肾错构瘤破裂出血诊治体会(附29例报道)

目的探讨肾错构瘤自发性破裂出血的诊断和治疗方法。方法回顾性分析了2005至2011年诊治的29例肾错构瘤自发性破裂出血患者的临床资料,其中20例急诊行手术治疗,3例行介入栓塞治疗,6例行保守治疗。结果 20例行急诊手术治疗患者术后恢复良好,3例行介入栓塞治疗患者病情稳定,6例行保守治疗患者中3例病情稳定,另外3例保守治疗过程中改行手术治疗。结论 B超和CT检查是诊断肾错构瘤自发性破裂出血的重要方法,外科手术仍为肾错构瘤破裂出血的主要治疗方法。     

肾错构瘤出血的诊断和治疗(附18例报告)

目的 探讨肾错构瘤出血的诊断和治疗方法.方法 2000年6月至2007年12月收治肾错构瘤出血18例患者,经超声、CT等影像学检查后,行开放性手术15例,保守治疗3例.结果 3例患者经保守治疗后出血不再继续,病情趋于稳定.所有手术均顺利完成,无术中大出血及死亡病例.术后病理诊断均为肾错构瘤,无恶变.18例患者均获随诊,随诊时间3个月至5年,随诊时进行超声、CT及IVU检查.行肿瘤剜除术6例患者无肿瘤复发,无继发出血,无尿瘘,IVU提示手术侧肾功能良好.行患肾切除术9例患者对侧肾功能良好.3例保守治疗患者,血肿吸收良好,肿瘤无明显变化.结论 肾错构瘤出血的诊断应结合临床,全面综合分析,超声和CT等影像学检查方法是肾错构瘤出血确诊的主要方法.其治疗方法包括保守治疗、选择性肾动脉栓塞术、肿瘤剜除术或肾部分切除术,出血严重、对侧肾功能正常者,可行患肾切除术.     

MRI化学位移成像技术在肾血管平滑肌脂肪瘤诊断中的应用

目的探讨磁共振成像(MRI)化学位移成像技术在肾血管平滑肌脂肪瘤诊断中的临床应用价值。方法回顾性分析12例CT证实和10例手术后病理证实的肾血管平滑肌脂肪瘤的MRI化学位移成像表现。结果目测法,22例肾血管平滑肌脂肪瘤中,16例在反相位信号明显下降,5例病灶在反相位信号无明显下降,但脂肪抑制后信号明显下降,1例病灶在反相位和脂肪抑制序列信号都无明显下降。结论 MRI化学位移成像技术结合MRI脂肪抑制序列对病灶内是否含有脂质、脂肪有极高敏感性,有助于肾血管平滑肌脂肪瘤的诊断和鉴别诊断。     

腹腔镜肾部分切除术治疗肾脏肿瘤52例的临床分析

目的：探讨腹腔镜肾部分切除术治疗肾脏肿瘤的治疗效果及新进展。方法：2008年10月-2012年1月采用腹腔镜经后腹腔途径对52例肾肿瘤患者行LPN,40例患者阻断肾动脉主干,12例患者选择性阻断肾段动脉,肿瘤直径3.9cm（0.8～4.9cm）,观察观察手术时间、热缺血时间、术中出血量、围术期并发症及预后。结果：52例手术均顺利完成。平均手术时间80min（50～160min）,平均热缺血时间23min（15～35min）,术中平均出血量79ml（10～260ml）。2例患者术后出现迟发出血,1例保守治疗治愈,1例行介入栓塞治疗。1例术后出现漏尿,2周自行愈合。平均住院时间8.5d（7～15d）。术后病理示肾透明细胞癌39例,乳头状肾细胞癌6例,嫌色细胞癌2例,嗜酸细胞腺瘤2例,肾血管平滑肌脂肪瘤3例,切缘均为阴性。随访12～36个月肿瘤无复发。结论：经腹膜后途径腹腔镜肾脏部分切除术治疗T1肾肿瘤安全有效,并发症少,保留肾单位功能恢复好,值得推广应用。     

