肾错构瘤的诊断与治疗(附31例报告)

目的：探讨肾错构瘤的诊断与治疗方法。方法：回顾性分析31例肾错构瘤的临床资料，其中30例行B超检查；25例行CT扫描；7例行MRI扫描；15例行IVP检查；2例行DSA检查。27例行手术治疗，其中7例术前诊断明确且肿瘤直径远大于4cm，行肾切除术；7例因肾破裂出血而争诊手术切除病肾；2例肾破裂出血者病情稳定，于次日明确诊断后进行手术切除；1例术前不能完全明确诊断，术中快速切片确定为肾错构瘤后行肿瘤剜除术；另4例作随访观察。结果：所有患者均经病理检查诊断为肾错构瘤，未发现有肿瘤恶变者。27例手术患者术后病情稳定。结论：CT和MRI是肾错构瘤最好的影像学诊断方法。对肿瘤直径＞4cm且逐渐增大伴明显症状者，应积极进行手术治疗，手术治疗应尽量保留有功能的肾组织。     

肾错构瘤破裂出血的急诊处理

目的：探讨肾错构瘤(RAML)破裂出血的诊治方法。方法：回顾性分析11例RAML破裂出血的急诊处理过程。结果：11例患者均经病理明确诊断，4例行患肾切除术，2例行肾部分切除术，5例行肿瘤切除术。11例患者均恢复良好。结论：B超和CT检查为术前确诊主要依据；对RAML破裂出血应采取积极的治疗态度；手术治疗仍为主要治疗方法。     

肾错构瘤的诊断和治疗(附22例报告)

目的：探讨提高肾错构瘤的诊断和治疗水平。方法：回顾性分析22例肾错构瘤的诊断和治疗结果：男10例，女12例，年龄16～67岁。肿瘤位于右侧9例，左侧13例；肿瘤大小0．4cm×0．6cm×0．7cm～13．5cm×14．3cm×15．2cm。主要临床症状为腰部不适、胀痛、包块、出血性休克等。结果：B超诊断准确率为86．4％（19／22），CT诊断准确率为90．9％（20／22），肿瘤小于4cm而无症状的7例采用B超、CT定期随访。手术15例，其中肿瘤直径小于4cm伴患侧腰痛或肉眼血尿的7例行肿瘤剜除术；直径大于4cm者8例，行肾部分切除术4例，肾切除术2例，因误诊为肾癌而行肾根治性切除术2例。结论：B超、CT、MRI等影像学检查对肾错构瘤的诊断准确率较高，必要时可作针刺活检及术中冷冻病理检查，关键是治疗方法的选择，即如何尽最大可能选择保留肾单位手术，其中选择性肾动脉栓塞术、肿瘤剜除术、肾部分切除术应作为首选。     

肾错构瘤自发性破裂出血的外科诊治（附7例报告）

目的探讨肾错构瘤自发性破裂出血的诊断和治疗。方法回顾性分析2003年5月至2008年3月收治的7例肾错构瘤破裂出血患者的临床资料。均行手术治疗,其中3例行患肾切除术,3例行肾部分切除术,1例行肿瘤剜除术。结果 7例患者术后均恢复顺利,所有患者均获随访,时间6个月～5年,无肿瘤复发。结论 B超和CT检查为肾错构瘤破裂出血术前确诊主要依据,手术仍为主要的治疗方法,术中尽可能选择保肾手术。     

肾肿瘤自发性破裂16例诊治分析

目的 探讨以自发破裂出血为主要临床表现的肾脏肿瘤的诊治. 方法 回顾性分析16例肾肿瘤自发性破裂患者的临床资料.所有患者均行B超和CT检查,3例行MRI检查以鉴别肾细胞癌与错构瘤,术前确诊12例.9例急诊行患肾切除术,5例行保留肾单位手术(nephron-sparing surgery,NSS),2例行选择性肾动脉栓塞术(transcatheter arterial embolization,TAE). 结果 14例手术患者术后病理诊断肾恶性肿瘤7例,错构瘤7例.16例均获随访,随访时间6～46个月,定期复查B超或CT,所有患者未见肿瘤复发,其中行TAE的2例患者,肿瘤明显缩小. 结论 自发破裂出血为主要临床表现的肾脏肿瘤中恶性肿瘤比例较高,螺旋CT是鉴别良恶性的主要方法.治疗以肾切除手术为主,良性肿瘤可考虑行NSS或TAE.     

