采用chevron切口治疗复杂性肾癌的临床研究(附15例报告)

目的：探讨选择chevron切口治疗复杂性肾癌的指征和优势。方法：15例诊断为肾癌的患者术前进行CT和（或）MRI检查,发现肿瘤体积巨大,其中5例发现肾静脉或下腔静脉瘤栓,2例发现肾癌合并对侧肾上腺转移。15例患者均采用腹部chevron切口行肾癌根治手术,术后获得病理结果。结果：15例患者均采用腹部chevron切口行肾癌根治、淋巴结清扫术,其中5例实施静脉取瘤栓手术,2例实施对侧肾上腺切除手术,手术均顺利实施,手术时间4.45±0.83h,术中出血量785±910ml,15例患者术后恢复顺利,并给予综合治疗,严密随访。结论：在肾癌的手术切口选择上,对于肿瘤体积大,局部淋巴结转移,合并静脉瘤栓及对侧肾上腺转移的病例可选择chevron切口,该切口手术暴露清晰,术中术后并发症少。     

腹部无小切口腹腔镜联合右胸小切口 Ivor - Lewis 食管癌根治术30例近期疗效

目的：评价腹部无小切口腹腔镜联合右胸小切口 Ivor - Lewis 食管癌根治术的安全性、可行性及短期疗效。方法：2012年至今我院行腹部无小切口腹腔镜联合右胸小切口 Ivor - Lewis 食管癌根治术30例,腹腔镜下游离胃并行 D2淋巴结廓清,腹腔内制作部分管状胃,右腋下第5肋间10～12cm 小切口进胸,游离食管并行胸内淋巴结廓清,将胃上提至胸腔,行食管胃胸膜顶吻合,镜下60闭合器完成剩余管状胃的制作。结果：手术经过顺利,其中中转开腹止血1例。手术平均时间160min,平均出血量25ml,所有病例无腹部并发症,无吻合口瘘,无肺内并发症,无胃排空延迟,均治愈出院。结论：腹部无小切口腹腔镜联合右胸微小切口 Ivor -Lewis 食管癌根治术是安全可行的,近期效果满意。     

乳腺癌根治术中横切口的应用

目的:分析横梭形切口在乳腺癌根治术中应用的优点。方法:采用横梭形切口行乳腺癌根治/改良根治术,并对其疗效、并发症等进行分析。结果:本组手术共134例,伤口Ⅰ期愈合122例,皮瓣坏死12例,肩关节活动良好,无局部复发病例。结论:应用横切口行乳腺癌根治/改良根治术,切口隐蔽,外形美观,皮瓣坏死率低是其腋窝清扫满意,可作为乳腺癌根治术的首选切口方式。     

腹部横切口在腹膜外盆腔淋巴结清扫术中的应用

宫颈癌根治术行腹膜外淋巴结清扫术时 ,多采用腹部纵形切口 ,原因在于手术野暴露面大和随时可延长切口。我院从 1 997年 5月份起 ,在行该手术时采用 Pfannenstiel术式改良法 ,也能顺利完成该手术 ,并收到较好的效果 ,现报道如下。一般资料我院妇科 1 997年 5月～ 1 998年 4月 ,宫颈癌根治术采用腹部横切口、腹膜外盆腔淋巴结清扫术1 8例。平均年龄 56.4岁 ( 34～ 68岁 )。鳞状上皮癌1 2例 ,腺癌 6例。临床分期据《FIGO 1 970年再次修订的国际分期法》: a1例、 b1 0例、 a4例、 b 3例。其中 b均为放疗后三周行手术治疗 , a有 2例为放疗后…     

肺癌腋下小切口根治术的临床疗效分析

目的探讨肺癌腋下小切口行根治术的临床疗效。方法 27例肺癌患者,作为研究组,该组经腋下小切口行肺癌根治术;同时选择21例具有完整临床资料的肺癌患者作为对照组,该组于后外侧切口行肺癌根治术。比较两组手术时间、出血情况、术后疼痛、住院时间、引流情况、肺功能和肩关节情况及死亡率。结果研究组术后3个月内死亡率与对照组比较,差异不明显;P>0.05,其余指标研究组优于对照组,占有明显优势,P<0.05。结论经腋下小切口行肺癌根治术的临床疗效满意。     

