马蹄肾供肾肾移植的研究现状

马蹄肾主要在胚胎发育时,双侧输尿管芽的内侧支互相融合,诱导两侧肾下极或上极融合在一起而形成。尽管存在解剖变异,但大部分马蹄肾具有良好的功能。马蹄肾可作为扩大标准供肾,为解决供肾不足提供一种选择。本文就马蹄肾作为肾移植供肾的特点、国内外现状以及手术经验做一综述。     

复杂肾肿瘤的肾部分切除术

随着手术技术的不断进步, 肾部分切除术被更多地应用于复杂肾肿瘤的治疗。本文分别对大体积肾肿瘤、完全内生型肾肿瘤、肾门/肾窦肿瘤, 以及特殊组织类型的肾肿瘤展开述评, 并对复杂肾肿瘤行肾部分切除术的现状、技术难点和风险等进行深入阐述, 以更加理性地看待复杂肾部分切除术。     

肾血管瘤

肾血管瘤是以血尿为临床表现的一种相当罕见的良性肿瘤。从1867年Virchow第一次报道以来已经有大约200例临床病例被陆续报道。本文总结归纳了最近国内外关于肾血管瘤临床治疗研究的文献报道,指出了肾血管瘤在手术治疗及腔内介入治疗方面研究的主要进展,讨论了肾血管瘤的类型、手术影响因素等,在此基础上,对肾血管瘤的治疗研究前景进行了展望。     

肾周感染

肾周感染是指在肾包膜与肾周筋膜(Gerota's筋膜)之间的脂肪组织所发生的急、慢性感染。如感染发展形成脓肿,则为肾周脓肿。肾周感染在临床比较少见,由于解剖的关系,临床上误诊率较高。国内外文献对该病的专著较少,现将肾周感染的有关文献作扼要的综述。     

肾切除前肾蒂间歇性阻断促进留存肾代偿性生长的初步研究

为探讨肾切除前肾蒂间歇性阻断对留存肾代偿性生长的影响,用45只Wistar雄性大白鼠随机分为三组,分别行在肾切除(N组),肾蒂间歇性阻断后左肾切除(P组),肾蒂间隙阻断方法为夹闭肾蒂5分钟,松开5分钟,如此重复5次)及假手术(S组)。以术后14天留存肾(右肾)肾重及肾重/体重比值判断肾代偿性生长程度。结果P组肾切除术后留存肾代偿性生长较N组更为明显。表明肾切除前肾蒂间歇阻断明显促进了留存肾的代偿性生长。其机制还有待进一步研究。     

双侧肾同时发生肾细胞癌的保肾手术治疗

目的评价保肾手术在双侧肾癌治疗中的作用。方法报告一组双侧肾同时发生的肾细胞癌行保肾手术治疗结果。１９９０～１９９６年５例双侧Ⅱ期肾细胞癌，肾肿瘤直径１．５～５．５ｃｍ，平均４．０ｃｍ；共１３枚肿瘤，其中４例２枚，１例５枚。３例一侧作肾根治性切除，一侧作保肾手术，２例双侧肾均作保肾手术。结果平均随访３０个月，１例术后３年发现肺转移，无１例局部复发。结论保肾手术对体积较小的双肾癌是安全有效的治疗方法。     

腹腔镜肾部分切除术治疗中心型或肾门旁肾肿瘤

自从1993年WINFIELD等报道了首例经腹腹腔镜肾部分切除术,1年后GILL等报道了首例腹膜后腹腔镜肾部分切除术以来,腹腔镜肾部分切除术在世界范围内迅速得到普及,现已成为肾脏实性小肿物的可选择的甚至是推荐的治疗方式。最初,腹腔镜肾部分切除术仅适用于单发、浅表、外凸为主的小型实性肿瘤;而随着腔镜手术经验的积累和腔内缝合技术的提高,腹腔镜肾部分切除术现在也越来越多地应用于复杂病例,如中心型肾肿瘤、肾门旁肿瘤、孤立肾肿瘤、囊性肿瘤、多发肿瘤、T2期或以上的肿瘤。     

孤立肾肾肿瘤外科保肾治疗策略的选择及初步探讨

目的:探讨孤立肾肾肿瘤保肾治疗策略的选择。方法:回顾本中心2017年2月—2022年3月收治孤立肾肾肿瘤患者41例,男28例,女13例,年龄59(27～79)岁。其中38例为体检或术后复查中发现,2例患者因血尿就诊,1例患者因腰腹部肿块就诊。肿瘤位于左肾14例,右肾27例,其中肾门部肿瘤2例,肿瘤直径24(8～75) mm。所有患者均在气管插管全麻下进行,其中4例行开放肾部分切除术,19例行腹腔镜肾部分切除术,11例行机器人辅助腹腔镜肾部分切除术,3例行小切口辅助腹腔镜肾部分切除术,4例行腹腔镜肾肿瘤微波消融术。记录手术时间、出血量、肾动脉阻断方式、肾动脉阻断时间、术中及术后并发症、术前及出院前血肌酐值、住院时间。结果:所有手术均安全顺利完成,无术中并发症发生,2例腹腔镜肾部分切除术采用分支动脉阻断,其余肾部分切除术均采用肾动脉主干阻断,腹腔镜肾肿瘤微波消融术均无阻断。2例患者出现术后并发症。开放肾部分切除术组、腹腔镜肾部分切除术组、机器人肾部分切除术组、小切口辅助腹腔镜肾部分切除术组及腹腔镜微波消融组中位手术时间(173 min vs 135 min vs 120 min vs 26...     

