腹腔镜保留肾单位肾肿瘤切除术治疗老年肾细胞癌患者的临床效果观察

目的:探究腹腔镜保留肾单位肾肿瘤切除术治疗老年肾细胞癌患者的临床效果.方法:选取我院老年肾细胞癌患者97例,按随机数字表法分为试验组(n=49)、对照组(n=48).对照组采取开放性保留肾单位肾肿瘤切除术,试验组采取腹腔镜保留肾单位肾肿瘤切除术.比较两组手术情况、术后3年生存率、肿瘤局部复发率.结果:两组肿瘤切缘阴性率...     

双侧肾肿瘤的外科治疗

我院近15年来共手术治疗肾肿瘤130例，其中双侧肿瘤5例。3例做一侧肾切除，另一侧做肾部分切除。1例两侧先后切除，术后进行血透及肾移植。1例化疗后口腔溃疡，进食后吸入性肺炎死亡。本文就双侧肾肿瘤的发病率、诊断和外科治疗进行详细讨论。     

保留肾单位手术治疗肾肿瘤18例分析

目的：评估保留肾单位手术治疗肾肿瘤的效果。方法：1995年4月－2001年5月，采用保留肾单位手术治疗肾肿瘤18例，恶性3例，良性15例，孤立肾1例，17例单侧肿瘤对侧肾正常，肿瘤直径1.0-8.0cm，平均3.5cm。17例行部分肾切除术，1例行肿瘤剜除术。结果：18例手术成功，随访2－72个月，平均32个月，未发现并发症和肿瘤复发。结论：保留肾单位治疗肾肿瘤安全有效，其临床应用越来越广。     

腹腔镜肾部分切除术治疗孤立肾肿瘤安全有效

美国一项研究显示，腹腔镜下行肾部分切除术（LPN）治疗孤立肾肿瘤安全有效[J Urol 2006，175（2）：454]。     

双肾错构瘤一侧破裂肾切除后对侧肾肿瘤的处理

我院 1 990～ 2 0 0 1年共收治双肾错构瘤并发一侧自发性破裂出血患者 7例 ,均行一侧肾切除术 ,对侧肾择期行保肾手术治疗 ,效果满意 ,现结合文献资料分析如下。1　资料与方法1 .1 　 一般资料本组 7例 ,男 4例 ,女 3例 ,年龄 2 1～ 62岁 ,平均 44岁。均以突发性腰腹部胀痛伴面色苍白、出冷汗等症状急诊入院 ,5例有休克早期表现。均经B超、CT及IVU检查 ,诊断为双肾错构瘤并发一侧肾错构瘤破裂出血。破裂出血侧肾错构瘤大小( 6.3cm× 5 .4cm)～ ( 1 1 .5cm× 8.7cm) ,未破裂侧错构瘤大小 ( 4 .5cm× 3.9cm)～ ( 6.2cm× 5 .6cm) ,未破裂侧…     

肾动脉栓塞在根治性肾切除术治疗肾肿瘤中的意义

１９８２年１０月～１９９３年１０月，行肾动脉栓塞加根治性肾切除术治疗肾肿瘤２４例，单纯根治性肾切除术２２例，１、３、５年生存率分别为８５．０％、６８．４％、５０．０％及８６．７％、７８．６％、５０．０％，统计学分析无显著性差异。结论：肾动脉栓塞对提高肾肿瘤病人的远期生存率无明显疗效。     

高龄患者巨大积水肾外伤后破裂的保守治疗体会

目的探讨对老年巨大肾积水外伤后破裂的患者采取保守治疗的可行性。方法对2001年至2014年5例老年巨大肾积水外伤后破裂患者的采取保守治疗的临床资料进行回顾性分析。结果所有5例老年肾积水外伤后破裂患者均采取保守治疗,无明显尿瘘、感染性休克、失血性休克等严重并发症。结论对于老年患者,如果外伤后引起巨大积水肾破裂,保守治疗是一种值得选择的治疗手段。     

孤独肾肾肿瘤患者行肾部分切除与经皮射频消融治疗的肾功能结果

肾部分切除术是小肾癌的推荐治疗方法。而经皮射频消融是安全、有效的治疗方法,与肾部分切除术相比有类似的短期肿瘤特异性生存率。目前尚缺乏热消融对肾功能保留的影响的数据。本研究分析了肾部分切除与经皮射频消融对孤独肾患者肾功能的影响。回顾性分析了2003至2009年间在罗切斯特的Mayo诊所接受肾部分切除或射频消融的孤独肾患者的临床资料,     

