小肾癌57例诊治报告

目的提高小肾癌的诊治水平。方法回顾分析57例小肾癌患者的临床资料,探讨小肾癌的诊治方法。蛄杲本组小肾癌病例多无明显症状,通过体检发现。19例行根治性肾切除术（RN）,38例行保留肾单位肾部分切除术（NSS）,所有病例术后均辅以免疫治疗。随访14～63个月,除1例死亡外,均无瘤存活。结论定期体检有助于早期发现小肾癌。采取RN或者NSS治疗小肾癌均能获得良好预后。有条件者应建议行术后免疫治疗。     

小肾癌的保留肾单位手术治疗

目的 探讨保留肾单位的肾部分切除手术治疗小肾癌的安全性和合理性。方法 对48例小肾癌患者行保留肾单位的肾部分切除术。男29例，女19例。平均年龄42岁（24～61岁）。平均肿瘤直径2．4cm（1．0～4．0cm）。病理分期T1N0M047例，双侧肾癌1例。评估肾蒂阻断时间、术后并发症及局部复发情况。结果 48例手术均顺利完成，肾蒂阻断时间平均18min（12～26min）。术后出血3例、漏尿1例。平均随访21个月，1例术后6个月局部复发行根治性手术，1例出现远处转移而死亡，余未见复发或远处转移。结论 保留肾单位的肾部分切除治疗小肾癌安全有效，手术指征可扩展至对侧肾脏正常的患者。     

11例小肾癌临床分析

目的:提高小肾癌的诊断和治疗水平,探讨不同手术方法的优缺点。方法:通过对收治的11例小肾癌的临床表现、诊断、治疗和预后进行分析并结合有关文献进行讨论。结果:11例全部根治性肾切除术,术后均经病理证实。8例获得随访,其中7例无癌存活,最长存活时间超过6年。结论:小肾癌术前经B超、CT、肾动脉造影等综合检查可明确诊断;手术方式根据具体情况采用根治性肾切除术或肾部分切除术、肿瘤剜除术。     

后腹腔镜保留肾单位术和根治性肾切除术治疗局限性T1b、T2a期肾癌效果分析

目的比较后腹腔镜保留肾单位术(NSS)和根治性肾切除术(RN)治疗局限性T_(1b)、T_(2a)期肾癌的效果。方法选取2014-03—2018-04间洛阳市第六人民医院收治的107例局限性T_(1b)、T_(2a)期肾癌患者。将行后腹腔镜NSS术的53例患者作为NSS组。将行后腹腔镜RN术的54例患者作为RN组。回顾性分析患者的临床资料。结果 2组手术时间、术中出血量和术后留置引流管时间、禁食时间、住院时间及并发症等差异均无统计学意义(P0.05)。NSS组手术前后血肌酐值变化幅度优于RN组,差异有统计学意义(P0.05)。结论后腹腔镜NSS和RN治疗局限性T_(1b)、T_(2a)期肾肿瘤的安全性与有效性相近。但后腹腔镜NSS术后血肌酐升高程度较RN术低,可作为首选的治疗方法。     

保留肾单位的肾癌切除术5例分析

我院自 1 991年 1月～ 2 0 0 0年 5月采用保留肾单位手术 (Ｎｅｐｈｒｏｎｓｐａｒｉｎｇｓｕｒｇｅｒｙ ,ＮＳＳ)治疗肾癌患者 5例 ,取得满意疗效 ,现报告如下。1　资料与方法1 .1 　 临床资料本组 5例 ,男 3例 ,女 2例 ,年龄 39～ 72岁 ,平均 5 4 .8岁。其中体检发现 3例 ,1例因内科疾病入院作常规Ｂ超检查发现左肾占位性病变 ,1例因左输尿管上段结石入院取石 ,术中探查发现左肾下极肿瘤。肿瘤均突出于肾表面。双肾癌 2例共计 5枚肿瘤 ,孤立肾癌 3例 (其中右侧 1例 ,左侧 2例 )。肿瘤直径 1～ 4ｃｍ ,平均 2 .3ｃｍ ,均位于肾皮质区 ,向外…     

