Analysis of renal cyst of high density containing proteinaceous fluid：report of 6 cases

Objective:To investigate clinical features and imageology of renal cysts of high density,containing proteinaceous fluid and increase the diagnosis and treatment level of this special type renal cyst.Methods:Six cases were proven to be renal cysts of high density(pathologically)from 2002 to 2007 were reviewed.Among 6 cases,1 was in the upper pole of kidney,4 were medial and 1 was located in the anus perineum.All were 2-5 cm in size.Ultrasonography(US)excretory unognaphy,multiphase CT and renal angiography DSA imaging was performed for preoperative diagnosis.The preoperative diagnosis found renal neoplasms in 4 and renal cysts in 2.All of them were operated by partial nephrectomy.Results:All of the 6 renal high density renal masses were resected surgically,which were proved pathologically to be renal cysts;high density present.All of them contained proteinaceous fluid with benign cyst walls on histologic examination.No recurrence was seen in any of these cases during a long follow-up.Conclusion:CT and B-US have a higher diagnostic value,which can show the internal shape and character better.B-US or CT guided puncturing biopsy can be better applied to atypical renal cysts.Once the correct diagnosis is acquired,laparoscopic surgical treatment should be carried out.     

Efficacy and safety of alcohol sclerotherapy involving single-session multiple injections to treat simple renal cysts: a multicenter, prospective, randomized, controlled trial

Background  Alcohol has been used for treating simple renal cysts since 1981. Since then, various observational studies have examined the technique, but they differ significantly in the details of the procedures and efficacy measures used. This has made it difficult to assess the safety and efficacy of this technique. We carried out a randomized controlled trial to evaluate the efficacy and safety of ultrasound-guided alcohol sclerotherapy involving single-session multiple injections to treat simple renal cysts.

Methods  A total of 144 patients with simple renal cysts were randomly allocated to either the treatment group (ultrasound-guided percutaneous drainage and alcohol sclerotherapy with single-session multiple injections) or control group (ultrasound-guided simple percutaneous drainage). Follow-up CT scans of ablated cysts were collected 3 and 6 months after the procedure. The outcome was considered successful if cyst volume between baseline and 6 months decreased by at least 87.5%.

Results  Intention-to-treat analysis revealed an average volume reduction of 94.2% in the treatment group and 50.8% in the control group (P <0.0001). The percentage of patients achieving successful outcomes was 88.9% (95% CI 77.0%-100.0%) in the treatment group and 22.2% (95% CI 6.54%-37.9%) in the control group (P <0.0001). The corresponding results in the per-protocol analysis were an average volume reduction of 96.4% in the treatment group and 50.8% in the control group (P <0.0001). The percentage of patients achieving a successful outcome was 94.3% (95% CI 85.6%-100.0%) in the treatment group and 22.2% (95% CI 6.54%-37.9%) in the control group (P <0.0001).

Conclusion  Alcohol sclerotherapy involving single-session multiple injections is safe and efficacious in the treatment of renal cysts. (ChiCTR-TRC-10001114, http://www.chictr.org)

     

Experience in the Surgical Treatment of Hepatic Hydatidosis

Of the 1290 cases of hydatidosis hospitalized,907(70.3%)cases of hepatic hydatid cyst(HHC) were treated surgicall in 1954-1990.There were 484(53.3%) males and 423(46.7%)females.     

Radical correction of Budd-Chiari syndrome

Background Interventional therapy is widely accepted as the first choice for the treatment of the Budd-Chiari syndrome but the use of radical correctional therapy should not be discarded. This study describes radical correction by controlling bleeding from distal end of pathological segment of the inferior vena cava （IVC） and discusses potential surgical errors and postoperative complications. Methods Of the 216 patients in the study, 78 were treated with simple membranectomy, 64 with dissection of the pathological segment of the IVC and vascular prosthesis or pericardial patch plasty, 60 with resection of the pathological segment of the IVC and orthotopic graft transplantation with vascular prosthesis, and 14 with resection of the occlusive main hepatic vein and its upper IVC, hepatic venous outflow plasty and vascular prosthesis orthotopic graft transplantation from the hepatic venous entrance to the IVC of right atrial ostium. Results Except 14 cases who were discharged after hepatic vein outflow plasty, four cases died postoperatively, and 198 patients were discharged without complications. The symptoms of 15 patients were relieved partially and 2 without any change. There were no deaths intraoperatively. Of the 112 cases who were followed up for 72 months, 13 suffered from a relapse. Conclusions Radical correction is a beneficial therapy in the treatment of Budd-Chiari svndrome.     

