肾盂旁囊肿的诊断与治疗

目的 总结肾盂旁囊肿的诊治经验。方法 回顾性分析14例肾盂旁囊肿患者的诊治资料，比较B超、CT、KUB加IVU等检查方法与治疗手段在肾盂旁囊肿中的应用意义。结果 13例囊肿去顶手术治疗者术后随访6—48个月，11例恢复良好，无复发，无并发症。2例合并高血压患者血压恢复正常。1例术后存在反复尿路感染。结论 B超、KUB加IVU及CT是诊断肾盂旁囊肿的有效方法，CT可作为首选。开放性囊肿去顶手术是理想的治疗方法。     

肾细胞癌的不典型CT、MRI表现

目的　分析肾细胞癌 (RCC)的不典型CT、MRI表现 ,探讨如何提高CT、MRI对RCC的诊断正确率。　方法　回顾分析 10 0例经手术、病理证实的RCC。男 71例 ,女 2 9例。年龄 2 9～ 75岁 ,平均5 5岁。其中透明细胞癌 82例、混合细胞癌 8例、颗粒细胞癌 5例、乳头状癌 4例、肉瘤样肾细胞癌 1例。共 10 1个瘤灶 ,最大径为 0 .8～ 9.0cm ,平均 4 .3cm。总结RCC的典型CT、MRI表现 ,统计不典型CT、MRI表现的RCC病例 ,并与手术、病理结果对照。　结果　 17例RCC在CT、MRI上呈不典型表现 ,分为四类 :少血供RCC :12例 ,其中透明细胞癌 3例、混合细胞癌 1例、颗粒细胞癌 5例、乳头状癌 3例 ;囊性RCC :3例 ,均为透明细胞癌 ;RCC合并大片出血 :1例 ,为乳头状癌 ;直径 <1cm的RCC :1例 ,为透明细胞癌。　结论　正确认识少血供及囊性RCC的CT、MRI表现 ,采用适当的扫描方法及仔细阅片有助于提高对RCC的诊断正确率。     

单纯性肾囊肿应用不同术式治疗的效果比较

目的 探讨并分析单纯性肾囊肿应用不同术式治疗的效果比较.方法 选取本院于2014年6月至2016年7月期间收治的单纯性肾囊肿108例,将所有患者按照随机数字表法分为试验组和对照组两组;试验组50例患者行经皮肾穿刺并无水酒精硬化(PAES)术,对照组58例患者行腹腔镜肾囊肿去顶术.采集患者术后恢复状况、手术疗效以及所花费用等资料,并进行统计分析对比.结果 患者年龄、性别、肾囊肿部位、肾囊肿分型等资料比较差异无统计学意义(P＞0.05).两组患者的并发症发生率与手术治愈率与所选治疗方式无明显关联,差异比较无统计学意义(P＞0.05).两组患者的手术用时、治疗所花费用、手术后住院时间与所选治疗方式有一定关联结果,差异比较具有统计学意义(P＜0.05).术后随访两组患者12个月,其中试验组所吸出囊液平均量(135±17.9)mL,注入所需99％无水酒精平均量(34 ±6.4) mL;所有患者抽出囊液颜色均为浅黄色或无色,细菌培养及细胞检查均无阳性;对照组术后随访情况:囊肿未复发患者55例,复发行二次手术患者3例.结论 对肾囊肿需手术治疗患者而言,PAES和经腹腔镜肾囊肿去顶术各有优劣势,具体实施方案需根据患者自身状况决定.对于单纯性肾囊肿并期望所花费用不高患者,对比于腹腔镜肾囊肿去顶术,PAES术具有并发症少、治疗承担费用低、患者遭受痛苦轻以及患者恢复较快等优势;而腹腔镜肾囊肿去顶术适用于其他类型肾囊肿患者,包括巨大肾囊肿、多发双肾囊肿或恶性无法排除等患者;若患者经PEAS疗效不佳甚至无效或者实施经皮肾穿刺不易者,均应考虑行腹腔镜肾囊肿去顶术.     