不同术式治疗多囊性肾癌的比较研究

目的 比较3种手术方式治疗多囊性肾癌(MCRCC)的安全性和有效性,探讨保留肾单位手术(NSS)对多囊性肾癌的最佳适用范围.方法 回顾性分析2006～2008年收治的28例多囊性肾癌患者的临床病理资料.根据术式的不同,将此28例患者分为保留肾单位术组(12例),根治性肾切除术组(13例),手助腹腔镜根治性肾切除术组(3例).收集整理3组患者的手术时间、术中估计失血量、输血情况、术后引流管留置时间、镇痛泵留置时间、术后住院天数、术后并发症情况及术后随访资料并行统计学分析.结果 28例MCRCC患者平均年龄51.9岁,男女比例3:1,肿瘤平均最大直径5.1 cm,T1N0M0者23例,T2N0M0者5例,2例为双肾癌,1例合并甲状腺癌.保留肾单位手术组患者在术中失血量、术后住院天数上多于根治性肾切除术组患者(P<0.05),而在手术时间、输血率、术后引流管留置时间、镇痛泵应用时间方面两组相比没有显著性差异(P>0.05).手助腹腔镜根治性肾切除术在术中估计失血量、术后引流管留置时间、镇痛泵应用时间、术后住院天数方面在数值上似优于其它两种术式,因例数较少,未纳入统计学分析.三组患者均未发生围手术期严重并发症.术后获得长期随访者21例,术后1月内首次随访的血肌酐和尿素氮水平均正常.平均随访时间18.1个月.21人均健在.结论 保留肾单位手术治疗5 cm以下的多囊性肾癌安全有效,近期效果与根治性肾切除术相似,但对位于肾脏中极或凸向肾盂的多囊性肾癌应慎用.手助腹腔镜手术的安全性和微创性为治疗MCRCC提供了又一选择.     

小肾癌保留肾单位手术与肾癌根治性切除术的临床疗效比较

目的探讨小肾癌行两种不同术式的临床效果差异。方法回顾分析65例小肾癌患者,其中行保留肾单位手术41例,肾癌根治性切除术24例,对两组患者在出血量、手术时间、术后平均住院天数以及术后并发症发生率等方面的情况进行统计学比较分析。结果保留肾单位手术组的手术出血量为240ml,较肾癌根治性切除术组的150ml多,且在术后平均住院天数、手术时间及术后漏尿发生率等方面,与肾癌根治术组比较,差异均具有统计学意义（P〈0．05）。而肾癌根治术组的术后肾功能衰竭、围手术期死亡、术后泌尿系感染发生率及术中胸膜、脾脏等脏器损伤的发生率等均高于保留肾单位手术组,差异有统计学意义（P〈0．05）。结论保留肾单位手术与肾癌根治性切除术都是目前较好的治疗小肾癌的手术方式,二者各有优缺点,应根据患者的个体情况选择合适的手术方式。     

保留肾单位的手术治疗肾癌(附16例报告)

目的 :探讨保留肾单位的手术治疗早期小肾癌的效果。方法 :行保留肾单位手术治疗肾癌 16例 ,其中双侧肾癌 2例 ,孤立肾肾癌 1例 ,对侧肾有病变或潜在功能受损肾癌 4例 ,对侧肾正常肾癌 9例。肿瘤平均直径 2 .8cm。 6例只行肿瘤切除术 ,10例行部分肾切除术。病理分期 :T110例 ,T2 6例。结果 :平均随访 5 2 .8个月 ,2例出现局部复发 ,1例死于肺部转移。生存时间 >8年 2例 ,>5年 8例 ,>3年 10例 ,>1年 15例。结论 :保留肾单位的手术是早期局限性肾癌的有效治疗方法 ,直径≤ 4cmT1～T2 期局限性肾癌是对侧肾正常的单侧肾癌保留肾单位手术的良好适应证     