Conservative management of renal masses in the elderly: our experience

Objectives To analyse a group of patients with clinically and radiologically detected renal neoplasms who were conservatively treated for various reasons. The patients were followed-up radiologically and intervened only if symptomatic. The natural progression of these masses and also a brief review of the literature is done. Methods The series was collected retrospectively from the case-notes of patients coded for renal neoplasms. Of the 13 patients followed up conservatively, eight were deferred surgery in view of their age (mean age—83.25 years), one patient had a single kidney, two were unwilling for surgery and two had severe co-morbidities which made them unfit for surgery. Results The mean age at diagnosis was 80.4 years (median—82; range 66–88). Seven females and six males were followed up for a mean and median follow-up of 38.38 and 34 months respectively (range—19 to 105 months). Six patients died during follow-up (mean-41.57 months). The average longest dimension at diagnosis and when last reviewed were 5.01 cm and 5.57 cm. However, only one of these died due to metastasis which developed during follow-up and two had to be angio-embolised for hematuria. The average rate of growth along the longitudinal dimension was 0.17 cm/year while the average change in volume was 11.97 cc/year. Conclusions Malignant renal neoplasms grow at a relatively slow rate. Without tumour growth the risk of metastasis appears limited. Thus expectant management can be considered as an alternative for a selected group of patients who are either unwilling or unfit or high risk for surgery.     

Contemporary management of small renal masses

Context

An increasing number of small renal masses (SRMs) with heterogeneous histology and clinical behaviour are being detected with modern radiologic imaging. Although surgical removal is the standard of care for small renal tumours, alternative minimally invasive and conservative treatment options are possible in selected patients with shorter life expectancy.

Objective

To systematically review indications, techniques, and outcomes of surgical and conservative treatments of SRMs.

Evidence acquisition

A literature search of English-language publications was performed using the Medline database from January 2000 to February 2011 using the terms renal mass and renal carcinoma in conjunction with the evaluated management options. The articles that provided the highest level of evidence were selected with the consensus of all the authors and reviewed.

Evidence synthesis

Only one randomised controlled trial comparing the results of elective nephron-sparing surgery and radical nephrectomy for low-stage renal tumours is available. Few comparative studies of different treatment options for SRMs have been published. The assessment of oncologic outcomes is therefore based mainly on observational studies. Most series of nonsurgical therapies have strong selection biases and relatively short follow-up. Treatment selection is based on the clinical and histologic characteristics of SRMs, on patient age and comorbidities, and on personal preferences and experience of the urologist.

Conclusions

Partial nephrectomy (PN) is the standard treatment for solitary SRMs whenever it is technically feasible. Laparoscopic PN is an alternative to open PN in experienced hands. The rationale of ablative treatments is to treat incidental cortical SRMs in patients at high surgical risk with potentially reduced morbidity. Active surveillance is considered an appropriate strategy for the elderly or for patients with significant comorbidity who have a shorter life expectancy. Percutaneous biopsies are increasingly being used to establish histology of SRMs and support treatment decisions, especially for patients who are candidates for nonsurgical treatment.     

腹腔镜手术保守治疗宫角妊娠临床分析

目的探讨腹腔镜手术保守治疗宫角妊娠的效果及预后。方法回顾性分析因宫角妊娠行腹腔镜手术保守治疗10例患者的临床病理资料,并进行随访。结果10例患者手术均顺利,无一例转行开腹,平均手术时间53．5min（40～75min）,平均失血量128ml（50-400ml）,无一例输血,平均住院3．7d（3-6d）。患者术后血β-hCG4周内均降至正常,术后30-60d月经正常复潮,复查B超子宫肌层回声尚均。随访所有患者无任何并发症发生,1例术后1^＋年再次妊娠,现妊娠3月一切正常。结论腹腔镜下保守治疗宫角妊娠是一种安全有效、微创且可行的方法,能很好地保留患者的生育功能,在有条件的医院,合理选择病例,对于血流动力学稳定,未破裂的宫角妊娠患者可积极开展此项手术。     

Conservative management of emphysematous pyelonephritis in a horseshoe kidney

Emphysematous pyelonephritis (EPN) is an acute infection of the kidney, characterized by the presence of gas in the renal parenchyma and collecting system. Conservative management is rarely effective to treat this severe infection and the accepted treatment consists of early nephrectomy. Herein, we report a case of EPN in a horseshoe kidney, presented in a 67-year-old, diabetic woman. A percutaneous drainage of the kidney, under computed tomography control, was realized in emergency to manage her sepsis. A pelvic ureteral calculus was found to be responsible for the urinary obstruction and the infection. It was extracted endoscopically, three weeks later and the evolution was uneventful.     