小切口手术治疗单纯性肾囊肿

目的　探讨小切口手术治疗单纯性肾囊肿的特点及适应证。　方法　手术切口取第12肋尖下方做长约 3～ 4cm的小切口 ,对单纯肾囊肿患者行小切口囊肿去顶术 ,对手术方法、疗效及适应证进行分析。　结果　小切口手术组 19例 ,囊肿均位于肾下极及中部背侧 ,手术时间 2 0～ 80min(34± 15min) ,术后未发生并发症 ,住院日 3～ 8d(4 4± 1 5d)。随访 3～ 6个月均无复发。　结论小切口手术治疗单纯肾囊肿具有手术操作简便、创伤小、恢复快、降低住院日及医疗费用等优点 ,其适应证是肾下极、肾中部背侧的单纯肾囊肿。     

超声造影与增强CT诊断肾细胞癌的比较研究

目的:比较研究SonoVue超声造影(CEUS)和增强CT(CECT)在肾细胞癌诊断中的应用价值.方法:对56例肾占位性病变行SonoVue超声造影检查(CEUS组),同时对其中53例行增强CT检查(CECT组).连续、实时、动态观测肾肿瘤及周边肾实质血流灌注情况,记录注射造影剂后皮质期、实质期及延迟期肿瘤增强形态、强化方式,并与CECT增强全过程相比较.结果:CEUS组癌灶增强主要表现为皮质期等增强,实质期、延迟期低或等增强,仅有少部分表现为三期轻微增强.确诊.肾恶性肿瘤42例,误诊4例;确诊良性肿瘤7例,误诊3例.CECT组确诊肾恶性肿瘤38例,误诊5例;确诊良性肿瘤6例,误诊4例.CEUS和CECT诊断肾恶性肿瘤的灵敏度、阳性预测价值、诊断准确率分别为91.3%/88.4%、93.3%/88.4%、87.5%/81.1%.结论:CEUS和CECT都能敏感显示肾细胞癌血供强化特征,在肾细胞癌的定性诊断中起到相互补充的作用.     

Radiographic surveillance of minimally and moderately complex renal cysts

OBJECTIVE

To assess the effectiveness of radiographic surveillance for managing minimally and moderately complex renal cysts.

PATIENTS AND METHODS

Forty‐three patients with 50 minimally or moderately complex renal cysts underwent radiographic surveillance at our institution. Study inclusion criteria were surveillance for >2 years (36 patients, mean follow‐up 3.0 years) or surveillance for >6 months with subsequent surgical excision (seven patients, mean follow‐up 3.3 years).

RESULTS

The complexity of the renal cysts was in the form of high attenuation before contrast‐enhanced imaging (‘hyperdense’) in 29 patients, thin septations in nine, borderline enhancement in six, thin calcifications in five, and a thick wall in one. The mean initial largest dimension was 2.9 cm and the mean final dimension was 3.0 cm, with the size increased in 29 cysts, decreased in 14 and with no change in seven. The cyst character worsened in seven patients, improved in four and did not change in 39. Eventually seven patients had surgery (laparoscopic partial nephrectomy in five and laparoscopic radical nephrectomy in two), which revealed renal cancer in five. Surgical intervention was prompted by growth alone in two patients, growth and worsening of cyst characteristics in two, new onset of flank pain in one, and appearance of an enhancing nodule in the wall or septa in two.

CONCLUSION

Radiographic surveillance is an effective method for managing patients with minimally or moderately complex renal cysts. Malignant lesions can be identified and removed while still of low grade and contained, and surgery can be avoided in most patients.     

改进后的肾囊肿CT引导下硬化剂治疗术

目的观察改进肾囊肿CT引导下硬化剂治疗术的疗效。方法386例肾囊肿经皮穿刺抽吸乙醇治疗,其中,单纯性肾囊肿243例,多发囊肿113例,双肾均有囊肿30例。囊肿直径1.5~7 cm。用9-14 G穿刺针穿刺抽吸,抽出囊液5~700 ml,注入99.7%无水乙醇保留而不抽出,乙醇量以抽出量的25%~50%计算。结果随访193例(251个囊肿),时间3个月~12个月,囊肿治疗有效率达98%以上,囊腔消失率达87%,并发症仅为局部腰部胀痛,无严重后遗症。结论改进后的CT引导下肾囊肿硬化剂治疗术是一种安全、并发症少,操作简单的有效治疗方法。     

Simple and complex renal cysts in adults: Classification system for renal cystic masses

Ultrasound and slice imaging are currently the key modalities for diagnosing simple renal cysts. Benign simple renal cysts are defined by a set of strict criteria. Any cystic lesions that do not meet these criteria should be classified as “atypical” or “complex” and considered as suspicious. For over three decades, the Bosniak classification has been the central tool for diagnosing renal cystic masses larger than 1 cm. The Bosniak classification is based upon the results of a well-established pre- and post-contrast computed tomography (CT) protocol. Lesions that are difficult to classify or that remain indeterminate after CT can benefit from a multimodal diagnostic approach combining CT, non-contrast-enhanced and contrast-enhanced ultrasound, and magnetic resonance imaging.     