囊性肾癌诊治体会

目的 提高囊性肾癌的诊治水平. 方法 回顾分析10例囊性肾癌患者术前影像学特点、病理特征和治疗方法.男7例,女3例.年龄38～74岁,平均56岁.患侧腰酸3例,体检偶然发现7例,有肾囊肿病史者2例.囊腔直径3.5～8.2 cm.术前B超检查诊断为肾癌6例,CT诊断为肾癌7例.8例术中行冰冻病理:肾细胞癌6例,未发现恶性倾向2例.10例均行根治性肾切除术. 结果 术后病理诊断:肾透明细胞癌9例,颗粒细胞癌1例.病理学分型:肾癌囊性坏死6例,多房囊性肾癌2例,肾囊肿恶变型2例.8例随访6个月～5年,6例无瘤存活,2例分别于术后13、20个月死于肿瘤转移. 结论 重视囊性肾癌独特的影像学特点、病理学特征,术中行冰冻病理检查,是提高囊性肾癌诊治水平的关键.     

保留肾单位手术治疗局限性肾癌的临床分析

目的评价保留肾单位手术治疗局限性肾癌的临床效果及可行性。方珐104例局限性肾癌患者行保留肾单位手术,肿瘤平均直径（39．35±13．5）mm。69例阻断肾蒂,其中冰泥降温43例。评价手术时间、肾蒂阻断时间、出血量、并发症及肿瘤控制情况。培暴104例手术均顺利完成。手术时间60∽425min,平均（95土25）min。平均肾蒂阻断时间（17士10）min。术中出血10～2000mL,平均（204士102）mL。术后病理透明细胞癌95例,囊性肾癌5例,乳头状肾细胞癌4例。其中pT1bN0Mo31例（70．2％）,pT1bN0M031例（29．8％）。手术切缘距肿瘤0．5～1．0cm。术后漏尿1例,出血1例,心衰1例,不完全性肠梗阻1例,101例（97．1％）获得随访,随访时间6～95月,平均（55士15）个月,1例出现卵巢转移瘤,1例术后36个月死亡。5年总生存率为99．0％。结论对于局限性肾癌,保留肾单位手术是一种安全、有效的术式,有可能取代根治性肾切除术成为小肾癌新的标准术式。     

小肾癌54例诊治分析

目的 提高小肾癌的诊断水平和治疗效果。方法 对54例直径小于3cm的小肾癌的诊断与治疗进行回顾性分析。结果 54例中因体检或其他疾病检查时发现者37例（68．5％）；腰痛9例（16．7％）；血尿5例（0．9％）；腰痛伴血尿3例。行根治性肾切除术43例．行保留肾单位手术11例。术后均经病理证实。术中快速冰冻切片证实5例。结论 小肾癌多为偶然发现。其早期诊断主要依靠B超、CT、MRI和DSA等影像学检查；手术视具体情况行根治性肾切除术或保留肾单位手术；小肾癌病理分期低。肿瘤体积小．预后较好，生存率高。     

小肾癌76例临床分析

目的　探讨小肾癌 (SRCC)的临床症状、影像学特征、分级分期与预后的关系。　方法　选择直径≤ 3cm的小肾癌患者 76例。其中有血尿、腰痛的 17例计为症状组 (2 2 .4 % ) ,健康体检或因其它疾患就诊偶然发现的 5 9例 (77.6 % )计为无症状组。 6 9例行B超检查 ,诊断率 84 .1% ;76例行CT检查 ,诊断率 94 .7%。　结果　 76例患者均行经腰部斜切口根治性肾切除术 ,病理诊断均为透明细胞癌。术后随访 32～ 87个月 ,平均 6 2 .7个月。症状组和无症状组术后 1、3、5年无瘤生存率分别为 10 0 .0 %、5 3.3%、33.3%和 10 0 .0 %、90 .6 %、77.4 % ,两组 3年和 5年生存率差异均有显著性意义 (P <0 .0 5 )。　结论　小肾癌的早期诊断主要依赖B超和 (或 )CT等影像学检查。无症状患者的远期无瘤生存率显著高于有症状患者。     

