经腹膜后腹腔镜技术结合工作台手术和自体肾移植术治疗双肾癌2例并文献复习

目的:探讨双侧肾癌的手术治疗方法。方法:采用同期经腹膜后腹腔镜技术结合工作台手术和自体肾移植术治疗双侧肾癌2例。结果:术后2例患者均恢复良好,无需血液透析。其中1例患者术后8个月死于肿瘤广泛转移。结论:对某些双侧肾癌患者采用腹腔镜、工作台手术和自体肾移植的组合手术方式是可行的。     

MR-DWI评价兔VX2肾移植瘤TACE疗效的实验研究

目的 探讨MR-DWI评价兔VX2肾移植瘤TACE疗效的应用价值.方法 新西兰大白兔22只,采用瘤块埋植法建立兔VX2肾移植瘤模型,经导管动脉化疗栓塞术治疗兔VX2肾移植瘤,MR检查评价兔VX2肾移植瘤TACE术疗效.结果 经导管动脉化疗栓塞术治疗后实验组肿瘤坏死明显,术后第3天瘤区ADC值（1.321±0.125）×10^-3mm^2/s明显增高于术前ADC值（1.139±0.072）×10^-3 mm^2/s（P＜0.05）;对照组术前术后ADC值差别无统计学意义（P＞0.05）.结论 经导管动脉化疗栓塞术是一种创伤小、疗效确切的兔VX2肾移植瘤治疗方法,MR-DWI是一种评价TACE术疗效的有效影像学方法.     

肾移植术后重症肺炎的临床护理

肾移植术是治疗慢性肾功能衰竭尿毒症最有效的方法之一.由于新型免疫抑制剂的应用或免疫抑制剂使用过度,导致机体免疫功能低下,使肾移植术后患者极易发生各种感染.重症肺炎是肾移植术后最常见的感染并发症,也是患者死亡的主要原因[1].本院2004年1月至2006年3月共收治10例肾移植术后重症肺炎患者,效果满意,现将临床观察和护理报道如下.     

肾移植术后发生原肾肾癌

1临床资料 患者男性,45岁,因慢性肾小球肾炎,尿毒症终末期而于1987年行同种异体肾移植手术,术后服用环孢素A、强的松等免疫抑制药物治疗。99年开始出现左肾区疼痛、血尿。B超检查示：双肾萎缩、左肾下极包块。CT检查示：左肾下极占位病变,大小约6．0cm×4．0cm。经术前准备,在气管插管全麻醉下行左肾癌根治性切除术。     

预防肾移植术后感染的中西医结合护理木

目的 探讨中西医结合护理方法在预防肾移植术后感染的作用,进一步完善肾移植术后预防感染的中西医结合护理方法.方法 对40例肾移植术后患者采用消毒隔离、预防呼吸系统感染及泌尿系统感染的中西医结合护理.结果 40例患者在住院期间无感染发生;术后追踪2个月,肺部感染l例,无尿路感染,口腔感染2例,经治疗后,感染得到控制,肾移植术后感染发生率为7.5%,40例肾移植患者均获得移植成功.结论 加强对肾移植患者术后中西医结合护理,是预防肾移植术后感染,获得移植成功的重要保证.     

铁对肾移植术后贫血改善的影响

肾移植患者在肾功能恢复后 ,随着体内抑制骨髓的毒素被清除 ,移植肾分泌促红细胞生长素 (erythropoietin,EPO) ,其贫血往往能迅速得以纠正 [1 ]。但并非所有成功肾移植患者的贫血均能得到纠正 ,且贫血纠正的时间也不完全相同。国外有研究认为 ,微量元素铁是影响肾移植后贫血纠正的一个重要因素。本文通过对长征医院全军肾移植中心 (本中心 )肾移植患者术后血红蛋白和铁含量的变化作前瞻性研究 ,以探讨铁对肾移植术后贫血纠正的影响。1　资料和方法1.1　病例选择　从本中心 1999年 1月至 10月间所进行的成功肾移植患者中 ,根据术后第 3天所…     

