三例肾脏原发少见肿瘤的临床特征及诊治分析

目的总结分析3例肾脏原发少见肿瘤的临床特征及诊治方法,提高对肾脏原发少见肿瘤的认识。 方法回顾性分析2018年5月至9月于中山大学附属第七医院泌尿外科诊治的术后病理证实的3例肾脏原发少见肿瘤的临床资料。 结果3例患者分别为：（1）54岁女性,因体检发现左肾占位1周入院,CT提示左肾巨大软组织肿块及肾门多个肿大淋巴结,行腹腔镜下根治性左肾切除术+淋巴结清扫术,术后病理：肾黏液管状与梭形细胞癌,术后3个月随访肿瘤无复发转移;（2）44岁男性,因左侧腰腹部胀痛1个月入院,MR提示左肾巨大占位病变,开放探查见肿瘤与降结肠粘连明显,遂行根治性左肾切除+降结肠部分切除术,术后病理：肾脏癌肉瘤,术后1个月局部复发并腹腔内多发转移,入肿瘤内科后辅以紫杉醇+多柔比星化疗及阿帕替尼靶向治疗,目前未观察到肿瘤继续恶化;（3）70岁男性,因左侧腰痛伴肉眼血尿3个月入院,CT提示左肾上极不规则低密度灶及腹膜后多发肿大淋巴结,行腹腔镜下根治性左肾切除+淋巴结清扫术,术后病理：高级别浸润性尿路上皮癌,拟二次手术,患者拒绝,术后6个月随访肿瘤无复发转移。 结论肾脏原发少见肿瘤临床症状及影像学表现常无明显特异性,容易误诊,应注意鉴别诊断,治疗以根治性切除为主,部分肿瘤预后不良,术后需密切随访,必要时尽早辅以放化疗及靶向治疗。     

肾移植术后早期严重肺部感染患者外周血CD4+T淋巴细胞计数的临床意义

Objective To explore the clinical implication of peripheral blood CD4+ T-cell counts in renal allograft recipients with severe pulmonary infection in the early stage after kidney transplantation. Methods From February 2007 to June 2008, we investigated the variation of peripheral blood CD4+ T-cell counts using flow cytometry in 28 cases of severe pulmonary infection 1 ～6 months after kidney transplantation (infection group), and 30 cases (control group) randomly selected that had stable situation and normal kidney function in the same period. Results CD4+ T-cell counts on the day of admission in infection group were significantly lower than in control group (184.1 ±117.5/μl vs. 518.6±232.7/μl, P<0.01 ). In infection group, 5 patients died and 4 of them had obviously declining trends of CD4+ T-cell counts during hospitalization course. Comparing to the day of admission, CD4+ T-cell counts of those survivors in infection group were significantly increased (184.1±117.5/μl vs. 406.5±163.9/μl, P<0.01) when infections were controlled. ROC analysis showed that CD4+ T-cell counts on the day of admission were accurate enough to identify who were susceptible to infection. In detail, the area under the curve (AUC) was 94.9% (P<0.01). CD4+ T-cell counts of 220/μl displayed the minimal misdiagnosis rate. Conclusions The variations of CD4+ T-cell counts are correlated to onset and progression of severe pulmonary infection in the early stage after kidney transplantation. Those who had CD4+ T-cell counts lower than 220/μl were at high risk of pulmonary infection. Direct measure and dynamic analysis of CD4+ T-cell subset have an important role in optimizing treatment and predicting prognosis of severe pulmonary infection in the early stage after kidney transplantation.     

肾移植术后早期严重肺部感染患者外周血CD4+T淋巴细胞计数的临床意义

目的 探讨肾移植术后早期严重肺部感染患者外周血CD4+T淋巴细胞计数的临床意义.方法 采用流式细胞术检测2007年2月至2008年6月期间,肾移植术后早期发生严重肺部感染的28例患者(感染组)外周血CD4+T淋巴细胞计数的变化,并随机选取同期肾移植术后病情稳定的30例患者(对照组)作为对照.结果 肾移植术后早期,感染组患者入院第1天CD4+T淋巴细胞计数显著低于对照组,分别为(184.1±117.5)个/μl和(518.6±232.7)个/μl(P<0.01).感染组患者中有5例治疗无效死亡,其中4例CD4+T淋巴细胞计数呈持续降低趋势;感染组中存活的患者在治疗恢复后,CD4+T淋巴细胞计数明显上升至(406.5±163.9)个/μl,与治疗前比较,P<0.01.受试者工作特征(ROC)曲线分析表明,CD4+T淋巴细胞计数减少能作为判断发生肺部感染的有效指标,其曲线下面积(AUC)为94.9%(P<0.01),CD4+T淋巴细胞计数为220个/μL时,其特异度为100%.结论 外周血CD4+T淋巴细胞的变化与肾移植术后早期严重肺部感染的转归密切相关.CD4+T淋巴细胞计数低于220个/μl的患者发生感染的可能性极大;测定外周血CD4+T淋巴细胞计数并动态分析对于优化治疗和判断预后有重要的参考价值.     

