原发性肾滑膜肉瘤一例报告并文献复习

Objective To discuss the presentations, pathologic features, diagnosis and treatment of primary synovial sarcoma of the kidney. Methods One case of primary synovial sarcoma of the kidney was reported and the relevant literature was reviewed. A 55-year-old man was admitted with complaint of right abdomen and flank pain for 5 h. Computerized tomography revealed a 12.5 cm × 11.0 cm × 9. 0 cm mass located at the middle and lower pole of the right kidney. The patient was taken radical nephrectomy. Results The diagnosis of primary synovial sarcoma of the kidney in the patient was confirmed by postoperative pathology. Under microscope, tumor was typically mitotically active, monomorphic spindle cells growing in intersecting fascicles or in solid sheets with epithelial differentiation. In some areas a haemangiopericytoma-like pattern was found. Immunohistochemical staining showed that the tumor cells were positive for the markers Vimentin, CD99 and Bcl-2, but CK was negative. The patient died of local recurrence and multi-metastasis at 8 months after surgery. Conclusions Primary synovial sarcoma of the kidney is extremely rare with a high grade of malignancy,and its prognosis is poor. The diagnosis depends on pathological features, Immunohistochemical studies and RT-PCR detection. Radical resection combined with chemicaltherapy is considered to be the most reliable treatment so far.     

应用普通膀胱镜气压弹道碎石治疗膀胱结石(附21例报告)

目的探讨气压弹道碎石术治疗膀胱结石的新方法。方法经膀胱镜置入气压弹道碎石设备，将膀胱结石击碎并取出。结果21例均顺利碎石并一次性将结石取尽。术中、术后无大出血、膀胱穿孔、黏膜损伤和水中毒等并发症。21例术后随访3～18个月，平均4．5个月。B超或KUB未见结石复发，无排尿不畅等尿道狭窄症状。结论应用普通膀胱镜气压弹道碎石是处理膀胱结石经济有效的治疗方法。     

原发性肾滑膜肉瘤一例报告并文献复习

目的 总结原发性肾滑膜肉瘤的临床表现、病理特点和诊治方法.方法 原发性肾滑膜肉瘤患者1例,男,55岁.因右腰背及上腹部疼痛5 h入院.无尿频、尿急、尿痛、血尿、发热等症状.CT检查示右肾中下极恶性占位可能,累及右肾门、肾动静脉及肝脏.行右肾肿瘤根治性切除术.结果 病理检查:肿瘤大小12.5 cm×11.0 cm×9.0 cm.镜下瘤细胞呈梭形、束状排列,细胞异型,可见核分裂相,部分区域见增生的薄壁血管,肿瘤呈浸润性生长,伴发炎症及大量坏死、出血.免疫组化染色示Vimentin、CD99、Bcl-2阳性,CK阴性.病理诊断为原发性肾滑膜肉瘤.患者术后2个月出现局部复发及肝肺转移,予异环磷酰胺、表阿霉素化疗1疗程,患者不能耐受.术后8个月死亡.结论 原发性肾滑膜肉瘤是一种罕见、高度恶性的肿瘤,预后不良,确诊需依赖病理检查、免疫组织化学及RT-PCR检测.根治性切除辅以化学治疗可行.     

两步法建立标准通道经皮肾镜取石术治疗上尿路结石:附208例报告

目的 探讨应用两步法建立标准皮肾通道经皮肾镜取石术的安全性和有效性.方法 2007年11月至2010年12月,应用彩超引导下两步法建立标准通道经皮肾镜取石术治疗上尿路结石患者208例,共235侧上尿路结石,其中包括:孤立肾12例,肾盏憩室合并结石3例,髓质海绵肾3例.结石纵径1.7~8.0 cm,横径1.6~5.5 cm.结果 208例均一期成功建立经皮肾镜碎石通道.203例行一期取石术,5例行二期取石术.平均通道建立时间15.7±12.3 min,平均手术时间72.6±33.9 min.一期手术清石率88.5%,二期手术清石率为93.6%.术中、术后输血患者16例.并发液气胸1例,灌注液外渗3例,无感染性休克及肠道、肝、脾等腹腔脏器损伤.结论 两步法建立标准皮肾通道的经皮肾镜取石术是安全和有效的方法.     