The radiographic evolution of radio frequency ablated renal tumors

PURPOSE: Radio frequency ablation (RFA) of renal tumors is a relatively new technology. Few groups are familiar with the posttreatment appearance of these lesions and how they differ from cryoablated renal masses. We describe the evolution of the appearance of these lesions on followup contrast enhanced (CE) computerized tomography (CT). METHODS AND MATERIALS: A total of 64 consecutive renal tumors treated with RFA from April 2000 to September 2003 for which posttreatment CE-CT was done were included in this study. CE-CT was reviewed at 6 weeks, 3 months, 6 months and every 6 months thereafter to determine the characteristic features and evolution of these lesions. RESULTS: Renal tumors were treated with CT guided percutaneous (34), laparoscopic (28) or open (2) RFA. At a median followup of 13.7 months (range 6 weeks to 29 months) 62 RFA lesions demonstrated an absence of contrast enhancement on CE-CT. Treated endophytic tumors developed a low density, nonenhancing, wedge-shaped defect with fat infiltration seen between the ablated tissue and normal parenchyma. Treated exophytic tumors retained a configuration similar to that of the original with a lack of contrast enhancement and minimal shrinkage. Percutaneous treated lesions developed a peritumor scar or halo that demarcated ablated and nonablated tissue (perirenal fat). Persistent tumor was marked by contrast enhancement within the ablation borders of the original mass in 1 case, whereas tumor recurred after initial successful ablation with an enhancing nodule in 1. CONCLUSIONS: The radiographic features and evolution of radio frequency ablated renal tumors are unique. Successfully treated tumors demonstrated no contrast enhancement, minimal shrinkage and occasional retraction from normal parenchyma by fat infiltration.     

单孔法后腹腔镜下肾囊肿去顶术

目的探讨单孔法后腹腔镜在肾囊肿去顶术中的应用价值。方法采用单孔法后腹腔镜下完成肾囊肿去顶术8例。男5例,女3例。年龄36～67岁,平均42岁。左侧5例,右侧3例。囊肿大小4．6 cm×4．3 cm～7．6 cm×10．2 cm,平均5．6 cm×8．5 cm。结果8例手术均成功,手术时间平均52（45～95）min,术中出血量平均25（0～100）ml,平均1．5（1～4）d拔除引流管,平均1．5 （1～3）d下床活动,术后住院时间平均4．5（3～5）d,8例术后随访1～6个月,经B超和CT或MRI等复查,肾囊肿无复发。结论单孔法后腹腔镜下肾囊肿去顶术具有微创、创口出血少、康复快等优点,具有较高的实用性,安全有效,是治疗肾囊肿的理想术式。     

腹腔镜联合经皮肾穿刺取石术治疗肾囊肿并肾多发性结石

目的 介绍腹腔镜联合经皮肾穿刺取石术治疗肾囊肿并肾多发性结石的技术要点和初步经验。 方法 选取20例肾囊肿并肾多发性结石患者行腹腔镜联合经皮肾穿刺取石术治疗肾囊肿并肾多发结石。结石最大4x3cm,最小1x0.5cm。先用腹腔镜行肾囊肿去顶术。然后根据术前CTA+CTU片制定手术方案和穿刺部位。在腹腔镜监视下行经皮肾穿刺,建立F18取石通道取石。 结果 20例患者均获得成功。结石全部取尽,手术效果满意。手术平均时间90min。没有出现出血、尿漏、肾盏颈撕裂和输尿管狭窄等严重并发症。术后平均住院时间5d。 结论 腹腔镜联合经皮肾穿刺取石术可以同时处理肾脏多种疾病。在处理肾盏内结石或肾盏颈细长,肾内型肾盂的患者较腹腔镜肾盂切开取石术容易操作,盏颈损伤小和结石清除率高。是腹腔镜肾盂切开取石术有益的补充和支持。     

21例囊性肾癌的诊治和随访结果分析

目的：增加对囊性。肾癌真实发病率和生物学行为的认识，提高术前诊断准确性。方法：回顾性分析1997年5月～2007年5月收治的所有。肾癌中存在囊性成分病例的临床特点、影像学表现、手术治疗方式的选择、病理特点以及随访的情况。结果：以囊性成分所占体积不少于肿瘤总体的75％为入选标准，筛选出21例囊性肾癌（22个病灶，其中病例17为双侧病变），占所有肾癌总数（312例）的6．7％，患者平均年龄为47．3岁（30岁到77岁）．4处病灶行。肾部分切除术（18．2％）．18处病灶行肾癌根治术（81．8％）；按病理分期T1期16例（76．2％），T2期5例（23．8％），T3期1例（4．8％）；按Bosniak分类，Ⅱ类4例（18．2％），Ⅲ类12例（54．5％），IV类6例（27．3％）。术后随访平均39．0个月（2～110个月，中位数33个月），除1例因术后心脏合并症死亡外，余20例（95．2％）均生存，没有肿瘤复发和转移。结论：囊性肾癌是一种少见的临床病理亚型，Bosniak分类能在一定程度上提高术前诊断的准确性，手术切除特别是保留肾单位手术能有效地治疗囊性肾癌，临床预后很好。     