Grading systems in renal cell carcinoma

PURPOSE: We reviewed updated literature data concerning several issues of renal cell carcinoma grading systems. MATERIALS AND METHODS: We performed a nonsystematic review of the literature. Data were identified by a MEDLINE search using a strategy including MeSH and free text protocols. From the MEDLINE search we collected 184 records. RESULTS: Although the original study was published in 1982, the independent predictive value of nuclear grades was only revealed in 2000 by the team from University of California-Los Angeles. Subsequently further data from our group and the group at the Mayo Clinic reconfirmed those findings, although similar cancer specific survival probabilities were noted among different grades. The prognostic relevance of nuclear grade justified the inclusion of that variable in algorithms and nomograms predictive of cancer specific survival, such as those provided by University of California-Los Angeles, the Mayo Clinic and Memorial Sloan-Kettering Cancer Center. Despite the routine clinical use of nuclear grade, several drawbacks have affected grading systems, such as interobserver and intra-observer reproducibility, and variability of the cancer specific survival probabilities stratified by grade. Several studies showed that intra-observer and interobserver agreement with regard to grade are only moderate with up shifting in all series. That issue might be due to the heterogeneity of renal cell carcinoma as well as to the lack of consensus about the minimal size of high grade tumor to be considered significant. Moreover, recent data underscore the role of histological subtypes. CONCLUSIONS: Grade is one of the most powerful prognostic factors in patients with renal cell carcinoma. The Fuhrman grading system is currently most widely used by pathologists in Europe and the United States. However, there is still a need for better standardization of nuclear criteria to improve interobserver reproducibility and a major consensus should be achieved by uropathologists.     

肾嫌色细胞癌的诊治（附4例报告）

目的 提高肾嫌色细胞癌的诊治水平。方法 回顾性分析4例肾嫌色细胞癌患者的临床资料。男3例，女1例，年龄34—76岁，平均52岁。结果 3例患者行肾癌根治术，1例行肾部分切除术。术后病理诊断为肾嫌色细胞癌，病理分期：pT1aNxMo 1例，pT1bNoMo3例。病理分级：G1 3例，G2 1例。免疫组织化学染色：CK8（低分子量细胞角蛋白）阳性，Vimentin（波型蛋白）阴性，Hale胶体铁阳性。随访4个月至8年，平均4年。4例患者均健在，无肿瘤复发或转移。结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌，影像学检查对其诊断有重要帮助，确诊有赖于组织病理学检查，手术治疗后预后较好。     

膀胱小细胞癌3例

目的 探讨膀胱小细胞癌的临床病理特征和诊治方法。方法 总结3例膀胱小细胞癌患者资料,结合文献复习讨论。结果 1例行膀胱部分切除术,术后4月复发转移7月死亡。1例行髂内动脉插管化疗,至今带瘤生存14月。另1例行膀胱部分切除术,术后6月无复发转移,至今健在。病理学检查肿瘤细胞较小,核浓染,胞浆稀少,核仁不显著,核分裂相多见。免疫组化NSE3例均阳性。结论 膀胱小细胞癌临床罕见,诊断主要依靠病理学检查,此病预后差,应提倡手术切除辅以放疗及全身联合化疗。     

小肾癌(附34例报告)

自１９８５～１９９６年诊治３ｃｍ以下肾癌３４例。其中无任何临床症状由体检发现者２３例（６７．６％），血尿５例（１４．７％），腰痛４例（１１．８％）血尿及腰痛均有者１例，因慢性肾功能不全经Ｂ超检查发现１例。行根治性肾切除２９例，单纯性肾切除２例，行肾肿瘤剜除术２例，术前误诊为肾盂癌而行肾输尿管全长切除１例。病理结果：透明细胞癌３２例（９４．１％），颗粒细胞癌１例，混合型（透明细胞癌＋颗粒细胞癌）癌１例。ＰＴ１１０例，ＰＴ２２４例。３０例（８８．２％）获得随访，平均随访时间３８．７个月。无癌存活者２９例，术后存活超过５年者７例，其中１例术后第６年死于肺转移     