贲门癌分型及转移特点在外科治疗中的意义

目的:探讨贲门癌分型和转移特点及不同手术方式的预后情况,制定合理规范的治疗方案。方法:1010例贲门癌手术患者,分别行标准根治术、扩大根治术和姑息性切除。胸腹联合切口609例,腹部正中切口136例,单纯开胸切口265例。联合胰脾切除57例。总结不同类型淋巴结转移的特点,分析不同手术方式的预后情况。结果:SiewertⅢ型占贲门癌的56.3%(569/1010),5年生存率仅39.19%,明显低于SiewertⅠ型和Ⅱ型患者,SiewertⅠ、Ⅱ和Ⅲ型的胸部淋巴结转移率分别为13.3%(13/98)、9.3%(32/343)和1.6%(9/569),而且差异有统计学意义。结论:SiewertⅠ、Ⅱ型可经胸行根治术;SiewertⅢ型食管受累者需经胸腹联合切除进行根治;其余的贲门下癌均可经腹完成根治。     

腹腔镜与开放性肾癌根治性切除术的对照研究

目的比较腹腔镜下与开放性根治性肾切除术治疗早期肾癌的安全性及疗效。方法收集2001年1月至2011年1月T₁～2N₀M₀期行腹腔镜下肾癌根治术、开放性肾癌根治性术患者的临床资料,随访至2012年2月,比较2组手术切口长度、手术时间、术中出血量、手术前后的血清肌酐变化值、血尿发生率、术后开始进食时间、术后引流天数、术后住院天数、局部复发率、远处转移率及生存率。结果腹腔镜组手术切口长度、术中出血量、术后开始进食时间、术后引流天数、术后住院天数均少于开放组,差异有统计学意义（均P<0.05）;而两组的手术时间、手术前后血清肌酐变化值、血尿发生率、局部复发率、远处转移率、生存率均无明显差异（均P>0.05）。结论腹腔镜下根治性肾切除术安全性和疗效与开放性根治性肾切除术相同,但手术创伤小,术后恢复优于开放性根治性肾切除术,可以作为治疗早期肾癌的首选术式。     

后腹腔镜下肾癌根治术60例临床观察

[目的]探讨后腹腔镜在肾癌根治术中的应用。[方法]对60例行后腹腔镜下肾癌根治术肾癌患者进行回顾性分析。[结果]60例肾癌患者,59例手术成功,1例中转开放手术。手术平均时间173．5min（95～300min）;失血量50～1500ml,中位失血量175ml;术后住院4～12d,平均7．2d。术后随访7～32个月,平均17个月。60例患者全部生存,无一例肿瘤局部复发或切口种植转移。[结论]后腹腔镜下肾癌根治术具有创伤小、恢复快等特点,是肾癌外科治疗的发展方向。     

抵钉座体外置入法经肛门外翻切除标本腹部无辅助切口腹腔镜低位直肠癌根治术的近期疗效

目的探讨抵钉座体外置入法在经肛门外翻切除标本的腹部无辅助切口腹腔镜低位直肠癌根治术中的近期疗效及应用价值。方法回顾性分析2015年6月至2018年6月在河南大学淮河医院肛肠外科接受腹腔镜低位直肠癌根治术的52例患者的临床资料,其中26例行抵钉座体外置入法经肛门外翻切除标本的腹部无辅助切口手术(NOSES组),26例行传统腹壁小切口取标本手术(LAP组)。并对其术中、术后资料进行分析。结果两组共52例患者手术均顺利完成,无中转开腹病例,两组患者手术时间、术中出血量、淋巴结清扫数目、术后并发症发生率、环周切缘情况、术后随访情况及术后肛门功能比较,差异均无统计学意义(均P0.05)。与LAP组相比,NOSES组术后胃肠道功能恢复时间、术后住院时间均更短,术后疼痛评分、额外镇痛药物使用率更低,住院费用更少,患者对术后腹壁外观满意程度更高(均P0.05)。结论抵钉座体外置入法经肛门外翻切除标本的腹部无辅助切口腹腔镜低位直肠癌根治术近期疗效满意,且在减轻术后疼痛、缩短术后住院时间、降低住院费用、腹壁外观更加美观等方面具有优势。     