肾错构瘤26例诊疗分析

目的：探讨提高肾错构瘤诊治水平。方法：对26例肾错构瘤的临床资料进行回顾性分析。结果：年龄28～70岁。肿瘤大小1.5～15cm,B超确诊率为73.9%（17/23）,CT确诊率为80.8%（21/26）。26例中,肾切除7例,根治性肾切除2例,错构瘤剜除术3例,肾部分切除4例,8例双侧错构瘤中2例同时行双侧肿瘤剜除术加肾部分切除,1例左肾部分切除术后1年,右肾肿瘤增大至5cm行剜除术,另5例一侧肿瘤行剜除术,另一侧因肿瘤体积尚小予以随访。2例未手术观察随访。结论：B超和CT为诊断错构瘤首选方法。肿瘤剜除术、肾部分切除术应作为首选治疗方法。     

肾血管平滑肌脂肪瘤的CT诊断及误诊分析

目的肾血管平滑肌脂肪瘤的CT诊断及误诊分析。方法笔者通过对2005年11月—2011年12月来我院就诊的肾血管平滑肌脂肪瘤患者62例进行回顾性分析研究。结果根据肾血管平滑肌脂肪瘤的CT诊断特征,以及常与肾血管平滑肌脂肪瘤混肴的肾细胞癌和肾脂肪瘤的CT诊断影像的特征,得出三者之间的鉴别异处,重点分析研究误诊的患者病例,确诊为少脂肪型肾血管平滑肌脂肪瘤者21例,其中5例被误诊为肾脂肪瘤,1例误诊为肾细胞癌。结论加强对脂肪瘤的认识,提高CT的诊断率,减少误诊率,保证患者的正确治疗。     

Isolated, spontaneous hematoma of the kidney. Report of 2 cases

Spontaneous hematoma under the renal capsula is a rare pathology. The authors report two cases with one male and one female aged respectively of 50 and 63 years. The symptomatology is presented by right renal aches associated with repetitive and total hematuria in male and atypical abdominal aches in female. The radiological explorations (IVP, renal sonography and Computered Tomography) had conclude in a renal cancer in the two cases. The diagnosis is made by the pathologic study. Some etiology may be searched such as malignant tumor, an angiomyolipoma, vascular abnormalities and disturbance to the hemostasis. If no etiology is find, a nephrectomy or a simple supervision can be discussed.     

后腹腔镜肾蒂阻断下保留肾单位肾肿瘤手术(附6例报告)

目的 探讨后腹腔镜肾蒂阻断下保留肾单位治疗肾肿瘤的方法及手术技巧. 方法收治肾脏外生性实体肿瘤6例患者,其中.肾细胞癌2例,肿瘤直径分别为2.5 cm和2.2 cm;肾错构瘤4例,肿瘤直径为2.5～3.5 cm.经后腹腔镜径路在自制的肾蒂阻断装置中阻断肾蒂,做保留肾单位的肾肿瘤手术,术中距肿瘤0.5～1.0cm处行肾脏部分切除术,创面缝合止血.结果 6例手术均成功,手术时间120～210min,中位数150min.术中出血150～200ml,中位数170ml.肾蒂血流阻断时间18～33 min,中位数22 min.2例肾细胞癌术后切缘阴性.术后随访6～12个月,未见肿瘤残留及复发.结论 后腹腔镜肾脏部分切除术中应用自制的肾蒂阻断装置,具有良好的止血效果、手术创伤小、视野清晰、操作方便、能最大限度地保留患肾等优点,术后恢复良好.     

Retroperitoneal bleeding caused by renal angiomyolipoma

An 81-year-old woman presented with left-flank pain, anaemia and a fast irregular pulse while using oral anticoagulation. Diagnostic investigation revealed retroperitoneal bleeding caused by a medium-sized renal angiomyolipoma. Angiomyolipoma was also found in the contralateral kidney. No tuberous sclerosis was ascertained. Bleeding stopped after discontinuation of anticoagulant therapy. Renal angiomyolipoma is an uncommon benign tumour which is frequently associated with tuberous sclerosis. Spontaneous retroperitoneal bleeding is a potentially life-threatening complication. This type of tumour is usually found incidentally on radiological examination.     

