超声造影定量分析负压封闭引流对兔创面血流的影响

[目的]采用超声造影定量分析负压封闭引流技术对软组织创面血流灌注的改善情况,并探讨该技术的可能作用机理。[方法] 8只免制备背部两处深层软组织缺损创面模型,分别给予间断VSD负压吸引和纱布覆盖,2 d后采用超声造影技术定量分析两组创面床内血流绝对峰值强度(API)、血流增强时间(TTP)、血流增强相对速度(ES)和以曲线下面积表示(AUC)的血流灌注量的变化。[结果]治疗2 d后,VSD组血流绝对峰值增大(P0.05),而纱布组减小(P0.05),VSD组的血流绝对峰值强度显著高于无菌纱布组[(13.43±1.53) dB vs (3.55±0.70) dB,P0.05]。VSD组血流达峰时间(TTP)治疗前后无明显改变(P=0.635),而纱布组2 d后TTP显著延长(P0.05),VSD组的TTP显著短于纱布组[(4.20±0.64) s vs (5.34±0.53) s,P0.05]。2 d后VSD组ES较治疗前明显增大(P0.05);而纱布组ES较治疗前明显减小(P0.05)。治疗后VSD组与纱布组比较,VSD组ES明显大于纱布组[(3.27±0.60) m/s vs (0.67±0.14),P0.05]。2 d后VSD组血流灌注量(AUC)增加(P0.05),而纱布组AUC减小(P0.05),VSD组的AUC明显高于无菌纱布组[(247.56±53.75) dB×s vs (64.18±7.91) dB×s,P0.05]。[方论]通过超声造影的定量分析,证明负压封闭引流技术能够有效改善创面深层软组织的血液灌注,这可能是该技术修复创面的重要机制之一。     

良性前列腺增生超声造影的初步研究

目的:分析并评价BPH的超声造影表现,探讨超声造影对研究BPH血流灌注的价值。方法:对48例经直肠超声引导下穿刺活检、病理证实为BPH的患者进行超声造影检查,观察前列腺内腺及外腺的超声造影表现并制作时间-强度曲线,分析超声造影开始增强时间、造影开始减退时间、造影剂渡越时间及峰值强度。结果:前列腺为富血供器官,造影增强明显。48例BPH患者前列腺内腺及外腺开始增强的时间分别为(26.68±3.76)、(31.24±5.33)s,内腺开始增强的时间显著早于外腺,尤以尿道周围区及内腺的包膜处明显(P=0.000);内腺及外腺造影剂完全退出时间分别为(200.68±59.40)、(157.56±50.66)s,内腺造影剂完全退出时间显著晚于外腺(P=0.000);内腺及外腺造影剂渡越时间分别为(173.94±60.14)、(129.21±56.91)s,内腺造影剂渡越时间显著长于外腺(P=0.000)。内腺及外腺造影峰值强度分别为(90.45±42.19)、(65.32±25.15)dB,内腺造影峰值强度显著高于外腺(P=0.000)。结论:超声造影检查能够连续观察BPH的血流灌注情况,有望成为研究BPH血流状况的有效方法。     