器官保存液中聚乙二醇对人红细胞聚集性和血液流变学的影响

背景：聚乙二醇作为一种非渗透性大分子物质,在器官保存液中可发挥保护细胞膜、维护细胞骨架完整性、防止细胞水肿、抗脂质过氧化和免疫调节的作用。 目的：探讨器官保存液中的聚乙二醇对人红细胞聚集性和血液流变学的影响。 设计、时间及地点：对比观察实验,于2008-10在解放军第二军医大学附属长征医院器官移植科完成。 材料：抽取接受体格检查的6名健康志愿者的肘前静脉血。 方法：在抽取的新鲜血液中按5∶1的稀释比分别加入生理盐水、器官保存液及含不同相对分子质量、不同浓度聚乙二醇的多器官保存液,按加入液体的不同分为：生理盐水组、器官保存液组、不添加聚乙二醇的保存液组、20聚乙二醇1,10,30 g/L和35聚乙二醇1,10,30 g/L组。 主要观察指标：室温下通过魏氏法检测红细胞沉降率、自动血液流变仪检测血液流变学指标、光镜观察红细胞聚集的形态学改变,分析聚乙二醇对人红细胞聚集性和血液流变学的影响。 结果：不含胶体的保存液对红细胞聚集无影响,含低浓度聚乙二醇的保存液对红细胞聚集性和血液流变学的影响较小,器官保存液组、20聚乙二醇30 g/L,35聚乙二醇10 g/L和35聚乙二醇30 g/L的保存液则可显著加快红细胞沉降率,降低红细胞变形能力,引起红细胞明显聚集。 结论：器官保存液中的聚乙二醇可引起红细胞聚集,降低红细胞变形能力,其相对分子质量越大,浓度越高,促进红细胞聚集的作用越明显,对血液流变学的影响越大。     

肾移植术后早期严重肺部感染患者外周血CD4+T淋巴细胞计数的临床意义

Objective To explore the clinical implication of peripheral blood CD4+ T-cell counts in renal allograft recipients with severe pulmonary infection in the early stage after kidney transplantation. Methods From February 2007 to June 2008, we investigated the variation of peripheral blood CD4+ T-cell counts using flow cytometry in 28 cases of severe pulmonary infection 1 ～6 months after kidney transplantation (infection group), and 30 cases (control group) randomly selected that had stable situation and normal kidney function in the same period. Results CD4+ T-cell counts on the day of admission in infection group were significantly lower than in control group (184.1 ±117.5/μl vs. 518.6±232.7/μl, P<0.01 ). In infection group, 5 patients died and 4 of them had obviously declining trends of CD4+ T-cell counts during hospitalization course. Comparing to the day of admission, CD4+ T-cell counts of those survivors in infection group were significantly increased (184.1±117.5/μl vs. 406.5±163.9/μl, P<0.01) when infections were controlled. ROC analysis showed that CD4+ T-cell counts on the day of admission were accurate enough to identify who were susceptible to infection. In detail, the area under the curve (AUC) was 94.9% (P<0.01). CD4+ T-cell counts of 220/μl displayed the minimal misdiagnosis rate. Conclusions The variations of CD4+ T-cell counts are correlated to onset and progression of severe pulmonary infection in the early stage after kidney transplantation. Those who had CD4+ T-cell counts lower than 220/μl were at high risk of pulmonary infection. Direct measure and dynamic analysis of CD4+ T-cell subset have an important role in optimizing treatment and predicting prognosis of severe pulmonary infection in the early stage after kidney transplantation.     

