肾癌根治术前肾动脉化疗栓塞的疗效观察

目的　评价根治术前化疗栓塞对肾癌预后的影响。方法　对 26例经术后病理证实并获随访的肾癌患者临床资料进行回顾性分析,分A、B两组,肾癌根治术前化疗栓塞组 16例(A组),单纯根治术组 10例(B)组。A组经肾动脉灌注化疗药物后,用碘油和化疗药物混合剂行末梢血管栓塞,用明胶海绵进行中心性栓塞,化疗栓塞后 2~5d行患肾根治术性切除。结果　A组术中出血量 150 ~500ml,平均 220ml;少于B组。A组 1、3、5年生存率分别为 86 .6%、72 .7%、58. 1%,两组比较,差别均有显著性意义 (P<0 .05 )。Cox模型分析表明,根治术前化疗栓塞是影响肾癌预后的独立因素。结论　肾癌根治术前化疗栓塞安全有效,对肾癌的治疗有积极意义。     

无水酒精肾动脉栓塞治疗肾癌

[目的]探讨无水酒精在肾动脉栓塞治疗肾癌中的价值。[方法]对18例肾癌病人用无水酒精经肾动脉栓塞,观察其血管造影表现及随访结果。[结果]肾动脉完全栓塞(100%)12例,栓塞后肾血管减少80%~95%4例,<80%2例。1~3个月内B超或CT复查肿瘤有不同程度的缩小和坏死。[结论]无水酒精肾动脉栓塞治疗肾癌,能使肿瘤缩小和坏死,可作为肾癌病人的术前栓塞和不能手术者的姑息性治疗。     

肾动脉灌注化疗加栓塞术在治疗巨大肾肿瘤中的临床应用

目的　研究肾动脉灌注化疗加栓塞术在治疗巨大肾肿瘤中的临床作用。方法　对 15例肾恶性肿瘤行肾动脉灌注化疗加栓塞术 ,肿瘤直径 10～ 2 2 .5cm ,化疗使用药物为丝裂霉素 2 0mg ,长春新碱 0 0 2mg/kg。应用明胶海绵加碘油施行肾动脉栓塞。结果　治疗后行根治性切除 12例 (80 % ) ,3例症状缓解。术中出血少 ,易剥离。手术时间缩短。结论　该法安全、有效 ,适用于巨大肾肿瘤治疗的辅助治疗。     

肾动脉栓塞在肾肿瘤治疗中的临床应用

目的:研究肾动脉栓塞对肾肿瘤的治疗方法和效果.方法:采用Seldinger法经皮穿刺行股动脉插管,以明胶海绵为主要栓塞材料,选择性肾动脉栓塞治疗肾肿瘤28例,其中18例栓塞后24～72小时内行根治性肾切除,8例晚期肾癌行单纯栓塞治疗.结果:28例肾肿瘤栓塞后体积缩小、肾周围见水肿、出血少.结论:肾动脉栓塞是治疗肾肿瘤的一种安全、有效的办法,并发症少,值得临床推广.     

经肾动脉用TNF和IL-2化疗栓塞治疗肾恶性肿瘤的临床研究

对9例肾癌患者在行肾动脉造影的同行，经肾动脉注入TNF和IL－2的混合液之后用明胶海绵碎块栓塞。栓塞后4天行二期患肾切除术，切除的肾癌标本多处切片做病理检查，并与单纯的肾动脉栓塞术的肾癌切片标本对照观察，发现用药组肿瘤细胞坏死范围、程度较对照组广，肿瘤组织中有较多的淋巴细胞和巨噬细胞浸润，而且肾静脉残端均为坏死的肿瘤细胞，从而为经肾动脉化疗治疗肾恶性肿瘤提供了一种新的治疗方法。     

术前超选择性肾动脉化疗栓塞对小肾癌保肾手术的价值

目的探讨术前超选择性肾动脉化疗栓塞对小肾癌保肾手术的影响及价值。方法29例小肾癌保肾手术患者中13例行术前超选择性肾动脉化疗栓塞,另16例作为对照组分析效果。结果术前介入治疗组1/3肾脏手术切除率92%,3年复发率0,无术后出血及尿漏发生,对照组分别为37%和18.9%,差异显著,(P<0.05),术后出血和尿漏发生率为25%和31%,两组差异显著,(P<0.05)。结论术前超选择性肾动脉化疗栓塞可以提高小肾癌保肾手术切除率,降低并发症和复发率。     

肾动脉栓塞在肾肿瘤治疗中的临床应用

目的：研究肾动脉栓塞对肾肿瘤的治疗方法和效果。方法：采用Seldinger法经皮穿刺行股动脉插管，以明胶海绵为主要栓塞材料，选择性肾动脉栓塞治疗肾肿瘤28例，其中18例栓塞后24～72小时内行根治性肾切除，8例晚期肾癌行单纯栓塞治疗。结果：28例肾肿瘤栓塞后体积缩小、肾周围见水肿、出血少。结论：肾动脉栓塞是治疗肾肿瘤的一种安全、有效的办法，并发症少，值得临床推广。     