DIAGNOSIS AND SURGICAL TREATMENT OF BRONCHOGENIC CYSTS

Between 1974 and 1993, 22 patients with bronchogenic cysts were operated on in our hospital; there were 14 men and 8 women, ranging in age from 11 to 62 years, The cyst locations were mediastinal in 13 (59.1%) and intrapulmonary in 9 (40.9%). There were symptoms (chest pain and recurrent bronehiolits) in 20 patients (91%). The preoperative complications included infection in the lung and in the cyst and dysphagia due to esophageal eornpression. Chest pain was the main symptom in mediastinal cyst and recurrent infection of lung in intrapulmonary cyst. Plain chest radiograms showed that a rousd shadow, occasional air-fluid levels, and peripheral calcification may be found in cysts. An operation is the best treatment for cysts. All cysts were completely excised. No postoperative complieations, late complica-tions, or recurrence developed in our patients.     

肝肾联合移植：单中心的经验

Background Simultaneous liver and kidney transplantation （SLKT） has been proven to be a favorable treatment for combined renal and hepatic end-stage disease. However, recipients receiving SLKT have a long medical history, poor general condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalance and acid-base disorders. This study aimed to explore the indications, surgical techniques, therapeutic experience, prevention and treatment of postoperative complications of SLKT. Methods The clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2008 were retrospectively studied. Indications for SLKT, surgical techniques, perioperative fluid management, immunosuppressive regimen and experience in prevention and treatment of postoperative complications were analyzed. Results All operations were successfully performed. Postoperative complications occurred in 13 cases （59.1%）, including pleural effusions （7）, intra-abdominal bleeding （2）, biliary complications （2）, repeated upper gastrointestinal bleeding （1）, and acute liver graft rejection （1）. All complications were treated conservatively. In this study, there were five deaths during follow-up, in which three perioperative deaths occurred due to serious conditions. Mortality at 3 months was 13.6%. The one and three year patient survival rate was 81.3% and 73.9% respectively. Conclusions SLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage to renal function. It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and more postoperative complications. The SLKT surgical techniques selected are based on the experience of surgeons, the anatomy of the recipient and primary diseases. It is essential to use the correct perioperative fluid management, reasonable immunosuppressive regimen, and prevention and treatment of postoperative infections, to improve the long-term patient survival after SLKT.     

Treatment of Special Renal Colic with Ureteroscope and Holmium YAG Laser

Objective To investigate the method of emergent relief of spectal renal colic and treatment of ureter diseases causing renal colic.Methods By analyzing 63cases of special re-nal colic treated with ureteroscope an d Holmium YAGlaser.Results 61cases of renal colic were re-lieved in a short period of time and the original ureter diseases causing renal coli were cured.Conclu-sion special renal colic could be treated with ureteroscope and Holmium YAG laser in a quick and ef-fective manner.     

Influence of early postoperative complication on the operative results in elderly intertrochanteric fractured patients

Objective： Early complications were analyzed in those with Evans Ⅲ type of intertrochanteric fracture treated with operation or nonoperative approaches. Methods：59 cases with Evans Ⅲ type of intertrochanteric fracture between June, 1999 to July, 2006 were admitted in our department. 38 patients were complicated with cardiovascular diseases, such as hypertension and arrhythmia. All the cases were operated. Results：58 cases were operated successfully. One died of pulmonary interstitial fibrosis. Grade data of different age brackets indicated that early infective complications had apparent differences between the operation and the control group. Compared with the control group, the operation group had benefits such as fewer complications, especially the infective complications, and incidence of lower extremities venous thrombosis, and the results showed notable differences. Conclusion：In elderly patients with Evans Ⅲ type of intertrochanteric fracture, the incidence of pulmonary infection was the highest. Venous thrombosis in lower extremities was the most serious complication. So it will be helpful to perform the quadriceps femories function exercise. The postoperative effect is also related with the operation approach.     