乳酸脱氢酶A在肾细胞癌中的表达及意义

【目的】分析乳酸脱氢酶A(LDHA)在肾细胞癌组织及细胞系中的表达情况并探讨其影响肾细胞癌细胞进展的方式。【方法】收集自2018年6月至2022年6月在我院通过手术方式获取的肾细胞癌组织标本52例及癌旁组织标本49例,免疫组织化学法比较LDHA的表达差异。通过qRT-PCR及Western blot实验检测LDHA在正常人近端肾小管上皮细胞系（HK-2）及肾细胞癌细胞系（A498, Caki-2, ACHN, 786-O）中的表达水平。构建LDHAshRNA重组质粒,转染至786-O以敲低LDHA表达,利用CCK-8、克隆形成实验及EdU染色法检测敲低LDHA表达对癌细胞增殖活性的影响。利用细胞葡萄糖摄取试验及乳酸分泌试验检测细胞糖摄取水平和乳酸分泌水平的变化。利用糖酵解压力测试实验检测细胞糖酵解能力的变化。【结果】免疫组化结果可见LDHA在肾细胞癌组织中表达明显高于癌旁组织,并且临床TNM分期越高的肾癌组织,LDHA的表达水平越高（P<0.05）。qRT-PCR和Western blot结果可见,LDHA在各肾细胞癌细胞系中的表达均较HK-2有明显升高（P<0.05）。在...     

肾移植后外周血CD4~+及CD8~+T细胞亚群计数的临床意义

背景:临床上常以流式细胞检测受者外周血CD4、CD8细胞比值来揭示与排斥或感染相关的关系。目的:探讨肾移植后排斥或感染时外周血CD4+及CD8+T细胞(简称CD4和CD8细胞)亚群计数的变化和意义。方法:应用流式细胞仪检测肾移植121例受者CD4、CD8细胞数进行检测。根据入院病情将患者分为移植后正常组、急性排斥组、肺部感染组进行观察。结果与结论:移植后正常患者和急性排斥患者相比,CD4、CD8细胞数差异均无显著性意义(P>0.05)。肾移植后肺部感染患者CD4、CD8细胞数则均显著低于移植后正常组(P<0.001)。当感染控制、症状改善时,CD4、CD8细胞数显著升高(P<0.001)。说明肾移植后CD4和CD8细胞计数可以作为免疫状态的参考,其对于感染的参考价值大于排斥,动态观察分析有助于指导治疗。     

经尿道等离子汽化电切联合术后吡柔比星膀胱灌注治疗腺性膀胱炎

目的探讨经尿道等离子汽化电切术联合术后吡柔比星膀胱灌注治疗腺性膀胱炎的临床疗效。方法对32例腺性膀胱炎患者在腰硬联合麻醉下行经尿道等离子汽化电切术;术后根据具体病情留置尿管5～7d,拔管前以化疗药物吡柔比星行膀胱灌注治疗,每周1次,共8次,后每月1次,连续10次。每3～6个月复查膀胱镜,观察膀胱黏膜情况,并选择性复查膀胱黏膜组织活检。结果 32例均手术成功,术中无严重出血和膀胱穿孔、水中毒等并发症发生,术后尿路刺激等症状均明显改善。术后随访4～36个月,23例治愈,6例好转,有效率90.6%;3例于术后6～10个月复发,复发者均再次行经尿道等离子汽化电切治疗。随访期间1例出现较严重的尿频、尿急、尿痛等膀胱刺激症,2例出现淡红色肉眼血尿,未发现恶变病例,无其他并发症。结论经尿道等离子汽化电切术联合术后吡柔比星膀胱灌注治疗具有安全、并发症少、疗效确切等优点,是治疗腺性膀胱炎的有效方法。     

腔镜尿道会师术与开放手术治疗尿道损伤的比较

探讨腔镜下尿道会师术的技术要点,比较腔镜手术与开放手术尿道会师术的优缺点。方法回顾性分析15例腔镜下尿道会师和23例开放手术尿道会师术治疗尿道损伤的临床资料,比较2组手术时间、术中失血量、术后住院时间、尿道狭窄发生率和最大尿流率等指标。结果腔镜治疗组尿道狭窄发生率、最大尿流率、手术时间、术中失血量和术后住院时间均显著少于开放手术组(P<0.05)。结论腔镜尿道会师手术时间短、创伤小、恢复快、术后效果可靠,是优于传统开放手术的替代方法。更多还原     

右径闭式二尖瓣扩张术中集血回输106例体会

右径闭式二尖瓣扩张术中集血回输１０６例体会解放军第一六九医院贺端清，曹振飞，莫放林，袁延才，赵娟，熊海云右径闭式二尖瓣扩张术是治疗风湿性二尖瓣狭窄的一种简单、有效的方式。因术中出血凶猛而较少被外科医师采纳。我院１９８５年７月至１９９１年１２月对３３１...