肾盂癌18 例临床分析

１９９０～１９９６年５月，我院收治肾盂癌１８例，均经手术病理证实。总结报告如下。１　临床资料本组１８例。男１５例，女３例。年龄４５～７８岁，平均年龄６１岁。病史２０天～４年。以血尿就诊者１４例、肾区疼痛不适５例、腹部包块３例。Ｂ超、ＩＶＵ检查及ＣＴ检查的诊断符合率分别为８３３％（１５／１８）、７２２％（１３／１８）及９３８％（１５／１６）。１０例行逆肾造影检查，诊断符合率为８０％（８／１０）。尿脱落细胞学检查９例，２例有阳性发现，诊断符合率为２２２％。按照ＴＮＭ综合分期，Ⅰ期２例，Ⅱ期…     

常用影像学检查对肾肿瘤的诊断价值(附110例报告)

近年 ,由于ＣＴ和ＭＲＩ等影像诊断技术迅速发展 ,肾肿瘤的临床诊断准确率明显提高 ,我院自 1979年～ 2 0 0 0年间共收治 110例肾肿瘤患者 ,治疗前行Ｂ超、ＩＶＵ、ＣＴ、ＭＲＩ等检查 ,现将影像检查统计分析报告如下 :临床资料和结果110例患者男性 80例 ,女姓 30例 ,男女为 2 .7:1,年龄 6～ 87岁 ,左肾肿瘤 5 4例 ,右肾肿瘤 5 5例 ,双肾肿瘤 1例 ,临床主要症状为血尿、疼痛、腰腹部包块、不明原因发热 ,无症状肾肿瘤 2 8例。 110例肾肿瘤手术97例 ,其中肾细胞癌 92例 ,肾恶性淋巴瘤 1例 ,肾母细胞瘤 2例 ,肾肉瘤样癌 1例 ,肾上腺皮质腺癌侵…     

双期动态CT扫描和腹部B超对胃癌术前TNM分期的评价(与手术、病理对照研究)

目的评价双期动态ＣＴ扫描和腹部Ｂ超以及两者相结合对胃癌术前分期的诊断价值。方法对６３例经胃镜活检证实为胃癌的患者行双期动态ＣＴ扫描，其中２０例同时行经腹Ｂ超检查。将ＣＴ和Ｂ超术前分期与手术、病理对照。结果ＣＴ的Ｔ分期和Ｎ分期的准确率分别为５３．２％和５８．０％，ＴＮＭ分期准确率为５６．７％。在２０例同期有ＣＴ和Ｂ超检查的病例中，Ｂ超Ｔ分期准确率为５０．０％，ＣＴ结合Ｂ超的Ｔ分期准确率为７０．０％，与单独ＣＴ组相比，差异有显著性（Ｐ＜０．０５）。Ｂ超排除了７例ＣＴ误诊肝、胰受侵的病例。ＣＴ结合Ｂ超的ＴＮＭ分期准确率为９０．０％，与单独Ｂ超准确率５０．０％相比，差异有显著性（Ｐ＜０．０５）。结论动态ＣＴ增强扫描与Ｂ超结合，对胃癌ＴＮＭ分期的准确率较高，有助于判断肿瘤是否侵及邻近器官     

肾错构瘤四例报告

１９９１年４月～１９９５年５月,我科共收治肾错构瘤４例,均行手术治疗,但术前均未确诊。现结合Ｂ超、ＣＴ检查结果,复习有关文献,对本病的诊断,治疗方法进行总结,现报告如下。１　临床资料１．１　一般资料　本组４例中男性１例,女性３例,年龄１３～４６岁,平均３２．２岁。肿瘤位于左侧１例,右侧２例,双侧１例。３例表现腰部胀痛,１例肉眼见血尿,１例无症状系因急性单纯性阑尾炎住院时Ｂ超检查发现肾肿瘤,４例均无高血压。本组３例行ＩＶＰ,其中１例肾功能形态正常,２例显示肾影增大,肾盂肾盏变形移位,诊断肾占位病变…     

细针穿刺对胰腺癌诊断价值的探讨

胰腺癌是消化系统常见的恶性肿瘤之一，近年来发病率有明显上升的趋势。我科１９９４年１月～１９９８年１２月间应用在Ｂ超引导下细针穿刺技术，检测胰腺癌并探讨其诊断价值。临床资料　本组２５例中，男１７例，女８例。年龄４２～６６岁，平均年龄５６岁。临床症状及体征：腹痛１６例，消瘦２５例，纳差２０例，黄疸１０例，腹水７例，腹块５例。全部病例均经Ｂ超、ＣＴ或ＭＲＩ、手术证实。胰头癌１７例，胰体尾癌８例。应用放射免疫检测血清中ＣＡ１９９。细针穿刺前，检测肝肾功能、血常规及出凝血时间。仪器为ＡＬＯＫ１２００型线…     

手术治疗乳腺包块360例结果对照分析

手术治疗乳腺包块３６０例结果对照分析曲凤坡主治医师王培军济南机车车辆厂医院（２５００２２）１９８３－１９９４年我院住院及门诊手术治疗乳腺包块共３６０例，术前皆行触诊和Ｂ超检查，９０例同时行钼钯拍片，１２例同时行ＣＴ扫描，手术后均行病理检查，现就术前术...     

