肾血管平滑肌脂肪瘤自发性破裂(附23例报告)

目的 探讨肾血管平滑肌脂肪瘤(RAML)自发性破裂的临床表现、诊断和治疗。方法 肾血管平滑肌脂肪瘤自发破裂23例，临床表现突发腰腹疼痛者21例，腰部酸胀者2例；其中伴血尿3例、恶心呕吐2例、休克3例、发热1例。23例B超检查，确诊13例；CT检查21例，确诊16例。结果 术前确诊RAML者16例，术中冰冻切片确诊2例，误诊为肾癌者4例、肾感染性病变者1例。行肾切除10例，肾部分切除和肿瘤剜除术各6例，数字减影血管造影(DSA)加栓塞术1例。结论 RAML自发性破裂后常改变临床症状和影像学特征，导致误诊和肾切除，综合分析临床表现和影像学资料可以提高术前确诊率，术中冰冻切片可以避免不必要的肾切除。     

肾血管平滑肌脂肪瘤的影像学特征与术式选择

目的：探讨肾血管平滑肌脂肪瘤(RAML)影像学特征及术式选择。方法：对71例肾肿瘤患者．均行B超和CT检查．63例诊为RAML；9例诊断肾癌不排除．其中4例另行MRI联合诊断为RAML。除1例因肿瘤巨大肾实质较少、出血较多或怀疑恶性变而行肾切除，1例行选择性肾动脉栓塞术外．其余均行保留肾单位手术。结果：70例术中及术后病理诊断为RAML；1例术前B超和CT检查诊断为RAML．病程10年．肿瘤未有明显变化，但术中肉眼和术后病理诊断为“肾透明细胞癌”。11例术中阻断肾蒂患者．术后肾功能无明显异常。患者术后B超复查无肿瘤复发和转移。结论：B超和CT是诊断肾血管平滑肌脂肪瘤的重要手段．必要时呵辅助MRI联合诊断。除极少病例需要行肾切除术，RAML患者应尽量行保留肾单位术。     

肾血管平滑肌脂肪瘤36例诊治体会

分析 36例肾血管平滑肌脂肪瘤 (RAML)的临床资料 :行IVP检查 36例 ,B超检查 35例 ,CT扫描 30例 ,MRI检查 11例 ,肾动脉造影 (DSA) 2例。手术治疗 32例 ,其中肾切除 2 0例 ,部分切除或瘤体剜除 6例 ,术前误诊断的 6例中 ,3例行肾根治切除术 ,3例因自发性肾破裂切除患肾。术中全部快速冷冻切片病理检查 ,诊断为RAML ,无一例恶变。术后随访 1～ 5年无复发。非手术治疗 4例随访观察。B超、IVP是RAML常用初步诊断方法 ,CT结合MRI是最好的影像学诊断方法 ,能提高术前诊断率。对肿瘤直径 >3cm且逐渐增大或肿瘤直径 <3cm伴明显症状者 ,应积极行手术治疗 ,尽量保留有功能的肾组织。     

肾血管平滑肌脂肪瘤的诊断与治疗

目的 探讨肾血管平滑肌脂肪瘤（错构瘤）的诊断与治疗方法。方法 回顾分析２２例肾错构瘤的临床资料。结果 诊断符合率Ｂ超为５４．５％,ＣＴ为８１．８％,术前诊断错构瘤１８例,误诊为肾癌４例,其中３例术中冻冻切片示错构瘤。行肿瘤剜除１１例,肾部分切除７例,肾切除３例,肾根治性切除１例。结论 ＣＴ是诊断错构瘤的首选检查手段,肿瘤体积小、脂仿含量少、瘤内出血是影像学改变不典型导致误诊的原因,仔细分析病史、影像学资料及术中冰冻切片可避免误诊,手术治疗应尽量采用保留肾脏的手术。     

