想的双侧肾癌治疗方法。治疗双侧肾癌的原则为尽可能切除肿瘤和最大限度保存。肾功能。     

肾癌多中心病灶和假包膜外肿瘤浸润的病理研究

目的 探讨保留肾单位手术(NSS)治疗肾癌时肿瘤周围正常肾组织安全有效的切除范围.方法2005年10月至2008年10月肾癌标本131例,其中行肾癌根治术103例,行NSS 28例.先行大体病理检查,然后分别在肿瘤假包膜外侧和距离肿瘤边缘3、5、10、15 mm各层面取材,每个层面取4块组织,HE组织染色.观察有无肾癌多中心病灶和假包膜外肿瘤的浸润范围等病理指标,分别测量病变到肿瘤边缘的距离,并统计肿瘤大小与以上指标的相关性.结果 131例肾癌标本中,肿瘤直径＜4.0 cm者61例,均未发现肿瘤周围浸润和卫星灶.肿瘤直径4～7 cm者46例,发现肿瘤周围浸润或卫星灶3例(6.5%),其中G3透明细胞癌1例,分别在距离肿瘤10、15 mm处发现卫星灶;集合管癌1例和G3透明细胞癌伴肉瘤样癌1例距离肿瘤周围15 mm均可见肿瘤浸润生长,集合管癌患者同时伴有远处转移和肾静脉瘤栓.肿瘤直径＞7 cm者24例,有肿瘤周围浸润或卫星灶4例(16.7%),其中1例G3透明细胞癌在肿瘤周围3 mm处发现卫星灶,另3例G2、G3透明细胞癌在肿瘤周围15 mm范围发现肿瘤浸润生长;有肾静脉瘤栓4例(16.7%);远处转移2例(8.3%).肿瘤直径与肿瘤周围浸润生长和卫星灶之间呈显著相关性(P＜0.05).结论直径＜4 cm的肾癌,行距离肿瘤周围正常肾组织切除宽度小的NSS,甚至简单的肿瘤剜除术安全有效;对部分仔细选择的4～7 cm肾癌,只要技术可行能够完整切除肿瘤,采用NSS治疗合理可行;而对于＞7 cm的肾癌,不建议行NSS.

Abstract：

Objective To explore the safe and effective width of a healthy parenchymal surgical margin in nephron-sparing surgery (NSS) for renal cell carcinoma. Methods From October, 2005to October, 2008, 131 renal carcinoma specimens (103 cases performed by radical nephrectomy and 28 cases by NSS) were studied. The tissue materials were taken at the site of pseudo-capsule, 3, 5, 10,15 mm laterally from the tumor edge respectively and HE staining. Specimens were examined grossly and microscopically for multifocal tumors, infiltration of tumor pseudo-capsule and other pathological features. The correlation between the renal tumor size and the pathological features were analyzed statistically. Results There were 131 specimens of renal carcinoma. In 61 cases with tumor diameter ＜4 cm, no case (0.0%) had multifocal tumors and infiltration of tumor pseudo-capsule. In 46 cases with tumor diameter 4-7 cm, multifocal tumors were found in 3 cases (6.5%), and infiltration of tumor pseudo-capsule was found in 2 cases. Among the 46 cases there was 1 collecting duct cancer accompanied with distant metastasis and renal vein tumor embolus. In 24 cases with tumor diameter ＞7cm, multifocal tumors were found in 4 cases (16. 7%) and infiltration of tumor pseudo-capsule was found in 3 cases. Four cases (16.7%) had renal vein tumor embolus. Two cases (8.3%) had distant metastasis. The renal tumor size was apparently associated with multifocal tumors and infiltration of tumor pseudo-capsule (P＜0. 05). Conclusions Mini-margin NSS, even simple enucleoresection, is a safe and effective approach for treating localized renal tumor of ＜4 cm. For carefully selected patients with tumor 4-7 cm, NSS is reasonable and feasible. But for the patient with tumor ＞7 cm,NSS is not recommended.     

肾脏恶性肿瘤并静脉转移的外科治疗

目的：探讨肾脏恶性肿瘤并发静脉内转移的外科治疗方法及预后。方法：报告10例肾脏恶性肿瘤，其中肾细胞癌6例，肾母细胞瘤2例，肾盂癌1例，肾平滑肌肉瘤1例。肾静脉内转移4例，肝下型腔静脉转移5例，肝后和肝上的腔静脉内转移1例。在根治性切除患肾的同时阻断瘤栓上下的腔静脉和对侧肾静脉，完整取除瘤栓，腔静脉壁受累者同时切除腔静脉壁，术后辅以免疫治疗和放射治疗。结果：随访7年，平均5年生存率40％，肾母细胞瘤生存期小于3年，腔静脉壁受累者生存期小于1年，并发区域淋巴结转移者5年生存率33％。结论：手术切除静脉内转移癌是提高患者生存期的惟一手段，其预后取决于原发癌肿的性质和癌栓是否完全切除，而与癌栓的位置无直接相关。静脉内肿瘤转移同时并发腔静脉壁受累或区域淋巴结阳性的患者预后较差。     

腹腔镜治疗肾错构瘤并肾静脉及下腔静脉瘤栓1例并文献复习

目的：探讨全腹腔镜治疗肾错构瘤并肾静脉及下腔静脉瘤栓的可行性分析。方法：回顾性分析1例腹腔镜治疗肾错构瘤并肾静脉及下腔静脉瘤栓患者的临床资料。患者,女,26岁,体检时发现右肾占位,B超示右肾窦内可见5．1cm×2．7cm高回声占位,边界欠规则,内见血流。CT示右肾盂旁可见一不规则团块状混杂密度影,大小为4．5cm×2．9cm×1．9cm,可见脂肪成分,最低密度-40HU;病变软组织部分明显强化,增强前后CT值分别为31HU和97HU,病变主要位于肾窦,部分延伸至肾静脉及腔静脉内。检索Pubmed和CBM数据库相关文献进行复习。结果：患者在全麻下行腹腔镜右肾切除及肾静脉、下腔静脉取栓术,瘤栓进入下腔静脉0．6cm。病理诊断右肾错构瘤。术后随访6个月无肿瘤复发和转移。结论：肾错构瘤并。肾静脉及下腔静脉瘤栓临床罕见,对选择性病例行腹腔镜肾切除并行肾静脉及下腔静脉取栓术安全可行。     

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.