腹部无切口经直肠肛门外翻切除标本的低位直肠癌根治术11例

目的 讨论腹部无切口经直肠肛门外翻切除标本的腹腔镜下直肠癌根治术的可行性及短期疗效.方法 完成腹部无切口经直肠肛门外翻切除标本的低位直肠癌根治术11例.结果 手术平均时间为（189.5±25.2）min,术中平均出血量为（25.4 ±9.4） ml,术后平均排气时间为（38.9±8.6）h,住院平均时间为（12.7±2.5）d,淋巴结检出平均数目为（13.5±4.1）枚,肿瘤平均直径2.7（0.6～ 5.3） cm,无术中及术后并发症.结论 腹部无切口经直肠肛门外翻切除标本的低位直肠癌根治术在技术上可行,具有良好的安全性,其远期效果还需要进一步研究.     

Radical nephrectomy using a chevron incision to treat complicated renal carcinoma: a report of 15 cases

OBJECTIVE To investigate the outcome and indications for radical nephrectomy with a Chevron incision to treat complicated renal carcinoma.METHODS Large renal carcinomas were found in 15 patients during a preoperative CT and/or MRI examination. A tumor thrombus in the renal vein or inferior vena cava was found in 5 cases, and a complication of metastasis in the contralateral adrenalgl and was found in 2 patients. All of the 15 patients underwent a radical nephrectomy by a chevron incision and the postoperative pathological results noted.RESULTS Of the 15 patients who underwent a radical nephrectomy and lymphadenectomy, 5 also received a thrombectomy, and 2 a contralateral adrenalectomy. All surgical operations were safe and successful. The mean operation time was (4.45±0.83) h, and the intraoperative blood loss was (785±910) ml. All patients recovered well after the surgery. Multimodal therapy was conducted in these cases, with rigorous follow-up.CONCLUSION In determining the type of incision for surgery of renal carcinoma, a chevron incision is suitable for cases with a large tumor, local nodal metastasis, thrombus of the renal vein or inferior vena cava and complicated metastasis to the contralateral adrenal gland. The incision produces a clear operating field with less intra- and post-operative complications.     

后腹腔镜根治性肾切除术治疗局限性肾癌的疗效研究

目的 研究后腹腔镜根治性肾切除术(laparoscopic radical nephrectomy,LRN)治疗局限性肾癌的效果及安全性.方法 选择局限性肾癌患者80例,分为LRN组39例和传统开放肾癌根治术(open radical nephrectomy,ORN)41例(ORN组),比较两组的临床疗效.结果 与ORN组相比,LRN组手术时间、住院时间、术后肠功能恢复时间、术中出血量、白细胞、C-反应蛋白、肌酐和尿素氮均明显降低(P<0.05);LRN组的切口感染、术后出血、深静脉血栓形成、肺部感染、气胸、泌尿系统感染等并发症发生率为12.82%,明显低于对照组的29.27%(P<0.05);随访3~30个月,LRN组有1例术后5个月出现双肺转移,经口服索拉非尼后,现在病情已平稳;ORN组有1例术后4个月出现双肺转移,2例术后1年出现肿瘤全身转移.结论 后腹腔镜根治性肾切除术治疗局限性肾癌安全、有效,与传统开放手术相比,具有术后恢复快、创伤小、并发症少等优点,临床应用价值更高.     