不典型肾错构瘤的诊断与治疗（附18例报告）

目的：探讨不典型肾错构瘤的误诊原因,提高其诊治水平。方法：回顾性分析18例不典型肾错构瘤的临床资料。18例均行B超检查,15例行CT扫描,8例行MRI扫描,6例行IVU检查。3例接受保守治疗;15例接受手术治疗,其中3例行肿瘤剜除术,5例行肾部分切除术,7例行肾癌根治术。结果：B超诊断肾错构瘤10例（10／18）,CT诊断肾错构瘤7例（7／15）。3例保守治疗者获得随访,肿瘤大小无明显变化,无转移。15例手术治疗者术后病理检查均为肾错构瘤,随访未见肿瘤转移或复发。结论：大部分肾错构瘤可通过B超、CT等影像学检查明确诊断;对于不典型肾错构瘤,术前应仔细分析影像学检查,结合病史尽量明确诊断,减少不必要的肾切除。     

肾错构瘤破裂出血的诊断及外科治疗(附9例报告)

目的提高肾错构瘤破裂出血的诊断和治疗水平。方法回顾性分析9例肾错构瘤破裂出血的诊治过程。结果9例患者均行外科手术治疗,其中3例行患肾切除术,2例行肾部分切除术,4例行肿瘤切除术。术后病理诊断均为肾错构瘤,无恶变。9例患者均恢复顺利,5例患者获随访,时间2个月~14年,平均91.6个月,无肿瘤复发。结论肾错构瘤破裂出血在临床上无典型临床表现,B超和CT检查为术前确诊主要依据,尽早手术探查是首选治疗手段,术中尽可能选择保肾手术。     

肾错构瘤的诊断与治疗(附32例报告)

目的：探讨肾错构瘤（AML）的诊断和治疗方法。方法：回顾性分析32例AML患者的诊治情况。结果：32例中，22例CT检查提示有脂肪组织，其中17例CT值为－9－98Hu,5例为20－40Hu；10例作MRI检查，T1加权像较低，T2加权像极高。22例手术标本经病理检查证实。对10例肿瘤直径＜4cm患者作门诊观察，10例作肾切除术，4例作肾部分切除术，8例作原位冷冻肿瘤剜除术。结论：CT对高密度的AML的分辨性较B超更敏感，MRI对AML的诊断有较高价值；对肿瘤直径＜4cm患者可作门诊观察；对肿瘤直径＞4cm的患者可作肾部分切除术及原位冷冻下肿瘤剜除术。     

肾盂鳞状细胞癌的诊断与治疗(附16例报告)

目的：探讨肾盂鳞状细胞癌的术前诊断及治疗效果。方法：回顾性分析16例肾盂鳞状细胞癌患者的诊断和治疗等临床资料。所有患者术前均行IVU检查，13例行B超检查，4例行CT和MRI检查；11例行根治性肾切除加局部淋巴结清扫术。结果：行IVU检查者仅提示4例有占位性变病，13例行B超检查者仅显示2例有占位性病变，4例行CT或MRI检查者均提示有肿瘤改变。近50％的患者术后1年内死亡。结论：术前诊断肾盂鳞状细胞癌的敏感方法为CT和MRI，其治疗方法首选根治性肾切除术，但预后差。     

肾错构瘤的诊断与治疗(附13例报告)

目的探讨肾错构瘤的诊断和治疗。方法本组13例患者手术治疗,4例行肿瘤剜除术,6例行患肾部分切除术,1例患者因急腹症就诊探查确诊切除患肾,1例恶变者行肾癌根治术,1例保守治疗。结果所有手术患者术后恢复顺利,术后随访6个月~2年,未见肿瘤复发。结论通过B超、CT等检查,大部分肾错构瘤的患者都可明确诊断,少数瘤体破裂大出血而诊断未明者,宜剖腹探查。手术是治疗肾错构瘤的主要方法,特别是对于肾错构瘤体积大于4cm者应尽早手术治疗。对少数非手术治疗者,应严密观察。手术宜尽量保留有功能的肾组织,恶变者行肾癌根治术。     