二次三尖瓣置换术的体外循环管理28例

目的：总结二次三尖瓣置换手术体外循环管理的经验。方法：对28例行二次三尖瓣置换术患者进行充分的术前评估,根据病情准备股动静脉插管、带气囊静脉插管,备血、白蛋白等,体外循环中维持灌注压60～85mmHg,使用超滤提高血红蛋白水平,调整电解质酸碱平衡。结果：行二次三尖瓣置换术患者28例全部顺利停机,术后治愈22例,好转出院5例,术后30天死亡1例。术中体外循环时间（110±35）min,阻断时间（82±20）min,自动复跳率68%,滤液量（1 819±423）mL,输注红细胞量（2.5±0.7）U。结论：完善的术前准备、适当的插管位置选择、精确的体外循环管理是手术成功的关键。     

泌尿系硅结石1例

<正>我院收治1例泌尿系结石患者,其成分为"硅结石",现报道如下。1病例报告患者女性,53岁,农民,因"左腰腹部疼痛3月"入院,在当地医院诊断泌尿系结石,行4次体外震波碎石治疗,未排出结石。既往体健。泌尿系CT提示单个结石,位于左输尿管中上段,第四腰椎平面,1.3cm×1.0cm×1.0cm,CT值:最小值为366 Hu,最     

输尿管镜下碎石清石术治疗输尿管上段、肾盂及肾上盏结石(附30例报告)

目的 探讨输尿管镜下应用瑞士EMS三代碎石、清石设备处理输尿管上段结石、肾盂及肾上盏内结石的临床疗效.方法 2005年12月～2008年5月,用上述方法治疗结石30例.结石大小:长径1.2～2.2 cm,横径0.8～1.2 cm,并发中重度肾积水21例,28例曾行体外冲击波碎石治疗.结果 30例中28例1次碎石成功,成功率93.3%.失败的2例中有1例因输尿管呈"N"扭曲致进镜失败而改行开放手术,1例有较大的肾孟结石碎石后残留结石,留置D-J管后行体外冲击波碎石治疗.结论 榆尿管镜下气压弹道联合超声碎石设备处理榆尿管上段、肾盂及肾上盏内结石可以取得良好的治疗效果.     

原发性肾滑膜肉瘤一例报告并文献复习

Objective To discuss the presentations, pathologic features, diagnosis and treatment of primary synovial sarcoma of the kidney. Methods One case of primary synovial sarcoma of the kidney was reported and the relevant literature was reviewed. A 55-year-old man was admitted with complaint of right abdomen and flank pain for 5 h. Computerized tomography revealed a 12.5 cm × 11.0 cm × 9. 0 cm mass located at the middle and lower pole of the right kidney. The patient was taken radical nephrectomy. Results The diagnosis of primary synovial sarcoma of the kidney in the patient was confirmed by postoperative pathology. Under microscope, tumor was typically mitotically active, monomorphic spindle cells growing in intersecting fascicles or in solid sheets with epithelial differentiation. In some areas a haemangiopericytoma-like pattern was found. Immunohistochemical staining showed that the tumor cells were positive for the markers Vimentin, CD99 and Bcl-2, but CK was negative. The patient died of local recurrence and multi-metastasis at 8 months after surgery. Conclusions Primary synovial sarcoma of the kidney is extremely rare with a high grade of malignancy,and its prognosis is poor. The diagnosis depends on pathological features, Immunohistochemical studies and RT-PCR detection. Radical resection combined with chemicaltherapy is considered to be the most reliable treatment so far.     

急诊经尿道前列腺电切术的临床价值(附29例报告)

目的 评价急诊行经尿道前列腺电切术的临床价值.方法 2002年11月～2005年6月,采用急诊经尿道前列腺电切术治疗医源性前列腺损伤、患者不配合导尿治疗造成前列腺部尿道损伤及膀胱血块填塞29例前列腺增生症病人,Ⅱ度增生14例（其中2例术后病理证实为前列腺癌）,Ⅲ度增生15例,国际前列腺症状评分（IPSS）为17～35分.结果 29例平均手术时间65 min,术后随访12～29个月,平均20.5个月,排尿情况良好.结论 急诊经尿道前列腺电切术治疗前列腺增生症合并急性膀胱血块填塞和尿道损伤安全有效,缩短病人住院周期,病人易于接受,但应谨慎选择病例.