超声造影检查在肾脏非典型占位性病变诊断中的价值

目的:探讨超声造影检查对肾脏非典型占位性病变的诊断价值。方法:回顾性分析2015年5月至2019年6月北京大学第一医院收治的44例肾脏非典型占位性病变患者的常规超声和超声造影检查资料。男26例,女18例。年龄(55.9±13.7)岁。44例共47个占位,均行常规超声检查观察肿物的位置、大小、回声、边界、彩色血流情况,做出常规超声诊断。行超声造影检查观察肿物增强时相、增强水平、增强模式、是否有环状增强,做出超声造影诊断。将超声检查诊断与最终病理或临床诊断进行比较。绘制受试者工作特征(ROC)曲线,比较常规超声和超声造影检查对肾脏非典型占位性病变的诊断效能。结果:本研究47个病灶中,诊断为恶性15个,良性32个。19个病灶经手术病理诊断,分别为肾细胞癌13个、肾淋巴瘤2个、肾囊肿3个、炎性肉芽肿1个;28个经增强CT或MRI检查诊断为良性肿瘤或假性肿瘤,且定期随访≥1年无变化,分别为血管平滑肌脂肪瘤5个、囊肿15个、肾连接部皮质缺损3个、肾柱肥大2个、未萎缩肾实质1个、驼峰肾1个、瘢痕1个。常规超声检查病灶最大径(2.5±1.3)cm。肾细胞癌常规超声检查以低回声多见(8/13);超声造影检查以快进快出为主(9/13),多为不均匀低增强(6/13),9个发现假包膜,6个发现坏死。2个肾淋巴瘤常规超声检查均为低回声;超声造影检查均为快进快出,等增强1个,低增强1个。5个肾血管平滑肌脂肪瘤常规超声检查为高回声;超声造影检查以慢进慢出为主(4/5),低增强2个,高增强2个,等增强1个。肾囊肿常规超声检查以无回声多见(16/18);超声造影检查,单纯性肾囊肿无增强,复杂性肾囊肿囊壁或分隔薄且均匀强化,呈慢进慢出、等增强或低增强。炎性肉芽肿常规超声检查呈囊实性;超声造影检查实性部分与肾实质同步强化,呈低增强。肾柱肥大、驼峰肾和局限性未萎缩肾实质常规超声检查为低回声;超声造影检查为与肾实质同进同出的均匀等增强,无明显包块轮廓出现。肾连接部皮质缺损和瘢痕常规超声检查为高回声,超声造影检查自始至终无增强。常规超声检查将1个炎性肉芽肿、1个未萎缩肾实质、2个复杂肾囊肿误诊为恶性,2个高回声肾细胞癌误诊为良性;超声造影检查仅将1个炎性肉芽肿误诊为恶性。常规超声检查对良恶性病变诊断的敏感性为86.7%,特异性为87.5%,准确性为87.2%,ROC曲线下面积0.871。超声造影检查对良恶性病变诊断的敏感性为100.0%,特异性为96.9%,准确性97.9%,ROC曲线下面积为0.984。常规超声与超声造影检查的ROC曲线下面积比较差异有统计学意义(P=0.03)。结论:超声造影检查对肾脏非典型占位性病变的诊断效能优于常规超声检查,对于常规超声检查诊断困难的肾肿瘤,以及酷似肾占位病变的良性病变和解剖异常的诊断和鉴别诊断具有优势。     

肾脏少脂肪血管平滑肌脂肪瘤患者21例临床分析并文献复习

目的提高对少脂性肾血管平滑肌脂肪瘤的认识,探讨其诊治方法。方法回顾性分析经术后病理证实的21例少脂性肾血管平滑肌脂肪瘤的临床特征及影像学表现。结果少脂性肾血管平滑肌脂肪瘤多见于年轻女性,超声显示肿瘤为低回声或等回声,彩色多普勒可见肿瘤内有血流信号。CT检查21例平扫期未见脂肪样低密度。其平扫CT值36~59 Hu。增强后CT值63~89 Hu。结论少脂性肾血管平滑肌脂肪瘤缺乏特异性的临床症状和体征,对病灶CT的细微分析能够给诊断带来帮助。应谨慎处理肾脏高密度病变以避免不必要的肾脏切除术。     

超声联合CT诊断巨大肾血管平滑肌脂肪瘤1例

目的 探讨巨大肾血管平滑肌脂肪瘤的诊断及鉴别诊断.方法 回顾性分析作者单位1例巨大肾血管平滑肌脂肪瘤患者的相关资料.结果 本例患者术前经超声和CT初诊发现腹腔巨大占位病灶,手术后病理确诊为肾血管平滑肌脂肪瘤.超声声像图特征:腹腔内可见形态不规则的稍强回声,边界欠清,内回声不均,右肾部分包膜显示不清,可见病灶包裹右肾上下...     