出血性肾血管平滑肌脂肪瘤的介入栓塞治疗

[目的]评价栓塞治疗出血性肾血管平滑肌脂肪瘤的近期疗效.[方法]5例患者共6侧肾脏均经CT证实为血管平滑肌脂肪瘤合并出血,采用超选择插管技术,使用碘油与平阳霉素混合乳剂对肿瘤进行栓塞,3侧病肾加注少量明胶海绵颗粒.所有病例随访6～12月.[结果]栓塞前肾动脉造影均可见异常增生的血管团,部分呈瘤样扩张,4例栓塞后肾功能无异常变化.随访6～12月,CT检查肾区有高密度碘油沉积,肿瘤略有缩小.1例双肾病变者子栓塞半年后出现肾功能不全,并一侧再次破裂出血.[结论]出血性肾血管平滑肌脂肪瘤栓塞治疗的近期疗效确切,安全,远期疗效仍有待进一涉观察.     

54例肾血管平滑肌脂肪瘤的诊断与治疗

目的：提高肾血管平滑肌脂肪瘤的诊断和治疗水平。方法：对诊治的54例肾血管平滑肌脂肪瘤患者的临床资料及随访结果进行回顾性分析。按肿瘤直径大小分为A组（肿瘤直径〈4cm）16例,B组（肿瘤直径≥4cm）38例。根据病变大小及症状分别采用观察随访、栓塞、肿瘤剜除、肾部分切除及肾切除术。结果：A组中14例无任何症状（87．50％）,未行手术干预;2例（12．50％）有症状,行肿瘤剜除术。B组均行手术治疗。其中行肿瘤剜除术14例,行肾部分切除术17例,行肾切除术7例。所有病例术后病理检查均证实为肾血管平滑肌脂肪瘤。随诊患者肿瘤无进展及恶变。结论：肿瘤直径〈4cm的患者多无临床症状,可临床随访;对有症状及肿瘤直径≥4cm的患者应积极手术治疗,治疗应尽可能最大程度保留患肾的功能。     

肾嫌色细胞癌10例临床病理分析

目的探讨肾嫌色细胞癌（renal chromophobe cell carcinoma,RCCC）的临床病理学特征、免疫学表型、鉴别诊断及预后。方法从组织形态学、免疫组织化学等方面进行回顾性分析10例RCCC病例。结果 10例中男女比2∶3,平均51.1岁。肿块直径2～11 cm,切面呈浅棕色及棕褐色,镜下肿瘤主要由多角形嫌色细胞构成,呈巢状、条索状及腺泡状排列。嫌色细胞胞质呈浅嗜伊红色细网状,胞核皱缩似葡萄干。免疫表型中CK、EMA、CD 10均见阳性表达病例。结论肾嫌色细胞癌是一种少见的肾肿瘤,预后好于其他肾脏肿瘤,形态学上与嗜酸细胞性腺瘤极其相似,掌握二者之间在形态学及免疫表型方面的差异性,将有助于肿瘤的诊断及鉴别诊断。     

肝脏血管平滑肌脂肪瘤12例临床经验分析

目的 回顾分析12例肝脏血管平滑肌脂肪瘤(Hepatic angiomyolipoma,HAML)的临床特点及病理特征,为临床诊断及治疗提供参考.方法 分析某中心2011年12例HAML的临床治疗经过及随访结果,结合文献复习进行讨论.结果 术前缺乏特异的临床症状、体征,影像学表现多样.10例手术切除后病理确诊,2例经肝穿活检确诊后未手术,随访4个月～6年2个月,均未见复发或转移.结论 HAML临床较少见,术前明确诊断困难,治疗首选手术切除,而肝穿活检或术中快速冰冻病理检查对指导治疗有重要的意义.     

A case of retroperitoneal fibrosis associated with renal angiomyolipoma

The authors performed intraperitoneal transposition of the right ureter in a patient who suffered from dilatation of the renal cavity-system due to retroperitoneal fibrosis. One and a half year later an angiomyolipoma was eliminated from the left kidney of the patient. Describing the associated occurrence of these 2 infrequent diseases the authors deal with the problem of etiology, diagnosis and treatment.     