进展期肾细胞癌的治疗进展

进展期肾细胞癌(RCC)的临床预后欠佳,由于其对于传统的放化疗的低敏感性,使得临床工作中缺乏较为有效的治疗手段.多个因素影响进展期肾癌的临床预后.目前免疫治疗可使部分进展期肾癌得到部分程度的缓解,新兴的靶向治疗在前期的临床实验中取得了令人满意的效果,使部分患者的肿瘤进展得以延迟,RCC靶向治疗制剂多针对RCC细胞增生、血管形成等多个靶向途径,包括Sorafenib,Sunitinib,Temsirolimus和Bevacizumab等.而联合免疫治疗,将对进展期肾癌的预后产生更为有效的改善.     

CYP1A1 activity in renal cell carcinoma and in adjacent normal renal tissue

Cytochrome P450-isoenzyme, CYP1A1, is responsible for the metabolic activation of several precarcinogenic environmental chemicals to their carcinogenic intermediates. Microsomal CYP1A1 activity in renal cell carcinoma (RCC) and in normal renal tissue was determined by measuring spectrofluorometrically the hydroxylation rate of benzo[a]pyrene. The study included 50 patients who underwent nephrectomy for RCC. Tissue specimens were taken from renal tumours and, as a control, from macroscopic normal renal tissue adjacent to the tumours. Normal renal tissues that were adjacent to poorly differentiated grade 3 tumours and/or to metastatic RCC contained significantly higher CYP1A1 activities than renal tissues next to well-differentiated (P = 0.02) and/or organ-confined tumours (P = 0.001). In conclusion, those patients who had tumours that could be considered aggressive on the grounds of poor cell differentiation or a metastatic feature of tumour, had remarkably higher CYP1A1 activities in their kidneys than the patients with less aggressive renal tumours. Received: 25 March 1997 / Accepted: 19 September 1997     

超声造影技术在肾癌诊断中的临床应用价值

目的研究超声造影成像技术对肾癌的临床诊断价值。方法对21例经手术病理证实的肾脏恶性肿瘤（肾细胞癌18例,肾盂癌3例）患者进行超声造影观察,分析其造影增强图像特点,并与增强CT对照分析。结果所有患者均获得清晰的肿瘤动态造影灌注图像。18个（100％）肾细胞癌病灶在超声造影（CEUS）和增强CT（CECT）皮质期均显示全瘤增强,CEUS及CECT表现为高增强分别为14个（77．8％1和16个（88．9％,P〉0．05）,等增强分别为4个（22．2％）和2个（11．1％,P〉0．05）。造影剂早于肾皮质消褪者在CEUS和CECT分别为13个（72．2％）和15个（83．3％）,与肾皮质同步消褪分别为5个（27．8％）和3个（16．7％）,两者无显著性差异。3例肾盂癌在超声造影及增强CT均呈全瘤强化,造影强度与肾皮质相同,较肾皮质提前消褪。结论超声造影成像技术能清晰显示肾癌的血流灌注特点,为临床提供了一种简便易行的肾癌诊断手段。     

Spoke-wheel-like enhancement as an important imaging finding of chromophobe cell renal carcinoma: A retrospective analysis on computed tomography and magnetic resonance imaging studies

AIM: Little information has been reported with regard to the radiological features of chromophobe cell renal carcinomas (CCRC). The aim of the present study was to identify imaging characteristics which lead to the histological diagnosis of CCRC. METHODS: The imaging findings of computed tomography (CT) and magnetic resonance imaging (MRI) were retrospectively analyzed in 11 patients with CCRC operated on at Tokyo Women's Medical University, Tokyo, Japan. RESULTS: None of the factors studied were significant in distinguishing the two variants, typical and eosinophilic variants. Enhanced CT scans showed a spoke-wheel-like enhancement with a central scar in 3 patients (27%). The radiological patterns were classified into two groups. Seven patients (64%) showed pattern 1 in which: (i) a hypodense to isodense enhancement compared to the renal medulla in the corticomedullary phase during dynamic CT; (ii) an isodense mass compared to the renal medulla in unenhanced CT scan; and (iii) a lobulated appearance were typically observed. Four patients (36%) showed pattern 2 that seemed to be similar to the features of clear cell carcinoma, having an alveolar structure including a hyperdense enhancement in the corticomedullary phase and an inhomogeneous appearance. A spoke-wheel-like enhancement was observed only in patients with pattern 1, and was more clearly demonstrated in larger tumors. CONCLUSIONS: The CT and MRI findings in CCRC patients were not uniform, but it was noted that a spoke-wheel-like enhancement with a central stellate scar, which might have been mistaken for oncocytoma, was one of important findings of CCRC. Tumors demonstrating a spoke-wheel-like enhancement with a central scar should be carefully managed, because they could be malignant.     