肾嗜酸细胞瘤诊治体会（附5例报告并文献复习）

目的：探讨肾嗜酸细胞瘤早期临床诊断及治疗方法。方法：5例肾嗜酸细胞瘤患者中3例术前诊断为肾癌行肾癌根治术;1例术中冰冻切片证实诊断后行肿瘤剜除术;1例巨大肾占位术前影像学诊断为恶性间皮瘤或脂肪肉瘤,行胸腹联合切口肿瘤切除术。结果：术后随访7～34月,平均15.2月,均无瘤生存。结论：超声、CT及MRI在肾嗜酸细胞瘤的诊断中具有重要作用,对于可疑病例,须行术中快速冰冻病理检查,确诊需要免疫组化检查,宜行保留肾单位手术。     

良性占位性病变误诊为肾癌的原因分析

目的　提高肾脏良恶性占位的诊断水平 ,降低误诊率。　方法　肾占位性病变患者 12例 ,年龄 35～ 6 9岁 ,平均 5 2岁。腰部胀痛不适 9例 ,其中 2例伴全程血尿 ;体检超声偶然发现肾脏占位 3例。术前均行超声、CT等影像学检查诊断为肾癌。　结果　 12例患者均手术治疗。术中行冰冻病理检查 7例 ,提示为肾脏良性占位 ,行肿块剜除或单纯肾切除术 ;按肾癌行根治术 5例 ,术后病理均为肾脏良性病变。随访 1～ 3年 ,无复发。　结论　临床医师不应过高评价CT及超声等影像检查的诊断学意义 ,对无法确诊病例可行手术探查 ,术中行冰冻病理检查提高确诊率。多数误诊的良性肾占位与肾癌的影像学表现不同。     

左侧多发性肾上腺囊肿并左侧重复肾双输尿管畸形1例

目的探讨多发性肾上腺囊肿合并重复肾双输尿管畸形的诊断、鉴别诊断和治疗。方藩回顾分析1例左侧多发性肾上腺囊肿并左侧重复肾双输尿管畸形的临床资料。并结合文献进行讨论。结果术前联合应用B超、CT检查，诊断为左肾上腺多发囊肿；行IVU检查。进一步发现了重复肾双输尿管畸形，避免了漏诊和误诊。行后腹腔镜肾上腺囊肿探查术。术中见左肾上腺有2个囊肿。因术前CT及术中均可见囊壁钙化，术中行冰冻病理检查诊断为假性囊肿，行囊肿切除术。随访18个月未见复发，结论治疗方法取决于囊肿大小、重复肾的功能、是否有并发症等。对囊壁有钙化者，术中应行冰冻病理检查以确定有无恶性病变。后腹腔镜肾上腺囊肿切除术是外科首选的治疗方法。     

不易确诊的肾错构瘤的诊断和治疗

目的探讨肾错构瘤的诊断和治疗方法。方法回顾性分析17例不典型肾错构瘤的临床和影像学资料,并与病理结果对照。结果术前诊断正确率B超为82.4%(14/17),CT为88.2%,结合MRI和肾动脉造影检查误诊者仅1例。17例行手术治疗,其中5例作肾切除术,16例现仍生存。结论综合分析临床、影像学资料和术后HMB-45检查以明确诊断,仔细分析术中冰冻切片结果,治疗以保留肾单位的手术为主。     

肾血管平滑肌脂肪瘤的诊断与治疗(附15例报告)

目的探讨肾血管平滑肌脂肪瘤的诊断与治疗方法。方法总结分析15例肾血管平滑肌脂肪瘤的临床资料。结果诊断符合率B超为66.7%,CT为86.7%。诊断为肾血管平滑肌脂肪瘤14例,误诊为肾细胞癌1例。行肿瘤剜除肾部分切除8例,肾切除4例,根治性肾切除1例。结论B超和CT是诊断肾血管平滑肌脂肪瘤的重要手段,脂肪含量少,瘤体出血是影像学不典型导致误诊的原因,术中快速冰冻切片可避免误诊。手术治疗应尽量采用保留肾脏手术。     

B超及CT诊断肾脏小肿瘤的临床价值(附48例报告)