Second primary malignancies associated with renal cell carcinoma histological subtypes

PURPOSE: Renal cell carcinoma has been linked to numerous secondary malignancies. We evaluated the risk of secondary malignancies by renal cell carcinoma histological subtype in patients with clear cell, papillary and chromophobe renal cell carcinoma. MATERIALS AND METHODS: We studied 2,722 patients who underwent nephrectomy for sporadic renal cell carcinoma at our institution between 1970 and 2000. All specimens were reviewed by a single urological pathologist for histological subtype. Associations of second primary malignancies by histological subtype were evaluated using the chi-square and Fisher exact tests. RESULTS: Of the patients studied 2,188 (80.4%) had clear cell, 378 (13.9%) had papillary and 128 (4.7%) had chromophobe renal cell carcinoma. Patients with papillary renal cell carcinoma were significantly more likely to have colon cancer (p = 0.041), prostate cancer (p = 0.003), any second malignancy (p <0.001) and multiple malignancies (p <0.001) compared with patients with clear cell renal cell carcinoma. In addition, patients with chromophobe renal cell carcinoma were significantly more likely to have colon cancer than patients with clear cell renal cell carcinoma (p = 0.020). Although patients with papillary renal cell carcinoma were more likely to have bladder cancer, the incidence did not differ significantly compared with that in patients harboring clear cell and chromophobe renal cell carcinoma (p = 0.193). We did not find a significant difference in the incidence of breast cancer, lung cancer, rectal cancer or lymphoma among histological subtypes. CONCLUSIONS: Our data indicate that patients with papillary renal cell carcinoma are more likely to harbor secondary malignancies, including colon and prostate cancer, than patients with clear cell renal cell carcinoma. These results may have important implications for patient education and followup evaluation, and they should prompt mechanistic investigations.     

The uncertainty of radio frequency treatment of renal cell carcinoma: findings at immediate and delayed nephrectomy

PURPOSE: Radio frequency thermal therapy for the ablation of renal cell carcinoma has been reported. Outcomes are usually measured by imaging alone. We have performed ex vivo and in vivo experiments using radio frequency in porcine models in our laboratory. We now report our early experience in the treatment of renal cell carcinoma in patients who underwent post-radio frequency radical or partial nephrectomy. MATERIALS AND METHODS: We treated 10 patients diagnosed with small renal masses with radio frequency. All masses were biopsied before treatment. In 4 patients 5 renal cell carcinomas were treated with radio frequency after surgical exposure of the tumor followed immediately by partial or radical nephrectomy (acute group). Six other patients were treated percutaneously with ultrasound or computerized tomography guided radio frequency under local anesthesia and intravenous sedation 7 days before partial or radical nephrectomy (delayed group). A median of 2 radio frequency cycles was applied. Mean total heating time was 17 minutes 15 seconds. Specimens were analyzed grossly and histologically. Triphasic contrast-enhanced computerized tomography and/or magnetic resonance imaging was performed before and 7 days after radio frequency treatment in the delayed group. RESULTS: Mean radiological largest diameter of all 11 masses was 2.4 cm. and mean gross diameter was 2.2 cm. Pathological examination demonstrated residual viable tumor in approximately 5% of the volume in 4 of the 5 tumors in the acute group and in 3 of the 6 masses of the delayed group. In 1 delayed case the viable tumor appeared to be in contact with the renal vein. No significant complications were observed in 9 of the 10 patients. In 1 delayed case, a subcapsular hepatic hematoma, biliary fistula and pneumonia developed and resolved. CONCLUSIONS: Based on our experience, we continue to consider percutaneous radio frequency for the treatment of small renal cell carcinomas as a potentially curative therapy. However, complete tumor cell death appears to be difficult to achieve with our current treatment protocol. More phase II testing is indicated to ensure that this technique is an effective and reproducible treatment alternative.