超声造影评价肝癌微波治疗疗效的初步应用

目的　探索超声造影能量多普勒血流检查评价微波治疗疗效的价值。方法　超声造影剂Levovist检查17例肝癌经皮微波凝固治疗病人。治疗前1d内及治疗后3d、7d对比检查能量多普勒血流图(PDI)、超声造影能量多普勒血流图(CEPDI)及瘤区再活检,并于治疗后1个月、3个月及6个月超声及增强CT随访。结果　(1)造影后CEPDI肿瘤区血流信号显示率明显增加(P＜0.05),并能显示瘤内细小血管的分布状况及其与周边血管尤其是肿瘤滋养血管及其分支进入肿瘤的详细部位;治疗后CEPDI瘤内及周边肿瘤滋养血管消失;(2)肝癌造影瘤内能量多普勒血流信号增强峰值时间平均43.3s,持续时间179.9s;(3)治疗后CEPDI瘤内血流阴性者再活检肿瘤坏死完全。结论　超声造影能量多普勒血流成像能清楚显示肝肿瘤滋养血管及其分支以及肿瘤内的分布状况,并能于治疗后短期内及时判断肿瘤坏死情况,可望成为临床超声检查观测肝癌局部治疗疗效并指导治疗的有效可靠方法。     

肾上腺髓质脂肪瘤

目的：总结肾上腺髓质脂肪瘤的临床特征、诊断和治疗方法。方法：回顾性研究１５例（１６侧）肾上腺髓质脂肪瘤患者的临床资料。１０例有腰背部疼痛症状,其中５例合并高血压;５例无任何自觉症状。１５例行Ｂ超检查示腹膜后或肾上腺区团块状回声,周边见包膜,内部回声不均匀。１５例行ＣＴ检查,１３例诊断为肾上腺髓质脂肪瘤,１例疑为肾癌,１例疑为肾血管平滑肌脂肪瘤。１１例行ＩＶＵ检查,６例示肾脏受压移位,５例为正常肾盂     

MSCT对肾血管平滑肌脂肪瘤的诊断价值

目的：探讨多层螺旋CT（MSCT）在肾血管平滑肌脂肪瘤诊断中的价值。方法：对手术证实的38例肾血管平滑肌脂肪瘤的术前多层螺旋CT资料进行回顾性分析,并在工作站行MPR、MIP图像重建,分析肾血管平滑肌脂肪瘤的MSCT表现,并与手术病理结果对照。结果：38例肾血管平滑肌脂肪瘤中,CT诊断血管平滑肌脂肪瘤的病灶被手术病理证实正确诊断的有32例,另外6例被病理证实为上皮样血管平滑肌脂肪瘤的病灶,其中3例CT误诊为肾癌,后期的3例被正确诊断。总诊断准确率达92.1%（35/38）。32例的血管平滑肌脂肪瘤CT平扫呈等、低、高低混杂密度的,其中31例显示有脂肪密度,多期增强扫描该31例皮质期肿块呈均匀或不均匀强化,但低于肾皮髓质强化,脂肪、坏死囊变、出血区无强化,分泌期肿块持续强化;1例整个病灶显示为高密度出血灶,多期增强扫描无明显异常强化;6例上皮样血管平滑肌脂肪瘤CT平扫呈均匀等密度,多期增强扫描显示皮质期明显强化,分泌期强化减弱。MIP显示其中31例血管平滑肌脂肪瘤的肿内迂曲、增粗的血管,其中1例无明显增粗迂曲血管影;6例上皮样血管平滑肌脂肪瘤内显示细小血管。结论：多层螺旋CT及多期增强扫描能对术前正确诊断肾血管平滑肌脂肪瘤有重要价值,但对上皮样血管平滑肌脂肪瘤的诊断尚需结合临床和实验室检查,甚至需要穿刺活检。     

乏脂肪肾血管平滑肌脂肪瘤的CT特征分析（附40例报告）

目的通过分析40例术前诊断为肾癌的乏脂肪肾血管平滑肌脂肪瘤的CT影像学特征,以期提高肾脏肿瘤的诊断准确率,减少过度治疗。方法回顾性分析40例术前影像学诊断为肾癌的乏脂肪血管平滑肌脂肪瘤,评价CT平扫及增强后三期扫描中肿瘤的大小、位置、强化模式、强化程度、是否伴有钙化等。结果肿瘤最大径1.6～7.9（3.48±1.68）cm;38例表现为实性占位,2例表现为囊实性占位（BosniakⅣ型）;1例肿瘤伴有钙化;就强化程度而言,13例表现为轻度强化,18例表现为中度强化,9例表现为明显强化;就强化模式而言,28例表现为延迟强化,12例表现为非延迟强化;10例表现为不均匀强化,30例表现为均匀强化。结论 CT强化程度,强化模式及特殊征象在乏脂肪肾血管平滑肌脂肪瘤的诊断中具有一定价值。     