同种异体肾移植术后肺部感染的护理体会

肾移植患者因术后免疫抑制剂的应用,机体免疫力下降,易并发感染,尤其是肺部感染。因此,如何有效预防肾移植术后肺部感染已成为肾移植术后患者的护理重点,本文就同种异体肾移植术后肺内感染的护理体会报告如下。     

预防肾移植术后感染的中西医结合护理

目的探讨中西医结合护理方法在预防肾移植术后感染的作用,进一步完善肾移植术后预防感染的中西医结合护理方法。方法对40例肾移植术后患者采用消毒隔离、预防呼吸系统感染及泌尿系统感染的中西医结合护理。结果40例患者在住院期间无感染发生;术后追踪2个月,肺部感染1例,无尿路感染,口腔感染2例,经治疗后,感染得到控制,肾移植术后感染发生率为7.5%,40例肾移植患者均获得移植成功。结论加强对肾移植患者术后中西医结合护理,是预防肾移植术后感染,获得移植成功的重要保证。     

肾移植术后患者并发糖尿病的危险因素分析

目的 探讨肾移植术后患者并发糖尿病的危险因素.方法 回顾性选取2018年1月-2019年12月于我院接受肾移植手术治疗的100例患者作为研究对象,根据患者术后是否并发糖尿病将其分为肾移植术后并发糖尿病组(n=38)和肾移植术后未并发糖尿病组(n=62).收集2组基本资料,并采用多因素Logistic回归分析法分析肾移植术后患者并发糖尿病的危险因素.结果 100例肾移植手术患者并发糖尿病38例,并发率为38.00％(38/100).多因素Logistic回归分析结果显示,年龄≥45岁、体质量指数(BMI)≥25 kg/m2、伴有糖尿病家族史、应用他克莫司方案、术后发生急性排斥反应是肾移植术后患者并发糖尿病的危险因素(OR=2.710;2.809;8.534;2.184;3.190,P<0.05).结论 肾移植术后并发糖尿病与患者年龄、BMI、糖尿病家族史、免疫抑制剂方案及急性排斥反应等密切相关,临床应当重视并予以相关预防控制措施以防止肾移植术后患者并发糖尿病.     

根治性肾癌切除术的护理研究

目的 探讨根治性肾癌切除术的术后护理方法.方法 回顾分析我科对12例患者术前,术后采取一系列有效的护理措施进行总结,加强巡视和观察.结果 患者经过有计划护理,有效预防并发症的发生,使患者早日康复,延长了患者生存时限.结论 根治性肾癌术后采取及时、合理、有效的护理措施,能促进患者早日康复,也是取得手术成功的重要保证.     

肾移植术后双侧乳头状肾癌1例

With the continuous development of kidney transplantation technique, the survival time after kidney transplantation is gradually prolonged. Thus, the malignant tumor has been the important influencing factor on the long-term survival for kidney transplantation patients. Renal cell carcinoma is a relatively common tumor after kidney transplantation. Besides, clear cell renal cell carcinoma and papillary renal cell carcinoma are the relatively common pathological types for renal cell carcinoma following kidney transplantation. However, bilateral renal cell carcinoma following kidney transplantation is comparatively rare. In this article, we presented a case of bilateral papillary renal cell carcinoma, which occurred after kidney transplantation. And the diagnosis and treatment were introduced in detail. The patient was 37 years old, and he underwent kidney transplantation 13 years ago in our hospital, because of kidney failure. After kidney transplantation, he had regular medical check-up every year. In this year, his urological ultrasound results indicated bilateral renal tumors. And then, he received abdominal and pelvic computed tomography, and the result also showed bilateral renal tumors, which were likely to be malignant tumors. After adequate consultation, the patient chose surgical treatment. The patient received long-term immunosuppressive therapy, because of kidney transplantation. Considering this, the surgeon decided to choose a staging surgical treatment, in order to reduce the bad influence of one-stage surgery. Then, the patient first underwent retroperitoneal laparoscopic radical nephrectomy for right renal tumor in our hospital, and he had no complications after operation. The pathological results showed papillary renal cell carcinoma. He was discharged successfully. He underwent retroperitoneal laparoscopic radical nephrectomy for left renal tumor in our hospital one month later, and he had no complications after operation. The pathological results also showed papillary renal cell carcinoma. He was discharged successfully two days after surgery. In the 3-month follow-up, the patient was recovering well. To sum up, the incidence of bilateral renal cell carcinoma following kidney transplantation is relatively rare, and bilateral radical nephrectomy is effective and safe treatment. Above all, it is the patient''s condition that determines the choice of staging surgery or simultaneous surgery.     