Long-term management of bilateral metastases of renal cell carcinoma to the choroid plexus

Background. Metastatic tumors to the brain presenting exclusively in the choroid plexus are exceedingly rare. These events are frequently associated with renal cell carcinoma (RCC), of which all reported cases have been solitary lesions. Method. The authors present the unusual case of a patient with metastatic RCC who developed bilateral tumors of the choroid plexus. These tumors, one of which was confirmed to be metastatic RCC by histologic analysis, were treated over a 5-year period with a combination of interventions, including surgical resection, stereotactic radiosurgery, and chemotherapy, in conjunction with continual radiological monitoring. Findings. Follow-up over a 5-year period demonstrated good control of the patients intracranial disease and very little neurologic sequelae. Interpretation. This strategy was successful in keeping the patient in good health with minimal neurological symptoms, despite the bilateral nature of the disease and its generally poor prognosis.Published online July 25, 2003     

Conservative management of pneumatosis intestinalis and massive pneumoperitoneum in the acute abdomen: a case report

We present a case of massive pneumoperitoneum in association with pneumatosis intestinalis that was successfully managed without surgery despite a clinical picture of an acute abdomen and biochemical evidence of inflammation and systemic upset. Recognition of non-surgical pneumoperitoneum is important to avoid unnecessary laparotomy, and clinical examination for the presence of peritonitis is the most important determinant of the need for emergency surgery.     

Growth kinetics of renal masses: analysis of a prospective cohort of patients undergoing active surveillance

Background

Active surveillance (AS) represents a treatment option for renal masses in patients who are not surgical candidates either because of existing comorbidities or patient choice. Among renal masses undergoing AS, some grow rapidly and require treatment or progress to metastatic disease. Patient and tumour characteristics related to this more aggressive behaviour have been poorly studied.

Objective

To report the analysis of a multi-institutional cohort of patients undergoing AS for small renal masses.

Design, setting, and participants

This prospective study included 82 patients with 84 renal masses who underwent AS in three Canadian institutions between July 2001 and June 2009.

Intervention

All patients underwent AS for renal masses presumed to be renal cell carcinoma (RCC) as based on diagnostic imaging.

Measurements

Age, sex, symptoms at presentation, maximum diameter at diagnosis (cm), tumour location (central/peripheral), degree of endophytic component (1–100%), and tumour consistency (solid/cystic) were used to develop a predictive model of the tumour growth rate using binary recursive partitioning analysis with a repeated measures outcome.

Results and limitations

With a median follow-up of 36 mo (range: 6–96), the mean annual renal mass growth rate for the entire cohort was 0.25 cm/yr (standard deviation [SD]: 0.49 cm/yr). Only one patient (1.2%) developed metastatic RCC. Amongst all variables, maximum diameter at diagnosis was the only predictor of tumour growth rate, and two distinct growth rates were identified. Masses that are ≥2.45 cm in largest diameter at diagnosis grow faster than smaller masses. This series was limited by its moderate sample size, although it is the largest published prospective series to date.

Conclusions

We confirm that most renal masses grow slowly and carry a low metastatic potential. Tumour size is a predictor of tumour growth rate, with renal masses <2.45 cm growing more slowly than masses >2.45 cm.     

Conservative management of renal artery pseudoaneurysm following partial nephrectomy

A bleeding renal artery pseudoaneurysm is a recognised complication occurring after partial nephrectomy. The bleeding is usually suspected when a patient presents with haematuria following the procedure and the reported management is with radiologically guided embolisation. We report a case of renal artery pseudoaneurysm successfully managed conservatively, giving another potential management option in non-torrential haemorrhage.     

Conservative management of retrocaval Ureter: A case series

IntroductionRetrocaval ureter is a rare congenital anomaly with the ureter passage posterior to the inferior vena cava. Surgical repair is suggested for patients with significant functional obstruction. However, there is little literature to suggest the management of asymptomatic patients.Case presentationCase 1 patient is a 29 year-old Indonesian man and case 2 patient is a 41 year-old Malay man. Both patients were asymptomatic and well.DiscussionThis report is the short follow-up, therefore making it impossible to elucidate the natural history of uncorrected retrocaval ureters.ConclusionAt 8 month and 6 month respectively, they remained well without symptoms. Our report suggests that immediate surgical repair is not always needed. Longer follow-up with larger patient population is needed to formally elucidate the natural history of this uncommon condition.