无功能性胰岛细胞瘤16例诊治体会

无功能性胰岛细胞瘤１６例，经病理证实恶性８例、良性８例。患者以上腹部包块、黄疸、体重减轻、上腹及腰背部疼痛和消化道不全梗阻就诊，钡餐、Ｂ超、ＣＴ、ＥＲＣＰ、ＭＲＩ检查和选择性腹腔动脉造影对本病有诊断价值。本病的治疗原则是尽早手术，本组１６例中１１例行手术切除，３例行内引流术，２例行单纯活检，术后疗效满意。     

原发性肝癌二期切除24例报告

1993年 8月～ 1996年 8月 ,我们对 2 4例不能切除的原发性肝癌 ,在采取综合治疗后进行二期手术切除 ,获得成功 ,现报告如下。1　临床资料2 4例中 ,男性 2 1例 ,女性 3例。年龄 2 3～ 5 6岁 ,中位年龄47.5岁。经Ｂ超、ＣＴ、ＭＲＩ等综合检查及ＡＦＰ测定诊断。 2 4例皆为原发性     

原发性肝癌的二期切除(附35例临床报告)

１９９３年８月～１９９８年３月 ,对３５例不能切除的原发性肝癌综合治疗后进行二期手术切除 ,获得成功 ,报告如下。１临床资料１ １一般资料全组男性３０例 ,女性５例 ;年龄１８～６７岁 ,中位年龄４５ ８岁。经Ｂ超、ＣＴ、ＭＲＩ、ＡＦＰ等检查诊断为中晚期肝癌。１ ２一期治疗方法１ ２ １经皮肝动脉化疗栓塞 (ＴＡＣＥ)本组２２例 ,采用ｓｅｌｄｉｎｇｅｒ氏法 ,经右股动脉穿刺插管至肝固有动脉。化疗采用联合方案 ,应用丝裂霉素、顺铂、５ -ＦＵ。栓塞采用超液碘油、明胶海绵。１ ２ ２肝动脉结扎 (ＨＡＬ) 肝动脉插管 (ＨＡＩ)／门…     

40例中晚期肝癌介入治疗体会

作为有效的姑息性治疗手段，肝癌的介入及栓塞治疗已广泛应用于临床。本文介绍我们基层医院开展４０例中晚期肝癌介入治疗的体会。１资料与方法 病例资料我院１９９６年３月至１９９８年３月收治的４０例中晚期肝癌患者，男性２２例、女性１８例，年龄３５岁～７０岁，平均（４８．４± ２．０）岁，诊断根据ＣＴ、ＭＲＩ、Ｂ超及病理、甲胎蛋白（ＡＦＰ）作出。临床分期符合１９７７年全国肝癌防治研究会议标准。Ⅱ期２例，Ⅲａ期１６例，Ⅲｂ期２２例。肝功能按Ｃｈｉｌｄ分级：Ａ级１４例，Ｂ级２０例，Ｃ级６例。本组有腹水、黄疸的５例…     

Diagnostic difficulties in rare variants of renal angiomyolipoma

Renal angiomyolipomas (AML) are the most common benign renal tumors. Although AML have a characteristic CT and ultrasound features, a differential diagnosis from other lipomatous tumors and renal cell carcinoma is not always possible. We present four cases of the most unusual radiological appearance of AML. Diagnostic difficulties arise in predominantly myocomponent lesions, in AML with haemorrhagic complications, in aggressive behavior of AML and coexisting renal cell carcinoma. When the diagnosis is equivocal, a fine needle aspiration biopsy is indicated. An accurate preoperative diagnosis of AML allows to avoid undesired nephrectomy and to perform preserving renal surgery in selected patients.     

Renal angiomyolipoma: a clinico-pathological study or eleven cases

Retrospective analysis of clinical and histomorphological features and follow up of eleven cases of renal angiomyolipoma (AML) encountered during the past twelve years at our centre was performed. These included seven female and four male patients, nine of them were symptomatic and two were incidentally detected on ultrasonography for other reasons. Eight patients had solitary and three had bilateral lesions on radiological investigations. None of the three patients with bilateral AML had associated tuberous sclerosis, however, a patient with tuberous sclerosis, showing solitary lesion on radiological investigation, was detected to have multiple lesions on thorough pathological examination of the nephrectomy specimen. The surgical treatment comprised of nephrectomy in six cases, enucleation in four cases and trueut biopsy in one case. Enucleation of the largest lesion was done in all three patients of bilateral AML. The mean follow up was of three years. Two patients with bilateral AML had radiological progression of size of other lesions, whereas one died due to excessive bleeding in the postoperative period. None of the patients had any evidence of recurrence or metastasis. Bilateral AML is not always associated with tuberous sclerosis, however, in patients with tuberous sclerous thorough sampling of nephrectomy specimen is recommended.     