不同亚型的囊性肾癌诊疗与预后分析

?目的:探讨不同亚型的囊性肾癌的诊疗及预后情况。方法:回顾性分析75例囊性肾癌患者的临床资料。患者术前影像学检查:56例考虑恶性病变,13例考虑单纯性肾囊肿,6例考虑为多房性肾囊肿。47例行根治性肾切除术,其中开放手术20例,腹腔镜手术27例;保留肾单位手术14例,其中开放手术9例,腹腔镜手术5例;后腹腔镜下肾囊肿去顶减压术13例 ,其中2例术中冰冻病理检查提示恶性,同期行根治性肾切除术,9例术后2～3周二期行根治性肾切除术,2例密切随访;1例行保留肾单位手术,术中冰冻病理检查提示恶性病变,同期行根治性肾切除术。结果:75例术后病理报告均为囊性肾癌,其中肾细胞癌囊性变38例,多房囊性肾癌16例,单房囊性肾癌（囊腺癌）8例,肾囊肿恶变13例。随访25～147个月,平均63个月,未见肿瘤复发和转移。结论:囊性肾癌的诊疗及预后需根据不同的亚型分析,保留肾单位手术可作为囊性肾癌的一种可选择的治疗方式。     

后腹腔镜手术Ⅰ期治疗双侧肾癌2例并文献复习

目的 探讨后腹腔镜手术Ⅰ期治疗双侧肾癌的可行性。方法 对2例双侧肾癌患者Ⅰ期施行后腹腔镜手术,一侧为后腹腔镜肾癌根治术,另一侧为后腹腔镜肾部分切除术。结果 2例手术均顺利完成,手术时间分别为6 h和4.5 h,术中肾段动脉阻断时间分别为25 min和18 min,术中失血量分别为600 mL和100 mL,术后住院时间分别为33 d和9 d。2例患者术后均出现血肌酐和尿素氮升高。其中1例患者术前即并发轻度肾功能不全,术后需要每周1~2次血液透析治疗。术后随访4~15个月,无肿瘤复发和转移。结论 针对合适的病例,后腹腔镜手术Ⅰ期可能治疗双侧肾癌是安全、有效、可行的。     

Nephron-sparing surgery for small renal cell carcinoma

Objective:To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods: From August 1997 to October 2008, 48 cases of small renal cell carcinomas were confirmed by surgery and pathology, and reviewed retrospectively. Of the 48 cases, there was 1 patient with bilateral tumors, 8 with solitary kidney tumors, 1 with unilateral tumor and a damaged contralateral kidney, and 38 with unilateral tumors and a normal contralateral kidney; 9 underwent tumor enucleation and the remaining patients received partial nephrectomy. Results:There were no local tumor recurrences and/or tumor metastasis at a mean follow--up of 60 months. Conclusion: Confirming conclusions from other centers, we have found that nephron-sparing surgery is an effective treatment for small renal cell carcinomas.     

保留肾单位的肾癌手术(附11例报告)

目的：探讨保留肾单位的肾癌手术治疗方法和疗效。方法：对1993年2月-2003年2月共11例经手术和病理证实为肾细胞癌的临床资料进行回顾性分析，其中双侧肾癌3例，孤立肾癌5例，对侧肾有病变或潜在功能受损的肾癌2例，对侧肾正常肾癌1例；11例中6例行肿瘤剜除术，5例行肾部分切除术。结果：本组术后无外科并发症，平均随访40个月，无局部复发和肿瘤转移。结论：对经选择的患者保留肾单位的肾癌手术安全可靠，疗效满意。     

肾嫌色细胞癌23例临床分析

目的 提高肾嫌色细胞癌的诊治水平.方法 回顾性分析23例肾嫌色细胞癌临床及病理资料,结合文献复习进行讨论.结果 21例行根治性肾切除术,2例行肾部分切除术.17例获得随访,随访9～74个月,所有患者均健康存活.结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌,B超、CT检查缺乏特异性,确诊有赖于典型的病理表现.其TNM分期均为早期,治疗以手术为主,预后良好.     