肾脏偶发占位病变的诊治体会

目的提高小于３．０ｃｍ偶发性肾脏占位病变的诊治效果。方法对４９例肾脏偶发占位病变的诊治进行回顾性总结。结果Ｂ超检查发现３６例,ＣＴ检查发现１３例。肾癌３１例,高密度肾囊肿１０例,肾错构瘤７例,肾皮质腺瘤１例。肾癌术后死亡１例,生存超过５年者１４例,１例肾错构瘤随诊肿瘤增大０．６ｃｍ,余未见异常。结论肾脏偶发占位病变应根据Ｂ超、ＣＴ、ＭＲＩ综合分析作出诊断,定性不明者应行术中冰冻病检。     

肾错构瘤破裂出血的急诊处理

目的探讨肾错构瘤破裂出血的诊治。方法回顾性分析15例肾错构瘤破裂出血的处理。结果15例患者术前均行B超和CT检查,术前确诊11例(73.3%)。均行手术治疗,其中行患肾切除术5例,行肾部分切除术3例,行肿瘤切除术7例。15例患者均恢复良好。结论B超和CT检查为肾错构瘤破裂出血术前确诊主要依据,治疗上以手术为主,应在保证手术安全的前提下行保肾手术。     

肾上腺肿瘤自发性破裂出血5例报告

目的 提高对肾上腺肿瘤自发性破裂出血的认识及诊治水平.方法 回顾性分析2004年1月到2009年3月,共收治5例肾上腺肿瘤白发性破裂出血患者的诊治资料,并进行总结.所有患者均以突发患侧剧烈腰痛急诊,行B超、CT检查发现肾上腺肿块较大,直径4.5cm～12cm不等,平均8.5cm,肿瘤性质均有病理明确.结果 5例自发性破裂出血的肾上腺肿瘤中,3例为嗜铬细胞瘤(其中1例失随访),1例肺癌肾上腺转移,1例肾上腺皮质癌.结论 肾上腺肿瘤自发出血较为少见,临床表现以突发性患侧腰痛、胸闷、心悸为主.B超、CT是有效的诊断方法.肾上腺肿瘤白发性破裂出血多见于较大功能性肿瘤和恶性肿瘤破裂出血.应在稳定生命体征的情况下,积极手术.     

原发性肾窦肿瘤三例报告

目的 总结原发性肾窦肿瘤的临床特点及治疗方法.方法 原发性肾窦肿瘤患者3例.女2例,男1例.平均年龄40(33～55)岁.临床表现为腰痛伴血尿1例,单纯腰部疼痛2例.肿瘤位于右侧2例,左侧1例.直径平均5.5(3.5～8.5)cm.3例均经行手术治疗. 结果行右肾窦肿瘤探查术1例,术中病理提示良性肿瘤,单纯切除肿瘤,病理报告为血管平滑肌瘤,随访3年未见复发.1例术中因肿瘤出血及肾盂破坏严重,行右肾切除,病理报告为血管平滑肌脂肪瘤,随访10个月未见复发.1例因肿瘤包绕肾动静脉,局部严重黏连,行左肾切除术,病理报告为脂肪瘤,随访4年未见肿瘤复发.结论 原发性肾窦肿瘤临床罕见,多为良性,易误诊为肾盂肿瘤,CT、MRI、IVU检查有助于鉴别;良性肿瘤直径<4 cm且无症状者可密切随访,有症状或直径>4 cm者可行肿瘤切除;肿瘤累及肾蒂并严重破坏肾盂者可行单纯肾切除;恶性肿瘤应行根治性肾切除.     

Radiological features of renal pelvic hemangioma: a case series

BackgroundRenal pelvic hemangioma (RPH) is often misdiagnosed as renal pelvis cancer (RPC) due to its similarity in presentation, and there are few reports on the imaging findings of RPH. This study is aimed at improving the understanding of imaging findings specific for RPH by a retrospective analysis of the imaging findings of RPH.MethodsRPH cases confirmed by pathology and with high-quality images were collected in the analysis. Nine cases of RPH were enrolled, of which 6 cases underwent ultrasound (US); 7 cases underwent computed tomography (CT), including 6 cases with an enhanced scan; and 2 cases underwent magnetic resonance imaging (MRI), including 1 case with an enhanced scan. All images of cases were analyzed and sorted independently by two senior attending radiologist blinded to the pathological results, according to the imaging indicators, such as the density and intensity on CT and MRI respectively. When the opinions between radiologists were inconsistent, images were re-evaluated together until a consensus was reached.ResultsNine cases of RPH were collected from 5 males and 4 females, aged 16–70 years old, with a median age of 41 years. Five cases were located in the left kidney and 4 cases were located in the right kidney. The clinical symptoms mostly presented with hematuria. Nine cases demonstrated solitary masses, with 4 cases with blurred margins and 5 cases with well-defined margins. The size of the mass was about 1.5–8.0 cm, and the median size was 2.5 cm. The US showed mostly hypoechoic masses and color Doppler flow imaging (CDFI) showed minimal to no blood flow signal. Unenhanced CT scans showed mostly hypodensity and mostly mild continuous enhancement on an enhanced scan. The intensity of lesions was commonly heterogeneous on MRI due to hemorrhage and necrosis. One case showed mild continuous enhancement on an enhanced MRI scan.ConclusionsThe imaging findings of RPH commonly present as a focal lesion with blurred or well-defined margins, mild and continuous enhancement, and no cachexia of the clinical symptoms. RPH should be differentiated from malignant tumors of the renal pelvis for treatment.     