Treatment of a Case of Asynchronous Bilateral Renal Cell Carcinomas with Inferior Vena Caval Thrombus and Hepatic Metastases

A 56-year-old man underwent a right radical nephrectomy withremoval of a vena caval thrombus and resection of hepatic metastasesfor right renal cell carcinoma. Twenty-one months after thefirst operation, a left renal cell carcinoma was detected whichwas treated with left radical nephrectomy and followed by hemodialysis.The patient then enjoyed an active life for 14 months but died18 months after his second operation due to lung metastasis.Bilateral radical nephrectomy and hepatic resection may be justifiedsince there is no strongly effective adjuvant therapy for suchadvanced cases.     

后腹腔镜根治性肾切除术治疗肾癌的临床分析

目的 评价后腹腔镜根治性肾切除术治疗肾癌的安全性及疗效.方法 回顾性分析后腹腔镜根治性肾切除术治疗53例肾癌的临床资料.结果 53例患者中,52例成功施行后腹腔镜根治性肾切除术,1例因粘连较重改行开放手术.手术时间75～220min,平均125min;术中出血50～420 ml,平均120ml;术后住院时间为6～12 d.发生手术并发症4例.病理检查显示,透明细胞癌47例,嫌色细胞癌5例,囊性肾细胞癌1例.随访1个月至5年,未见肿瘤复发转移.结论 后腹腔镜根治性肾切除术治疗T1～2N0M0期肾癌安全、有效.

Abstract：

Objective To evaluate the safety and efficacy of retroperitoneal laparoscopic radical nephrectomy in the treatment of renal cancer. Methods The clinical data of 53 cases who underwent retroperitoneal laparoscopic radical nephrectomy were analyzed retrospectively. Results Fifty-two cases achieved successful retroperitoneal laparoscopic radical nephrectomy, a conversion to open surgery was required in one case because of severe adhesion. The operation time was 75 min to 220 min ( mean, 125 min), the blood loss was 50 ml to 420 ml ( mean, 120 ml), and the postoperative hospital stay was 6 d to 12 d. Complications occurred in 4 cases. Pathological examination showed that 47 cases were of renal clear cell carcinoma, 5 of chromophobe carcinoma, and 1 of cystic renal cell carcinoma. Follow-up for 1 month to 5 years showed no mimor recurrence and metastasis. Conclusion Retroperitoneal laparoscopic radical nephrectomy is a safe and effective treatment for patients with stage T1 ～2N0M0 renal cell carcinoma.     

肾结石合并肾盂鳞状细胞癌2例临床分析合并文献复习

目的探讨肾结石合并肾盂鳞状细胞癌的发生机理、诊断、鉴别诊断及治疗方法。方法对1例术前诊断为右肾结石合并肾肿瘤患者行根治性右肾切除术;另1例左肾结石伴重度积水合并感染的患者行左肾切除术,术中冷冻切片检查提示为恶性肿瘤,遂扩大手术切除范围,行根治性肾切除＋输尿管部分切除术。结果 2例患者病理诊断结果均为肾盂鳞状细胞癌,1例术后6个月死于全身功能衰竭,另1例术后随访至今（20个月）无复发。结论肾结石合并肾盂鳞状细胞癌恶性程度高、早期诊断较难,尿路造影及CT等检查结果有助于明确诊断,治疗方法以根治性肾切除术为主。     

Recurrent renal cell carcinoma arising in Wilms' tumor.

A 19-month-old black girl had a radical nephrectomy for a Wilms' tumor that contained areas of epithelium indistinguishable from renal cell carcinoma. She was treated with chemotherapy but subsequently had pulmonary metastases develop and massive abdominal recurrence. The recurrent tumor was histologically renal cell carcinoma with no identifiable Wilms' tumor elements. The child died with recurrent and metastatic tumor 13 months after nephrectomy. Pathologic, immunoperoxidase, and flow cytometric studies of this unusual case are presented.     