Prognostic value of multifocality on progression and survival in localized renal cell carcinoma

OBJECTIVE: Incidence of multifocality in Renal Cell Carcinoma (RCC) is estimated at between 5 and 25%. Multifocality has been largely studied because of the growing interest in conservative surgery which is a risk of local recurrence. The aim of this study is to evaluate the relationship between multifocality and other prognostic parameters and whether it is an independent prognostic factor. MATERIAL AND METHODS: From 1980 to 1990, 255 patients (median age: 60.9 years) were treated by radical nephrectomy for pT1 to pT3b N0M0 RCC. The median follow-up time was 183 months. Multifocality was defined as the existence of at least one other tumoral localization, macroscopically and microscopically diagnosed as renal cell carcinoma, in the same kidney. Studied parameters were: age, sex, side, size, stage, Fuhrman's grade, capsular invasion, renal vein involvement and microvascular invasion. Survival was assessed with Kaplan-Meier and Cox models. RESULTS: 37 cases of multifocal RCC were diagnosed (14.5%). There was only a significant correlation with stage (p=0.002) and with capsular invasion (p=0.002). No other factor was correlated with multifocality. It had no influence on the risk of metastatic progression, overall or specific survival. CONCLUSION: There is a significant correlation between capsular invasion and multifocality that has to be considered before proposing conservative surgery for a localized RCC. Multifocality has no influence on survival or metastatic progression in case of radical nephrectomy.     

Imaging characteristics of papillary renal cell carcinoma by computed tomography scan and magnetic resonance imaging

AIM: To analyse the differences in the patterns between clear and papillary renal cell carcinomas using magnetic resonance imaging (MRI) and dual-phase helical computed tomography (CT). METHODS: We examined seven patients with papillary renal cell carcinoma, and six with clear cell carcinoma. The highest attenuation value of tumors in the corticomedullary phase (CMP) and the excretory phase (EP) was measured using the observer-defined region of interest (ROI). MRI consisted of T1-weighted and T2-weighted spin-echo imaging. RESULTS: All five tumors except for one with papillary renal cell carcinoma showed homogenous hypointensity, but all six tumors with clear cell carcinoma showed heterogeneous hyperintensity on their T2-weighted images. In the CMP, the mean CT numbers of the papillary renal cell carcinomas were significantly lower than those of the clear cell carcinomas. The mean enhancement of the papillary renal cell carcinomas in the CMP and the EP was significantly lower than that of the clear renal cell carcinomas. The mean CT numbers of the clear cell carcinomas in the CMP were markedly increased from those on the unenhanced CT; those in the EP were decreased gradually. But the mean CT numbers of the papillary renal cell carcinomas in the EP were still slightly more increased than those in the CMP. The enhancement patterns of the papillary renal cell carcinomas in the CMP and the EP were homogenous, but those of the clear cell carcinomas were heterogeneous. CONCLUSIONS: We can speculate the differential diagnosis from clear to papillary renal cell carcinoma using MRI and dual-phase helical CT.     

后腹腔镜技术治疗肾盂旁囊肿的体会

目的:总结经腹膜后腹腔镜囊肿去顶术治疗肾盂旁囊肿的经验,讨论手术适应证和手术要点。方法:采用经腹膜后腹腔镜囊肿去顶术治疗肾盂旁囊肿7例。结果:7例手术均获成功。术后无并发症。手术时间30~120m in,平均65m in;术中出血30~80m l,平均55m l;术后住院5~8d,平均6.5d。结论:后腹腔镜手术治疗肾盂旁囊肿可望成为治疗肾盂旁囊肿的首选方法。     

Case report of a giant renal oncocytoma

This report represents the third largest renaloncocytoma in English literature. The tumor wasconsidered as a renal cell carcinomapreoperatively based on the physicalexamination and radiographic findings.