乏脂肪肾血管平滑肌脂肪瘤的CT表现及病理特征

目的：探讨乏脂肪肾血管平滑肌脂肪瘤（RAML）的CT表现,以提高其诊断水平。方法：回顾性分析23例经手术病理证实的RAMLCT表现,并与临床病理进行对照分析。结果：20例RAML呈边界清楚的类圆形肿块,3例呈不规则形,边界欠清,病灶均向肾外突出。18例表现为实性肿块,1例为囊实性,1例伴有钙化,3例伴有出血,CT片上瘤内均未见脂肪性低密度。CT平扫14例呈略高密度,4例等密度,1例低密度,4例密度欠均匀。增强扫描19例表现为均匀强化,4例不均匀强化,17例表现为延迟性强化,6例表现为一过性明显强化。结论：乏脂肪RAML多表现为边界清楚的实性肿块,病灶呈外生性生长,CT观察其形态、密度及强化方式等影像学表现并结合临床,有助于提高该病定性诊断的准确性。     

Development of renal tumors in rats on intermittently injected methylcholanthrene and nitrosodimethylamine

Experiments on 892 non-inbred male rats studied the development of renal tumors in the animals intermittently administered two substances different in the mechanism of carcinogenic action. Renal pre-injection of methylcholantherene (MC) in a small dose insufficient to induce renal tumors in the study period, followed by dermal applications of this agent was shown to enhance a blastomogenic effect, as manifested by both early occurrence of precarcinogenic changes and early development of renal tumors at the site of primary injection of MC into the kidney. The effect of nitrosodimethylamine (NDMA) intermittently injected in a nephrotropic dose was studied in the second series of the experiments. The intermittent injection of NDMA in courses during 8 weeks gave rise to renal tumors in the early period, caused increases in the number of tumors and in the area of renal tumor proliferates. The mechanism of enhanced renal blastomogenesis is discussed in terms of the mechanisms responsible for initiation and progression.     

Retrospective study of renal images on bone scans

Renal images shown on 254 bone scans employing Tc 99m MDP were analyzed to evaluate the renal abnormalities. Among these cases, there were 43 cases of abnormal renal visualization. Of these abnormal cases, 27 cases were proved by laboratory data, radiographs, echograms, CT findings and autopsy records. 14 cases of renal abnormalities were presented; hydronephrosis due to ureteral obstruction (4 cases), renal dysfunction (3 cases), renal cell carcinoma (2 cases), contracted kidney (2 cases), nephrectomy (2 cases) and renal stone (1 case). Three cases showed super bone images with widespread metastatic lesions of malignant tumors. The remaining 10 cases were not revealed renal abnormalities from other clinical findings.     

Triple primary cancers involving kidney,urinary bladder,and liver in a dye worker

A case of triple primary cancers (renal cell carcinoma of the kidney, transitional cell carcinoma of the bladder, and hepatocellular carcinoma of the liver) was reported at autopsy. A 53-year-old man, who had a history of exposure to benzidine, underwent nephrectomy for a left renal cell carcinoma and 10 years later, transurethral resection of bladder tumor (TUR-Bt) for a transitional cell carcinoma of the bladder. At the age of 65, he was diagnosed as having multiple hepatic tumors. Histological examination of biopsy specimens showed these lesions to be undifferentiated carcinomas. Immunohistological examination of both biopsy and autopsy specimens revealed that multiple hepatic tumors were hepatocellular carcinomas, not metastatic tumors from kidney or urinary bladder: tumor cells of hepatic tumors were positive for α-fetoprotein, although renal cell carcinomas and transitional cell carcinomas of urinary bladder were positive for Ber-EP4 and keratin, respectively. These findings suggest not only that immunohistological examination is helpful for the diagnosis of multiple primary cancers but also that benzidine may be hepatocarcinogenic in addition to those cancers that are known to be associated with benzidine exposure, i.e., renal cell carcinomas and transitional cell carcinomas in urinary bladder. Am. J. Ind. Med. 31:44–49 © 1997 Wiley-Liss, Inc.     

保留肾单位手术治疗肾细胞癌的临床研究

[目的]探讨保留肾单位的肾部分切除手术治疗肾癌的安全性和合理性。[方法]对13例肾癌患者行保留肾单位的肾部分切除术。男8例，女5例。平均年龄49岁。平均肿瘤直径3．2cm。病理分期均为T1N0M0。评估肾蒂阻断时间、术后并发症及局部复发情况。[结果]13例手术均顺利完成，肾蒂阻断时间平均15min。术后无出血及漏尿。平均随访47．2个月，未出现局部复发或远处转移。[结论]对于适合的肾肿瘤患者，保留肾单位的肾部分切除术是一种安全有效的术式，可在不降低生存率的前提下保留患肾功能。手术指征可扩展至对侧肾脏正常的患者。