Endoscopic minilaparotomy partial nephrectomy for solitary renal cell carcinoma smaller than 4 cm

BACKGROUND: For small, incidentally discovered renal cell carcinoma, partial nephrectomy is becoming more widely accepted as an alternative to radical nephrectomy and the need for minimally invasive approach is increasing. METHODS: We carried out endoscopic minilaparotomy partial nephrectomy in seven cases of solitary renal cell carcinoma smaller than 4 cm. Five of them were without renal pedicle clamping. All procedures were done through single skin incision (5-8 cm) using a 30 degrees telescope. Hemostasis was achieved with a harmonic scalpel, a microwave tissue coagulator, an argon beam coagulator and autologous fibrin glue. RESULTS: There were no perioperative complications. All patients had negative surgical margins. The operating time was 157-275 min (average 209 min). The blood loss was 20-1200 ml (average 525 ml). Postoperatively, renal function as assessed by serum creatinine was within normal limits. Neither local recurrences nor metastases were observed during a follow-up of 6-15 months. The postoperative course was markedly improved over that expected from standard open surgery. CONCLUSIONS: With minimal morbidity and complications, endoscopic minilaparotomy partial nephrectomy is feasible for small renal cell carcinoma.     

肾脏小肿瘤临床与病理资料的分析

目的：探讨肾脏小肿瘤（Small renal mass,SRM）的临床与病理资料的特点。方法回顾性分析2011年哈尔滨医科大学附属肿瘤医院收治的接受根治性切除术或肾部分切除术的36例肾脏小肿瘤患者的临床与病例资料,所有患者的肿瘤应为局限性的实体肿瘤,并且有CT或MRI影像检查报告。结果36例肾脏小肿瘤患者中,肾透明细胞癌32例,乳头状肾细胞癌3例,良性肿瘤1例。接受肾脏根治性切除术的患者34例,仅有2例男性患者接受肾部分切除术。36例肾脏小肿瘤患者肿瘤最大径平均值为2．9 cm。结论在收集到的36例肾脏小肿瘤中病理类型最多的为肾透明细胞癌。36例肾脏小肿瘤患者绝大部分的手术方法为肾脏根治性切除术。     

Nature of Lesions Undergoing Radical Nephrectomy for Renal Cancer

Aim: The aim of the present study was to evaluate retrospectively histopathologically-diagnosed lesionsthat were detected in the kidney after radical nephrectomy for a preoperative diagnosis of kidney cancer.Methods: The medical records of 83 patients (51 male, 32 female) were included. Preoperative staging wasaccomplished by various methods including physical examination, blood hemography and biochemistry,abdominal ultrasonography (US), chest x-ray, abdominal computed tomography (CT) and abdominal magneticresonance imaging (MRI). Results: Totals of 70 patients underwent radical nephrectomy and 13 nephronsparing surgery. Of the 83 patients, 70 had malignant lesions (renal cell carcinoma, squamous cell carcinomaor other malignancies) 13 had a variety of benign lesions, the most frequently detected being oncoytoma (6),angiomyolipoma (3), xanthogranulamatous pyelonephritis (2), cortical cyst (1) and chronic pyelonephriticchange (1). Conclusion: It was concluded that in spite of great technological developments regarding radiologicalimaging modalities such as US, CT and MRI, benign lesions might still be detected pathologically in patientswho undergo radical nephrectomy with the preoperative diagnosis of renal cancer. But, all renal masses shouldbe regarded as malignant and should be managed surgically otherwise proven benign.     

Severe Dyspnea due to Pulmonary Metastasis of Renal Cell Carcinoma: Is Cytoreductive Surgery of Value?

Here, we present a case in which cytoreductive surgery, like left radical nephrectomy, was effective in the treatment of pulmonary metastases and para-aortic metastases from renal cell carcinoma. A 28-year-old man underwent left radical nephrectomy with pulmonary metastasectomy for the diagnosis of metastatic left renal cell carcinoma. The histologic diagnosis was clear cell carcinoma G2, pT3N1M1. He subsequently underwent i.m. administration of IFN-α, 5 million units per day for 30 days. The nasal oxygen mask was weaned gradually, and the chest tube was removable due to cessation of the continuous production of pleural fluid. The patient was well until one year after operation.