肾血管平滑肌脂肪瘤误诊原因及对策

从１９８４年起共收治４９例肾血管平滑肌脂肪瘤（错构瘤），其中１１例因Ｂ超为低回声或（和）ＣＴ为中高密度而误诊为肾癌。将１１例误诊者与典型错构瘤的脂肪成分与临床特点进行分析比较。结果：前者脂肪密度仅占２１．１±１．４％，而后者为６７．１±１８．９％。提出避免误诊的几点经验，确难鉴别者应考虑动脉造影或术中冰冻活检以指导治疗。     

The application of ultrasound contrast agents in the characterization of renal tumors

The aim of this article is to describe the current ultrasound (US) contrast agents employed in the characterization of renal tumors and to report our experience in the use of a contrast-specific ultrasound technique pulse inversion harmonic imaging (PIHI).A total of 23 renal masses were prospectively evaluated by conventional US, CDUS, PIHI and finally by helical-CT (HCT). The study was performed using a wideband convex array 2–5 MHz transducer and a US digital apparatus . PIHI scanning of each renal mass was performed before and after the injection of Levovist. To reach a definitive diagnosis HCT and/or histological findings were considered as the reference procedures. Eleven solid renal cell carcinomas (RCCs), one embryonal metanephric adenoma (EMA), seven angiomyolipomas (AMLs), and four cystic RCCs were analyzed. Solid RCCs revealed a higher contrast enhancement than AMLs with a typical pattern on conventional US. The EMA and AML with an atypical pattern revealed intense contrast enhancement during the arterial phase, progressively decreasing during the delayed phase. Cystic RCCs showed intense contrast enhancement on the peripheral thick wall during the arterial phase decreasing during the delayed phase. PIHI with Levovist may differentiate solid RCCs from AMLs with no hypervascular pattern while solid RCCs show a higher intensity of contrast enhancement than hypervascular AML.     

Partial nephrectomy for renal tumours: the Singapore General Hospital experience.

From January 1991 to August 1998, 220 radical nephrectomies were performed for renal cell carcinoma (RCC). During the same period, 27 patients underwent partial nephrectomy for their renal tumours. These included 19 male and 8 female (mean age, 54; range, 35-75). Their clinical presentation, diagnostic modalities and surgical outcome were evaluated. The lesions included 18 RCCs, 7 angiomyolipomas (AMLs), 1 oncocytoma and 1 dysoncogenetic renal tumour. Only 8 patients had specific urological symptoms. Computerised tomography (CT) scan was diagnostic in 78% of cases. Tumour size ranged from 15-50 mm for RCC and 30-190 mm for AML, respectively. Operative time averaged 92 minutes (range: 35-145). The hospital stay ranged from 3 to 25 days (mean 11). Complications occurred in four cases (14.8%); there was one death (3.7%). No tumour recurrence was detected during a mean follow up of 20 months. None of the patients developed significant renal impairment. Partial nephrectomy is feasible in small RCC and some large AML, and can be offered in selected patients.     

超声造影对肾脏占位病变的诊断意义

目的评价超声造影对彩色多普勒超声诊断肾肿瘤的临床意义。方法应用彩超检查２７个（２６例）肾脏占位病变,观察超声造影前后病变内血流显示情况。结果超声造影后：（１）肾癌病灶内血流信号明显增强,显著增强者占７２％;（２）肾错构瘤７５％无增强,肾囊肿均无增强;（３）肾柱肥大增强与肾实质一致。造影前后诊断敏感性分别为７４％与１００％。结论超声造影有助彩超更准确评价肾肿瘤血供状况,对肾占位病变诊断与鉴别有重要临床意义。     