保留肾单位手术治疗肾肿瘤的研究现状

近20年,随着影像学技术的发展和健康查体的普及,小肾癌检出率的提高非常明显。外科手术是治疗肾癌的主要手段。最初保留肾单位手术(NSS)仅用于行根治性肾切除术(RN)将导致功能性无肾、必须透析的患者(包括孤立肾、对侧肾功能不全、双侧多原发肾细胞癌)。现在NSS对于T1a、T1b和对侧肾脏功能正常患者的应用日益增多,且治疗效果与RN相似。NSS相比肾癌根治术延长了长期生存时间,降低了心血管疾病发生率。     

肾癌根治术(附61例报告)

目的探讨肾癌手术治疗的方法与效果。方法总结61例肾癌根治性切除术治疗经验。结果61例术后病理诊断,透明细胞癌50例,颗粒细胞癌9例,混合细胞癌2例。所有病例术前检查均未发现淋巴结转移及静脉癌栓形成。结论在肾癌根治术中首先分别结扎肾脏动静脉是保证手术成功和良好预后的较好方法。     

Laparoscopic partial nephrectomy for T1a renal tumors is safe and feasible

Background  Some patients with exophytic renal masses less than 4 cm and suboptimal renal function, or a solitary kidney and bilateral renal tumors are considered for laparoscopic partial nephrectomy (LPN), which is feasible for early-stage renal tumors, although it is still considered technically difficult and time consuming. Shortening the time of the operation and renal warm ischemia are required urgently. In this study, we report our initial experiences of LPN, especially with some improved surgical techniques.

Methods  Between July 2005 and October 2009, 74 patients with T_1a renal tumor were treated by LPN, 39 using transperitoneal approach and 35 using retroperitoneal approach. In all cases, the tumor was removed with a margin of 0.5 cm. We compared glomerular filtration rate (GFR) preoperatively and postoperatively, and renal warm ischemia time between traditional ligature and Hem-o-lok methods.

Results  All operations were completed successfully, and there was no conversion to open surgery. Mean operation time was 76 minutes (range, 68–120), mean time of renal warm ischemia was 23 minutes (range, 15–32), and mean blood loss was 65 ml (range, 40–300). No hemorrhage or urine leak was observed in two cases with the collecting system sewn. Thirteen cases used Hem-o-lok to clamp the suture instead of traditional ligature, and mean time of renal warm ischemia was (16.5±2.3) minutes (range, 12–18). Mean postoperative hospital stay was 6.3 days (range, 5–12). Sixty-seven cases had renal clear cell carcinoma, six papillary renal cell carcinoma, and one renal collecting duct carcinoma. All the tumor margin specimens were negative. The mean follow-up was 30.6 months (range, 3–51), and no recurrence or metastasis was observed.

Conclusions  LPN for pT₁ stage renal tumor was safe and feasible. Hem-o-lok instead of traditional ligature to clamp the suture when sewing the renal wound could shorten the warm ischemia time.

     

系统性淋巴清扫肾癌根治术的临床应用(附27例报告)

目的 探讨应用系统性淋巴清扫肾癌根治术在肾癌治疗中的疗效.方法 对27倒肾癌的患者采用系统性淋巴清扫肾癌根治术治疗,在行根治性肾切除的同时行系统性淋巴清扫.术后获得随访22例.结果 行系统性淋巴清扫肾癌根治术治疗肾癌27例均顺利完成手术,未发现严重并发症.手术时间110～190分钟,平均155分钟,平均出血量220ml,术后病理透明细胞癌25例,混合性细胞癌2例.术中发现2例浸润到肾周围脂肪,5例见局部淋巴节转移.术后获得随访22例,占81.5%,随访时间10～33个月,平均25个月,随访者中生存率76.2%.结论 系统性淋巴清扫肾癌根治术治疗肾癌,具有达到准确分期,有效切除肿瘤,防止局部复发,改善预后,更好地提高患者生存率等优点,是治疗肾癌的一种好方法.