Hypercalcemic crisis due to a mediastinal parathyroid cyst diagnosed by ultrasound-guided fine needle aspiration

Hypercalcemic crisis, generally accepted as serum calcium concentration greater than 3.5 mmol/L,constitues a life-threatening endocrinologic emergency,and is most frequently caused by either primary hyperparathyroidism （PHPT） or malignant diseases.Parathyroid cysts are uncommon lesions, most of that are located in the low part of the neck. By routine neck ultrasound scan investigation in a large series of 6621 patients, only 5 parathyroid cysts were detected, yielding a prevalence of 0.075% in setting of unselected patients.The parathyroid cysts in the mediastinum are much less frequently encountered, with only 106 cases reported in English literature.2,3 Moreover, less than half of these cases presented as functional with elevated serum calcium and parathyroid hormone, and only 10 cases were associated with hypercalcemic crisis.3 Herein, we present a rare case of mediastinal parathyroid cyst associated with recurrent hypercalcemic crisis, which diagnosed by ultrasound-guided fine needle aspiration （FNA）.     

Neodymium：Yttrium Aluminum Garnet Laser for Mini-Percutaneous Treatment of Upper Urinary Tract Stones

To observe the efficacy and safety of mini-percutaneous nephrolithotomy with Neodym- ium:Yttrium Aluminum Garnet (Nd-YAG) laser in the treatment for upper urinary tract stones, from December 2005 to September 2006, 31 patients with renal stones, 15 patients with ureteral stones and 7 patients with renal and ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone-free rate were analyzed retrospectively. Our study showed that the percutaneous renal access (F14-F18) was successfully established under B-ultrasound guidance in all cases. Immediate phase Ⅰ lithotripsy was performed in 47 cases through single tract, and in one case through two tracts. Delayed phase Ⅱ lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55 to 180 min with an av- erage time of 100±15 min. Lithotripsy time was from 25 to 135 min and the average lithotripsy time was 65±11 min. No severe complications occurred in our series. Complex renal stones were cleared in 34 of 38 cases (89.5 %). All ureteral stones were completely removed in 15 cases (100 %). It was concluded that mini-percutaneous nephrolithotomy with Nd:YAG laser for the treatment of upper urinary tract stones by combination of rigid ureteroscope and flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter operative time and safety.     

CT引导下注射无水乙醇肝囊肿硬化治疗

目的探讨CT引导下经皮穿刺注射无水乙醇硬化治疗肝囊肿的疗效。方法本组36例患者CT检查和（或）超声检查证实为肝囊肿共48个,其中多发性囊肿共4例,单发性囊肿共32例;囊肿直径约5.0cm～11.8cm。所有病灶均在CT引导下进行肝囊肿穿刺抽液,然后注入适量无水乙醇硬化治疗;术后随访6～18个月行CT检查观察治疗效果。结果 36例患者全部顺利完成治疗,肝囊肿穿刺成功率100%,本组无水乙醇硬化治疗肝囊肿有效率约为94.4%。结论对于体积较大或有临床症状的单纯性囊肿,CT引导下经皮穿刺注射无水乙醇硬化治疗具有较好的治疗效果,是值得临床广泛推广的。     

对超声引导下硬化治疗肾囊肿的疗效评价

目的 探索一种安全、有效、副作用小的治疗肾囊肿的新方法。方法 对50例肾囊肿患者，在超声引导和监视下囊内注射四环素溶液进行硬化治疗。结果 囊肿治愈率为93～％(54／58)，一次性治愈率为79．3％(46／58)．总有效率几乎为100％。结论 超声引导下囊内注射四环素硬化治疗肾囊肿是一种更为安全、有效的新方法。     

Smac和XIAP基因在肾细胞癌中的表达及意义

目的 探讨Smac和XIAP基因在肾细胞癌组织中的表达及其临床意义.方法 采用免疫组织化学法检测95例肾癌标本不同分型、分级、分期及10例正常肾组织中Smac和XIAP的表达,分析其表达与肾癌分级、分期的关系及二者表达相关性.结果 Smac在各型肾细胞癌中随分期、分级的增加表达减低,XIAP在各型肾细胞癌中随分期、分级的增加表达增高,二者的表达呈负相关.结论 Smac和XIAP表达与肾细胞癌分期、分级关系密切,共同参与了肾癌的发生发展. Abstract： Objective To study the expression and significance of Smac and XIAP in renal cell carcinoma(RCC). Methods The expressions of Smac and XIAP were detected using SP immunohistochemical technique in 95 cases of RCC and 10 cases of normal renal tissue. Results The postitive expressions of Smac were statistically significant differences in different clinical statges. The postitive expressions of XIAP were higher in RCC related to the lower histological grade. Smac protein and XIAP protein expression had negative correlation. Conclusions It indicate that Smac and XIAP may play an important role in RCC. The expression of Smac and XIAP are statistically significant associated with tumor grade and clinical stage.     