Cytoreductive Nephrectomy Following Immunotherapy-Base Treatment in Metastatic Renal Cell Carcinoma: A Case Series and Review of Current Literature

The role and timing of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma receiving immunotherapy-based regimens is unclear. However, the ability to achieve a complete response for metastatic renal cell carcinoma likely requires a nephrectomy at some point during treatment. Here we present a case series of three patients with metastatic clear-cell renal-cell carcinoma who received front-line immunotherapy-based treatment and subsequently underwent a cytoreductive nephrectomy. All three patients had a complete response to therapy and have subsequently remained off systemic therapy for a median of 531 days (range, 476–602). We also review the limited literature in this setting and highlight ongoing clinical trials. Although the role of cytoreductive nephrectomy in patients with metastatic renal cell carcinoma receiving immunotherapy-based treatment is uncertain, a subset of patients will benefit from either an immediate or deferred cytoreductive nephrectomy. Ongoing trials are underway to further determine how to incorporate cytoreductive nephrectomy into the treatment paradigm for patients with metastatic renal cell carcinoma.     

Cryosurgical ablation of renal cell carcinoma.

BACKGROUND: Small renal masses are being commonly diagnosed incidentally in older patients. A partial nephrectomy is the first-line nephron sparing treatment option for these lesions. However, probe ablative therapy such as cryoablation is emerging as an alternative option for select patients requiring nephron sparing surgery. METHODS: The current literature regarding the management of small renal lesions with cryoablation was retrospectively reviewed. We selected six of the largest published series of renal cryoablation with a total of 320 patients. The diagnosis, staging, treatment options, mechanism, efficacy and morbidity associated with renal cryoablation were evaluated. RESULTS: Renal cryoablation for localized small renal masses is well tolerated and associated with a low complication rate. The range of mean tumor size in our literature review series (320 patients) was 2.3 to 2.6 cm. After a range of mean follow-up of 5.9 to 72 months, including a series with a minimum of 5 years of follow-up, the cancer specific survival was 97% to 100% and overall patient survival was 82% to 90.2%. CONCLUSIONS: Renal cryoablation, based on available clinical reports, appears to be a curative option for patients with small localized renal cell carcinomas (RCCs) who are unwilling or unable to undergo a partial nephrectomy. With encouraging intermediate oncological follow-up available, longer-term follow-up is needed to validate the use of cryoablation as a primary treatment option.     

Fibrinogen在术前肾癌患者血清中水平变化及临床意义

  目的  探讨肾癌患者术前血浆Fibrinogen水平与临床病理特征及患者预后的关系。  方法  选取2000年1月至2003年12月天津医科大学附属肿瘤医院泌尿肿瘤科患者286例为研究对象。术前常规测定所有患者血浆Fibrinogen水平, t检验或ANOVA分析术前血浆Fibrinogen水平与多个临床病理特征相关性, 并进一步通过单因素分析及Cox回归模型对预后影响因子进行分析。  结果  术前血浆Fibrinogen水平与Fuhrman分级、肿瘤大小、T分期及术后远处转移密切相关(均P < 0.001)。单因素结果显示, Fuhrman分级、肿瘤大小、T分期及术前血浆Fibrinogen水平与患者总生存时间显著相关(P < 0.001, P=0.001, P < 0.001, P < 0.001)。进一步通过Cox回归模型分析发现, 术前血浆Fibrinogen水平是肾癌术后患者的一个独立预后因子(P=0.001)。  结论  术前血浆Fibrinogen水平与肾癌术后患者远处转移及预后显著相关, 是肾癌术后患者的一个独立预后因子。      

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。     

肾脏嗜酸性细胞瘤的诊断与治疗

目的:探讨肾嗜酸性细胞瘤的诊疗方法,提高肾嗜酸性细胞瘤的诊疗水平.方法:回顾性分析本院12例肾嗜酸性细胞瘤患者的临床资料,并结合文献探讨其诊疗方法及预后.结果:12例患者术前影像学均诊断为肾占位性病变,其中T1aN0M0期5例,T1bN0M0期 7例.术中及术后病理学检查证实为肾嗜酸性细胞瘤.2例行根治性肾切除术,10例行根治性肾部分切除术,术后随访18~36个月无复发转移.结论:肾嗜酸细胞瘤系肾脏的良性倾向肿瘤,预后良好,术前仅靠临床症状和影像学特征难以与肾癌相鉴别,易误诊为肾癌.对于可疑病例,须行术中快速冰冻病理检查.诊断需依据病理组织学、免疫组化及特点综合判断.治疗以保肾手术首选,术后应密切随访.     