肾血管平滑肌脂肪瘤的外科治疗：（附26例报告）

报告外科治疗肾血管平滑肌脂肪瘤２６例２８个肾脏，其中肾切除１５例，肾部分切除４例，肿瘤剜除７例９个肾脏。认为由于肾血管平滑肌脂肪瘤在Ｂ超、选择性肾动脉造影和ＣＴ扫描中有其特征性表现，通常可以在术前作出正确诊断。对肿瘤自发性破裂出血，恶性变和外科治疗进行了讨论。     

Spontaneous rupture of infected renal cyst presenting sudden onset of right flank distension: a case report

A 21-year-old woman was referred to our hospital for sudden onset of right flank distension. Ultrasonography, abdominal CT scan and MRI revealed a giant cyst 20 x 11 x 10 cm on the right kidney. Percutaneous puncture of the lesion was performed and fluid was drained. The fluid was yellowish and puriform. Gradually, the drainage fluid creatinine concentration increased. Cystography revealed communication between the lesion and the pyelocalyceal system. The patient underwent drainage for 25 days, causing the cyst to almost fully collapse. No recurrence has been detected in the follow-up for about 1 year. This case is the 38th case of the rupture of a renal cyst reported in the Japanese literature. We reviewed 37 cases of rupture of renal cysts previously reported in Japan.     

肾错构瘤破裂的诊断和治疗（附33例报告）

目的：探讨肾错构瘤破裂的临床特点、诊断和治疗方法。方法：回顾性分析2003年1月～2012年12月收治的肾错构瘤破裂出血者33例临床资料,男15例,女18例,年龄16～62岁,平均39岁。33例多因腰腹部疼痛不适或肉眼血尿入院。疼痛多表现为胀痛。首诊中以无诱因腰腹部疼痛入院者28例,其中突发性疼痛者14例,单纯性血尿3例,疼痛伴发血尿4例,血尿伴感染2例,外伤致血尿者2例。21例采用肾脏手术治疗,12例采用保守方法治疗。结果：2l例手术者均获得成功,术后恢复良好,无明显异常并发症。术后均证实为错构瘤。结论：肾错构瘤存在自发性破裂的可能,外伤亦能诱发瘤体破裂。瘤体直径〈4cm时,破裂出血几率较小;直径超过4cm时,自发性破裂的发生牢明显增加。超声和增强CT检查是诊断肾错构瘤的有效方法。     

Coexistence of cyst and tumor in the same kidney: a case report

A case of renal cyst associated with renal tumor is presented herein. A 40-year-old male patient visited our outpatient clinic for left renal cyst which had been found by ultrasonography on routine clinical examination. CT scan demonstrated an irregular area in the cyst wall measuring about 2 cm in thickness which showed enhancement of density with contrast medium. Magnetic resonance imaging (MRI) also demonstrated a round mass with abnormal signal on the cyst wall, protruding into the cyst cavity. Transabdominal radical nephrectomy was performed on 13 July 1987, and to the resected kidney was attached a cyst measuring 7 cm in diameter in the lower pole. Grossly, the cyst contained amorphous red-brown material which turned out to be old blood clots and the wall harbored a tumor (3.0 x 2.5 cm). Histologically, the tumor was renal cell carcinoma, the surface of which was covered with necrotic tissue. The coexistence of renal cyst and tumor is rare and 62 cases were collected from the Japanese literature including our case, and discussion was made in relation to the etiological factors.