超声引导下无水乙醇硬化治疗甲状舌骨囊肿临床应用研究

目的 探讨超声引导下无水乙醇硬化治疗甲状舌骨囊肿的临床应用价值。 方法 115例甲状舌骨囊肿随机分配入单纯抽液组、硬化治疗组及传统手术组,单纯抽液组超声引导下直接将囊液抽净,硬化治疗组则超声引导下将囊液抽净后注入无水乙醇行硬化治疗,术后1个月、3个月、6个月、12个月比较残存囊腔体积变化,12个月比较三组各自总体有效率及不良反应情况。 结果 单纯抽液组与硬化治疗组术后残存囊腔体积变化差异明显,差异有统计学意义（P<0.05）,单纯抽液组有效13例,有效率65.0%,硬化治疗组有效53例,有效率94.6%,传统手术组有效35例,有效率89.7%,三组疗效差异明显,差异有统计学意义（P=0.03）。 结论 超声引导下无水乙醇硬化治疗甲状舌骨囊肿经济便捷、疗效确切,值得临床推广。     

不典型肾血管平滑肌脂肪瘤诊断与治疗

目的 探讨不典型肾血管平滑肌脂肪瘤的误诊原因,提高其诊治水平.方法 回顾性分析20例不典型肾血管平滑肌脂肪瘤患者的临床资料.20例均行B超检查,17例行CT扫描,10例行MRI扫描,8例行IVU检查.5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超诊断肾血管平滑肌脂肪瘤12例(12/20),CT诊断肾血管平滑肌脂肪瘤9例(9/17).5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血管平滑肌脂肪瘤,随访未见肿瘤转移或复发.结论 大部分肾血管平滑肌脂肪瘤可通过B超、CT等影像学检查明确诊断;对于不典型肾血管平滑肌脂肪瘤,术前应仔细分析影像学检查,必要时应根据术中冰冻切片决定手术方案,减少不必要的肾切除. Abstract： Objective To investigate the misdiagnosis causes of atypical renal argiomyolipoma(RAML), and to improve its diagnosis and treatment. Methods We retrospectively analyzed the clinical datas of 20 patients with atypical RAML.Twenty cases made B-ultrasonography,17 cases made CT scan,10 cases made MRI scan,8 cases made IVU examination. of all patients, 5 cases were treated conservatively,15 cases underwent operations, 3 cases underwent tumor enucleation, 5 cases underwent partial nephrectomy, and 7 cases underwent radical nephrectomy. Results The positive diagnosis rate of ultrasonography and CT scan was 60%(12/20) and 53%(9/17). The 5 cases treated conservatively had no change by follow-up, no significant change in tumor size, without metastasis.Fifteen cases underwent operations were confirmed RAML after postoperative pathological examination, no tumor metastasis or recurrence in follow-up. Conclusions The majority of RAML can be diagnosed definitely by ultrasonography and CT scan. As to atypical RAML, we should carefully analyze image information before operation. Necessarily, we can decide operational plan according to frozen section, so as to avoid unnecessary nephrectomy.     

后腹腔镜下肾切除术

目的 探讨后腹腔镜下肾切除术的临床应用价值.方法 回顾性分析我院自2008年5月至2009年9月68例后腹腔镜下肾切除术患者的临床资料.首先清除腹膜外脂肪,打开肾周筋膜,沿腰大肌方向分离至肾蒂,游离肾动脉、肾静脉及输尿管,并用Hem-o-lok夹闭后离断之,继续游离肾脏.延长腰部切口,将患肾取出.结果 所有患者除1例因肾蒂周围粘连较严重,无法分离中转开放外,均获成功,未发生周围脏器及大血管损伤等严重并发症.手术时间60～120 min,平均90 min,失血量50～150 ml,平均100 ml.术后2～3 d拔除创腔引流管.术后平均住院时间8～10 d,平均9 d.平均随访5个月,对侧肾功能正常.结论 后腹腔镜肾切除术损伤小,住院时间短,患者恢复快. Abstract： Objective To investigate the clinical efficacy of retroperitoneal laparoscopic surgery in nephrectomy. Methods The way was retrospective analysis of 68 patients who were our in-patients and took the operation of retroperitoneal laparoscopic nephrectomy from May 2008 to September 2009. First of all, cleaning the extraperitoneal fat and then open the perirenal fascia,freeing the tissue along with psoas to renal pedicle and next freeing renal artery,renal vein and ureter,occlusing them with Hem-o-lock and then disconnected them,continuing freeing the kidney. Elongating the incision in the waist,taking out the kidney with tuberculosis. Results Only one case in all patients changed the operation type into opening since the adhesion around the renal pedicle was so serious that the target couldn't be freed clearly. All operations turned out to be successful and had no serious complications like the injury of large vessels and important organs around. Operation times are among 60 mins to 120 mins, 90 mins on average and blood losses are between 50 ml and 150 ml, 100 ml on average. Taking off the drainage tube 2 to 3 days after operations. The hospital stays after operations were 8-10 days, 9 days on average. The average follow-up period was 5 months and the function of the kidney in the other side was normal in this period. Conclusions Retroperitoneal laparoscopic nephrectomy has advantages of minimal invasion,short hospital stay and rapid recovery.     