Contemporary Minimally Invasive Treatment Options for Renal Angiomyolipomas

Renal angiomyolipomas (AMLs) are benign renal masses that are often asymptomatic and detected incidentally. However, treatment might be necessary in symptomatic presentations or when the mass exceeds 4 cm in size. While the goal of management for renal AMLs is to relieve symptoms and prevent hemorrhage, a priority is renal function preservation, especially given the propensity of these lesions to recur. The traditional treatment for renal AMLs is renal angioembolization or surgical excision of the lesion. With advancements in minimally invasive surgery, several other modalities have now emerged for nephron sparing approaches. These include angioembolization, laparoscopic and percutaneous ablative therapies such as radiofrequency ablation, cryoablation and microwave ablation, and pure or robot-assisted laparoscopic partial nephrectomy. Given the relatively low frequency of renal AMLs requiring treatment, much of the available literature on these minimally invasive approaches is largely extrapolative, based on series on small renal masses, i.e. renal cell carcinoma (RCC). This report is based on a thorough review of the published literature to date on the minimally invasive treatment and outcomes of renal AMLs.     

肾肿瘤剜除术治疗肾细胞癌、肾血管平滑肌脂肪瘤

目的探讨肾肿瘤剜除术治疗肾细胞癌及肾血管平滑肌脂肪瘤的疗效。方法回顾分析15例在我院进行肾肿瘤剜除术的肾细胞癌及肾血管平滑肌脂肪瘤患者的临床及病理资料。结果全部肾肿瘤均成功剜除，平均热缺血时间为15min，术中肿瘤剜除面平均出血25ml，术后无继发出血，无急性肾小管坏死、慢性肾功能不全及尿瘘等并发症发生。术后平均随访时间为2．5年，均未见肿瘤复发或转移。依据2003AJCC肾癌分期方法，所有肾癌患者均为Tla期，组织学形态为透明细胞癌。病理分级按Fuhrman标准为G1。结论肾肿瘤剜除术对有假性包膜的Tla肾细胞癌和肾血管平滑肌脂肪瘤是有效和安全的，术后并发症少，可以最大程度地保留肾脏功能。     

Benign pathological findings in 303 Chinese patients undergoing surgery for presumed localized renal cell carcinoma

Objective: To analyze the incidence of benign lesions in Chinese patients undergoing nephrectomies for renal masses identified as localized renal cell carcinoma (RCC) in preoperative imaging. Methods: Between 1999 and 2007, 303 patients (112 female, 191 male) with presumed localized RCC underwent nephrectomy (234 radical nephrectomies and 69 partial nephrectomies). Preoperative computed tomography images and pathological findings were reviewed and analyzed. Results: Pathological examinations revealed 31 (10.2%) benign lesions in the 303 patients. Among these 31 benign lesions, 15 (5.0%) were angiomyolipomas (AML) and only four (1.3%) were oncocytomas. Significantly, 20 (17.9%) of the 112 female patients had benign lesions compared with 11 (5.8%; P = 0.001) male patients. Benign renal lesions were found in five (25.0%) of the 20 patients with renal masses smaller than 2 cm, 13 (13.0%) of the 100 patients with renal masses 2–4 cm in size and 13 (7.1%) of the 183 patients with renal masses larger than 4 cm. Conclusions: Patients in the present study population show a low incidence of benign renal lesions, approximately half of them being AML. Female patients and patients with renal masses smaller than 4 cm are more likely to have benign renal lesions.     

Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size

IntroductionCystic renal cell carcinoma (cystic RCC) is thought to carry an improved prognosis relative to clear cell RCC (CCRCC); however, this is based on small case series. We used a population-based tumor registry to compare clinicopathologic features and cancer-specific mortality (CSM) of cystic RCC with those of CCRCC.Materials and methodsThe Surveillance, Epidemiology, and End Results database was queried for all patients diagnosed and treated for cystic RCC and CCRCC between 2001 and 2010. Clinical and pathologic factors were compared using t tests and chi-square tests as appropriate. Kaplan-Meier survival analysis compared CSM differences between cystic RCC and CCRCC.ResultsA total of 678 patients with cystic RCC and 46,677 with CCRCC were identified. The mean follow-up duration was 52 and 40 months, respectively. When compared with CCRCC patients, those with cystic RCC were younger (mean age 58 vs. 61 y, P <0.001), more commonly black (22% vs. 9%, P<0.001), and female (45% vs. 41%, P = 0.02). Cystic RCCs were more commonly T1a tumors (66% vs. 55%, P<0.001), well differentiated (33% vs. 16%, P<0.001), and smaller (mean size = 3.8 vs. 4.5 cm, P<0.001). Cystic RCC was associated with a reduction in CSM when compared with CCRCC (P = 0.002). In a subset analysis, this reduction in CSM was seen only for those with T1b/T2 tumors (P = 0.01) but not for those with T1a RCCs lesions (P = 0.31).ConclusionsWe report the largest series of cystic RCC and corroborate the findings of improved CSM when compared with CCRCC for larger tumors; however, no difference was noted in smaller tumors, suggesting that tumor biology becomes more relevant to prognosis with increasing size. These data may suggest a role for active surveillance in appropriately selected patients with small, cystic renal masses.     