后腹腔镜下马蹄肾半肾切除

目的 探讨马蹄.肾的影像学诊断及腹腔镜技术在其治疗中的应用价值. 方法马蹄肾患者7例.男5例,女2例.年龄11～47岁,平均33岁.以腰腹胀痛、血尿或尿路感染就诊.病程3～11个月.均经B超、IVU和螺旋CT检查明确诊断,均为单侧患肾,左侧5例,右侧2例;患肾IVU均不显影,对侧肾脏显影良好,行后腹腔镜下马蹄肾半肾切除术.结果 后腹腔镜马蹄肾半肾切除术耗时110～150 min,术中出血20～55 ml.术后2～3 d拔除切口引流管,切口均一期愈合,3～4 d出院.7例随访2～13个月,患者原有腰腹胀痛、血尿或尿路感染症状消失,术后1个月实验室复查肾功能均在正常值范围,未发生相关并发症.结论 后腹腔镜技术行马蹄肾半肾切除术视野清晰、出血少、创伤小、手术时间短、术后住院时间明显降低,是治疗马蹄肾的重要术式.     

肾折叠和肾固定术在巨大肾积水治疗中的应用

目的　评价肾折叠和肾固定术在治疗巨大肾积水患者中的作用。　方法　对 18例巨大肾积水患者在去除梗阻病因的同时 ,实施肾折叠和肾固定术。　结果　 18例患者手术顺利 ,无严重并发症。术后随访 3个月～ 3年 ,患者肾积水程度均显著减轻 ,患肾均出现不同程度显影。　结论对尚有功能的积水肾行肾折叠成形和肾下极外展固定 ,可提高尿液排空能力 ,促进肾解剖和肾功能的恢复     

Urologist-Acquired Renal Access for Percutaneous Renal Surgery

Objectives. In most endourology programs an interventional radiologist is employed to acquire renal access for percutaneous renal surgery. Over the last 13 years the senior endourologist at Oregon Health Sciences University has acquired access without employing a radiologist. We report our experience with urologist-acquired renal access for percutaneous renal surgery in 522 cases.Methods. We reviewed the records of all patients at our hospital who underwent percutaneous renal surgery between August 1983 and December 1996 with renal access being obtained in the operating room by a urologist.Results. Four hundred fifty-six patients underwent 522 procedures. Indications for percutaneous renal surgery were renal and proximal ureteral calculi (n = 516), retained ureteral stent (n = 3), and intrarenal collecting system tumor (n = 3). We were successful in gaining access to 513 of 522 kidneys (98.3%). Access was obtained via a subcostal approach in 344 procedures, over the 12th rib in 152 procedures, over the 11th rib in 15 procedures, and transabdominally in 2 procedures. Sixty-five patients (12.7%) required a second or multiple sites to facilitate complete removal of calculi. Our overall complication rate was 15.3%. Blood transfusion was required in 5.4% of the cases, ileus developed in 1.9%, pneumothorax in 1.1%, intraoperative hydrothorax in 1.1%, postoperative pleural effusion requiring aspiration in 0.9%, and septic shock in 0.9%. Our overall success rate for stone removal was 94.5%.Conclusions. In our experience, the urologist is able to safely and effectively obtain percutaneous access to the collecting system for percutaneous renal surgery as a one-stage procedure without the aid of interventional radiologists.     

Renal Adenoma Associated with Renal Cyst Formation

We report a renal adenoma associated with renal cyst formation in a 49-year-old male. A small renal mass inside a right renal cyst was discovered incidentally by ultrasonography. A right nephrectomy was performed. A pathologic examination revealed a well-differentiated, benign papillary tumor which was composed of slightly eosinophilic cells. We therefore diagnosed this patient as having a renal adenoma with hemorrhage.     

Renal Imaging in Patients with Renal Impairment

In patients with renal impairment, the incremental benefits from administration of contrast media for imaging studies need to be carefully assessed relative to the potential increased risks of worsening renal dysfunction and systemic adverse effects. This review provides an overview of risk and benefits of iodinated and gadolinium-based contrast agents; examines their relationships to contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF), respectively; and discusses various clinical strategies to minimize the risk of CIN and NSF. Specifically, renal imaging strategies aimed to minimize the adverse effects of contrast media as well as alternatives to iodinated and gadolinium-based contrast-enhanced renal imaging are proposed with emphasis on non–contrast-enhanced magnetic resonance imaging.