超声引导下分步法硬化治疗高龄巨大肝、卵巢囊肿的临床价值

目的:分析超声引导下分步法硬化治疗高龄巨大肝囊肿和卵巢囊肿的临床价值。方法:对海南省文昌市人民医院与沧州市中心医院收治的28例高龄单纯巨大肝囊肿和15例高龄巨大卵巢单纯性囊肿行超声引导下穿刺置管并用50%葡萄糖及无水乙醇进行分步硬化治疗,随访12个月观察其疗效。结果:43例高龄巨大肝囊肿和卵巢囊肿中,最大囊肿容积约14 000mL,最小囊肿容积约2 300mL。随访12个月发现囊肿完全消失或容积缩小80%以上的有31例(72.1%),囊腔容积缩小50%以上的9例(20.9%),囊腔容积缩小50%以下的2例(5%),囊肿增大的1例(2%)。总的治疗有效率为93%,无效率为7%。术中或术后副反应:酒精样反应27例(63%),发热9例(21%),囊腔内出血2例(5%),疼痛11例(26%)。结论:对高龄巨大肝囊肿和卵巢囊肿进行穿刺置管分步硬化治疗的方法创伤小、疗效确切、并发症少,可作为首选的治疗手段。     

CT引导下穿刺硬化治疗肾盂旁囊肿

目的 探讨CT引导下经皮穿刺抽吸硬化治疗肾盂旁囊肿的临床应用价值.方法 回顾分析在CT 引导下经皮穿刺抽吸硬化治疗肾盂旁囊肿患者7例.治疗要点包括选择最佳层面、穿刺点、进针角度及深度;抽净囊液,注入无水乙醇并保留.结果 7例均穿刺成功,治愈率100％,无严重并发症发生.结论 CT引导下经皮穿刺抽吸注硬化剂治疗肾盂旁囊肿,穿刺成功率高,并发症少,疗效显著,是治疗肾盂旁囊肿的首选方法,值得临床推广应用.     

B超引导下经皮穿刺注射消痔灵与无水乙醇治疗肾囊肿疗效比较

目的 观察比较B超引导下经皮穿刺注射消痔灵液或无水乙醇治疗肾囊肿的疗效。方法 86例单纯性肾囊肿随机分成2组，在B超引导下经皮穿刺抽液后，注入硬化剂，1个月和3个月复查B超。结果 消痔灵液与无水乙醇在治疗肾囊肿疗效方面无明显差异，而在副反应与并发症方面，消痔灵液发生率明显低于无水乙醇组。结论 B超引导下经皮穿刺注射硬化剂治疗肾囊肿方法简便，疗效确切，消痔灵液治疗肾囊肿具有和无水乙醇相似的疗效。且更为安全。     

CT引导肝、肾囊肿介入治疗的体会

目的总结CT引导下肝、肾囊肿穿刺硬化治疗的方法和治疗效果。方法 67例91个囊肿,其中肝囊肿19例,肾囊肿48例,在CT定位下经皮穿刺抽吸,行无水酒精反复冲洗并硬化治疗,并随访全部病例。结果所有病例成功完成了囊内液体的抽吸,治疗过程中无严重并发症发生。治疗后随访3～12个月,囊肿较治疗前缩小1/3者10例,缩小1/3～2/3者21例,囊肿消失者58例,有效率100%。结论 CT引导下肝、肾囊肿穿刺硬化治疗是一种安全有效的治疗方法。