经直肠超声造影在外周带前列腺癌诊断中的应用价值

目的探讨经直肠超声造影在外周带区前列腺癌（PCa）诊断中的应用价值。方法对56例经病理证实为前列腺癌患者的超声造影表现进行回顾性分析。观察灰阶超声、彩色多普勒超声特点,以及病灶造影增强模式.用Q-LAB软件对病灶及其周围组织造影参数进行对比分析。结果 56例外周型前列腺癌患者,常规灰阶超声低回声结节42例,高回声结节8例,混合回声结节6例;彩色血流异常丰富38例。前列腺癌超声造影表现以快速高增强为主,45例前列腺癌表现为高增强,8例前列腺癌表现为等增强,3例表现为低增强,同时16例增强病灶内存在无增强区。结论经直肠超声造影检查对前列腺外周带癌的诊断有重要价值。     

Clinicopathological features and prognosis of synchronous bilateral renal cell carcinoma: an international multicentre experience

OBJECTIVE: To present a multicentre experience and the largest cohort to date of nonmetastatic (N0M0) synchronous bilateral renal cell carcinoma (RCC), as because it is rare the single-institutional experience is limited. PATIENTS AND METHODS: We retrospectively studied 10 337 patients from 12 urological centres to identify patients with N0M0 synchronous bilateral RCC; the clinicopathological features and cancer-specific survival were compared to a cohort treated for N0M0 unilateral RCC. RESULTS: In all, 153 patients had synchronous bilateral solid renal tumours, of whom 135 (88%) had synchronous bilateral RCC, 118 with nonmetastatic disease; 91% had nonfamilial bilateral RCC. Bilateral clear cell RCC was the major histological subtype (76%), and papillary RCC was the next most frequent (19%). Multifocality was found in 54% of bilateral RCCs. Compared with unilateral RCC, patients did not differ in Eastern Cooperative Oncology Group performance status (ECOG PS) and T classification, but bilateral RCCs were more frequently multifocal (54% vs 16%, P < 0.001) and of the papillary subtype (19% vs 12%), and less frequently clear cell RCC (76% vs 83%, P = 0.005). For the outcome, patients with nonmetastatic synchronous bilateral RCC and unilateral RCC had a similar prognosis (P = 0.63); multifocality did not affect survival (P = 0.60). Multivariate analysis identified ECOG PS, T classification, and Fuhrman grade, but not laterality, as independent prognostic factors for cancer-specific survival. CONCLUSIONS: Patients with N0M0 synchronous bilateral RCC and N0M0 unilateral RCC have a similar prognosis. The frequency of a familial history for RCC (von Hippel-Lindau disease or familial RCC) was significantly greater in bilateral synchronous than in unilateral RCC. The significant pathological findings in synchronous bilateral RCC are papillary subtype and multifocality.     

Nephron-sparing surgery in multiple bilateral angiomyolipomas

We report on a 17-year-old white woman with multiple bilateral renal angiomyolipomas (AMLs) in the absence of tuberous sclerosis. Multiple hyperdense lesions were detected in both kidneys by sonography. A computed tomography (CT) scan confirmed mainly fatty tissue. Sparing as much functional tissue as possible, eight AMLs of the right kidney were resected. The largest removed tumour measured 7 x 4 x 2.4 cm. Renal function was completely preserved. An AML is a benign, generally unilateral renal tumour. Treatment is necessary in cases of flank pain, spontaneous bleeding, obstruction by tumour growth and tumours exceeding 4 cm in diameter. Patients who present are often symptomatic due to pain, retroperitoneal bleeding or haematuria. An AML occurs either sporadically or in association with tuberous sclerosis. Bilateral or unilateral multiple AMLs are rare.