目的　探讨B超、CT诊断肾脏小肿瘤 (直径≤ 3cm)的临床价值。　方法　回顾性总结4 8例肾脏小肿瘤患者的临床表现与B超、常规CT、螺旋CT薄层扫描和冰冻切片的诊断结果。男 2 9例 ,女 19例 ,平均年龄 4 9岁。其中无临床症状者 4 3例 ,血尿 2例 ,腰痛 2例 ,血尿伴腰痛 1例。　结果　 4 8例患者术后病理诊断肾细胞癌 (RCC) 36例 ,肾血管平滑肌脂肪瘤 (RAML) 7例 ,嗜酸细胞腺瘤 4例 ,后肾腺瘤 1例。B超诊断正确率为 75 % (36 / 4 8) ,常规CT为 81% (39/ 4 8) ,螺旋CT薄层扫描为91% (2 0 / 2 2 ) ,术中冰冻病理为 95 % (19/ 2 0 )。　结论　肾脏小肿瘤的偶发率和良性率较高 ,B超和常规CT鉴别其良恶性有一定难度 ,螺旋CT薄层扫描和冰冻切片检查有助于正确诊断。     

Influences of renal stone surgeries on renal function--evaluation of renal function with 99mTc-DMSA renal scintigraphy]

From 1984 to 1990, 99mTc-DMSA renal scintigraphy was performed before and after nephrolithotomy (15 cases), pyelolithotomy (15 cases), percutaneous nephrolithotripsy (PNL: 15 cases) and extracorporeal shock wave lithotripsy (ESWL: 16 cases, 17 kidneys) in order to evaluate of influences of renal stone surgeries on split renal function. DMSA renal uptake change ratio of treated kidneys of nephrolithotomy (-24.94 +/- 5.60%) was significantly lower than that of PNL (-0.06 +/- 3.92%), pyelolithotomy (-4.08 +/- 4.79%) (p less than 0.01) and ESWL (-7.72 +/- 3.87%) (p less than 0.05). The average change ratios of contralateral kidneys were as follows: PNL 4.80 +/- 4.21% nephrolithotomy 4.67 +/- 4.73%, pyelolithotomy -1.46 +/- 5.39% and ESWL -2.02 +/- 4.44%. One to 3 weeks after PNL, the cold area on the renal image was found in 10 (66.7%) of 15 cases. In cases of ESWL, DMSA renal uptake decreased even 4-10 weeks (mean 7 weeks) after treatment. In conclusion, possivility of deterioration of renal function after ESWL was suggested.     

Transplantation of renal primordia: renal organogenesis

Dialysis and allotransplantation of human kidneys represent effective therapies to replace kidney function, but the former replaces only a small component of renal function, and the latter is limited by lack of organ availability. Xenotransplantation of whole kidneys from nonprimate donors is complicated by humoral and severe cellular rejection. The use of individual cells or groups of cells to repair damaged tissue (cellular therapies) offers an alternative for renal tissue replacement. However, recapitulation of complex functions such glomerular filtration and reabsorption and secretion of solutes that are dependent on a three-dimensionally integrated kidney structure are beyond the scope of most cellular replacement therapies. The use of nonvascularized embryonic renal primordia for transplantation circumvents humoral rejection of xenogeneic tissue and ameliorates cellular rejection. Renal primordia are preprogrammed to attract a vasculature and differentiate into a kidney and in this manner undergo organogenesis after transplantation into the mesentery of hosts. Here we review a decade’s progress in renal organogenesis.     

AusDiab renal study: indicators of renal disease

SUMMARY: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) was designed to determine the prevalence of diabetes and abnormal glucose metabolism, lifestyle and health behaviours and early indicators of renal disease in Australian adults. the study screened 11247 adults aged ≥ 25 years residing in randomly selected districts in all States and Territories of Australia between April 1999 and December 2000. Diabetes and hypertension were detected in 7.5% and 28.8%, respectively. Proteinuria was detected in 2.5% of subjects tested and serum creatinine was elevated in 1.06%. Dipstick screening followed by analysis of a mid-stream urine sample revealed haematuria in 6.8% of subjects tested. Body mass index scores indicated that 48.2% of all men screened were overweight, and a further 19.1% were obese. of the women, 30.2% were overweight and 21.8% obese. the results of the AusDiab study suggests one-third of the Australian adult population have at least one indicator of renal disease.