Clinical Efficacy of Super-Selective Renal Artery Embolization for Rupture of Renal Angiomyolipoma

OBJECTIVE To evaluate the efficacy of selective transcatheter arterial embolization (TAE) in renal angiomyolipoma (AML) spontaneous ruptures with hemorrhage.METHODS A retrospective evaluation was carried out in 21 renal AML cases with acute bleeding confirmed by imaging. Selective renal arterial embolization was used to control bleeding. All the cases were detected by renal arteriography had abnormal vascular hyperplasia and enlarged blood vessels. RESULTS Initial renal arteriography for all the patients showed that tortuous, hypervascular, and aneurysm-forming angiogenic components with aneurysm formation occurred in 13 cases (61.9%)and extravasation of the contrast agent was found in 8 cases (38.1%). Immediate complete obliteration was technically successful in 19 (90.5%) of the 21 patients. To prevent uncontrollable complications, 3 patients received nephron-sparing surgery after hemodynamic status was stabilized with TAE a week later. Two days and 3 days after the embolizations, 2 patients presented with incomplete embolizations and then underwent nephrectomy when they were in a stable condition. There were no significant differences in the plasma creatinine levels before and after the treatment. All the patients were followed up for 6 months to 6 years (median, 45 months). The largest tumor diameter was reduced from (11.57?4.28) cm to (9.57?2.28) cm. The tumor had no blood supply and no relapses have occurred.CONCLUSION TAE is a technically feasible and minimally invasive procedure for ruptured renal angiomyolipoma. The aneurysms were a predictor of renal AML spontaneous rupture and detection of such aneurysms by CT may help to determine the timing of embolization. In patients who still need surgical treatment, TAE can make tumor resection easier to perform and reduce blood loss during the operation.     

肾上皮样血管平滑肌脂肪瘤2例及文献复习

  目的  探讨肾上皮样血管平滑肌脂肪瘤(epithelial angiomyolipoma, EAML)的临床病理特征, 进一步认识本疾病。  方法  回顾性研究2002年7月至2012年8月2例肾EAML患者的临床及病理资料并进行随访, 结合复习文献, 对其临床病理特点、生物学行为及预后进行分析。  结果  2例患者都为女性, 平均年龄47.5岁, 均为左肾EAML。无明显阳性体征, 2例在B超和CT均发现肾占位, 其中1例CT强化不均匀, 1例增强检查呈渐进性强化, 延迟期强化程度略减低。分别行左肾部分切除术和根治性左肾切除术。组织形态学的主要特征均呈明显的上皮样分化。  结论  分析结果提示: EAML生物学行为与经典型肾AML不同特征在于浸润性生长方式、细胞学异型性, CT对其诊断有重要意义, 但病理结合免疫组化能够确诊, 手术是主要的治疗方法, 其预后大多数良好。      

Effect of Peripheral Blood CD4 CD25 Regulatory T Cell on Postoperative Immunotherapy for Patients with Renal Carcinoma

Objective: To investigate the effect of peripheral blood CD4 CD25 regulatory T cell on postoperative immunotherapy in patients with renal carcinoma. Methods: 38 patients with renal cell carcinoma were recruited, and 20 patients from the operation group purely underwent the radical nephrectomy therapy, 18 patients from the combined group successively underwent the radical nephrectomy therapy and IFN- adjuvant immunotherapy. Additionally, 12 healthy subjects were recruited in the same period of time and regarded as the control group. Flow cytometry was used to detect CD4 , CD8 , CD4 CD25 T lymphocyte subset content and the ratio of all parts in the pre-operative period, in the first post-operative week and in the third post-operative month, compare and analyze its variation trend. Results: The CD4CD25 T lymphocyte subset content of individual renal carcinoma patients was significantly higher than that of the control group, also increases with the progression in the tumor stage (<0.05). The post-operative CD4 CD25T lymphocytes of individual operation group and combined group patients showed different degrees of increment, but the increment of the combined group was significantly lower than that of the operation group (<0.05). For the combined group patients with less pre-operative CD4 CD25T lymphocytes, their levels would increase after the immunotherapy, while the pre-operative patients with more CD4 CD25 T lymphocytes were the opposite situation. Conclusion: The detection of peripheral blood CD4CD25 regulatory T lymphocyte subset can reflect the anti-tumor immune status of renal cell carcinoma patient body. It can contribute to predict the prognosis of immunotherapy and provide reference for the choice of renal carcinoma post-operative adjuvant immunotherapy.