树突状细胞瘤内注射联合放疗对小鼠肾癌组织Bcl-2和Bax表达的影响

目的:研究放疗增强树突状细胞免疫治疗小鼠肾癌的作用与机制。方法:应用Ren-ca肾癌细胞制作BALB/c小鼠皮下移植瘤模型,分为对照组、单纯放疗组、单纯DC组和DC联合放疗组共4组进行治疗。皮下荷瘤的BALB/c小鼠,在接种瘤细胞后第12~16天,连续5d接受肿瘤局部放射治疗,7Gy6MeV/次,并于第11、15、19和22天分别4次在肿瘤部位直接注射未负载肿瘤抗原的DC细胞,1×106/次,第28天处死小鼠。检测各组肿瘤生长速度和质量。利用免疫印迹法(Westernblot法)检测肿瘤组织的相关凋亡蛋白表达。结果:接受不同治疗的小鼠体内肿瘤质量明显不同,未治疗组为(5·3±0·8)g,单纯DC组(4·5±0·7)g,单纯放疗组(2·8±0·3)g,DC联合放疗组(1·1±0·7)g,经Wilcoxon-Mann-Whitney秩和检验,DC联合放疗组与单纯治疗组和对照组之间差异均有统计学意义,P<0·01。DC联合放疗组肿瘤组织中抗凋亡蛋白Bcl-2表达下调,促凋亡蛋白Bax表达上调。结论:瘤内注射DC联合放疗比单一方法明显提高抑制Renca肾癌细胞在BALB/c小鼠的生长,其增效作用涉及肿瘤细胞的凋亡机制。     

三氧化二砷经肝动脉栓塞化疗对兔肝移植瘤的作用

 目的　探讨As2 O3 经肝动脉栓塞化疗对肝移植瘤的作用。方法　采用实验组 1(生理盐水 )、实验组 2 (碘化油 )、实验组 3(As2 O3 +碘化油 )经肝动脉注射治疗肝移植瘤一次 ,实验组 4 (As2 O3 )经肝动脉插管灌注药物 (连续 7天 )。观察肿瘤平均瘤重、平均瘤重抑制率、肿瘤细胞形态学变化 ,检测bcl 2 /bax基因表达和VEGF表达。结果　实验组平均瘤重分别为 16 .0 8± 2 .6 9g、3.4 4± 0 .84 g、1.5 2± 0 .2 6 g和4 .87± 0 .73g ,平均瘤重抑制率分别为 78.6 1%、90 .5 5 %和 6 9.71% ,实验组 3移植瘤瘤重低于其他实验组 (P <0 .0 5 )。实验组 3、4移植瘤组织bax基因表达显著上调、bcl 2基因表达显著下调 (P <0 .0 5 )、VEGF表达下调 (P <0 .0 5 ) ;电镜观察实验组 3、4均有典型的瘤细胞凋亡改变。结论　As2 O3 经肝动脉栓塞化疗对兔Vx 2肝移植瘤有显著抑瘤作用 ,碘化油能增强As2 O3 对肝移植瘤的抑制作用 ,两药具有协同作用。     

术前超选择性肾动脉化疗栓塞对小肾癌保肾手术的价值

背景与目的：肾癌生存期统计结果表明：小肿瘤、周围性、分界明确的肿瘤可行保留肾单位手术，其结果与根治性肾切除术一样有效。到目前为止，保肾手术适应证已扩展到对侧肾脏正常或没有出现肾功能不良的患者。然而，保肾手术比根治性肾切除术有更多的技术挑战，如术后出血、尿漏、急性肾功能衰竭、动静脉血栓等等。在保肾手术前行超选择性肾动脉化疗栓塞是否会降低术后并发症及肿瘤复发率，尚无结论。本研究旨在探讨术前超选择性肾动脉化疗栓塞对小肾癌保肾手术的影响及价值。方法：29例直径小于等于3cm的肾癌患者，按随机原则将其中13例先行超选择性肾动脉化疗栓塞，后行保肾手术；另16例直接行保肾手术作为对照组分析。结果：研究组1／3肾脏手术切除率92％、术中平均出血量110ml、术后出血0、尿漏并发症率8％、3年复发率0和3年生存率100％，对照组分别为37％、235ml、25％、31％、18．9％、93．8％。结论：术前超选择性肾动脉化疗栓塞可以提高小肾癌保肾手术切除率，降低并发症和复发率。     

肾包膜侵犯状况对于肾癌临床症状及分期的意义

背景与目的：肾细胞癌是致死率最高的泌尿系统肿瘤,肾包膜侵犯状况可能与肾癌的临床病理特征及预后相关,但目前在这方面的研究很少。本研究探讨了肾包膜侵犯状况对于。肾癌临床症状及分期的意义。方法：根据肿瘤与。肾包膜之间的关系把肾包膜侵犯状况分为浸润而未穿透包膜和浸润且穿透包膜。回顾分析2006年在我科接受手术治疗的经病理确诊的101例连续肾癌病例的临床症状、术后病理显示的肾包膜侵犯状况以及TNM分期（AJCC 2002年版）,并比较3者之间的联系。结果：55例为体检发现,24例诉腰痛,18例有肉眼或镜下血尿,14例有恶液质等全身症状或者伴有转移症状。大体标本77例肿瘤直径≤7cm,50例44cm。病理T1期68例,T2期9例,〉T2期24例,其中N1-2或M1期的有19例。24例主诉腰痛的病例,肿瘤均未穿透肾包膜;而11例穿透肾包膜的,患者均无腰痛主诉。对于≤4cm的肾癌,腰痛与肾包膜穿透与否无明显相关：当肿瘤〉4cm时,29％（10／35）例无腰痛主诉的病例肿瘤已穿透肾包膜;当肿瘤〉7cm时,53％（8／15）例无腰痛主诉的病例中肿瘤穿透肾包膜;有转移症状或全身症状的病例,43％（6／14）肿瘤穿透肾包膜;无转移症状或全身症状的病例中,6％（5／87）肿瘤穿透肾包膜。40％（40／101）的病例出现肾包膜浸润,其中11例穿透肾包膜：在肿瘤〉7cm的病例中,71％（17／24）出现肾包膜浸润。当肾癌局部未穿透。肾包膜时,是否有包膜浸润对于肿瘤的淋巴结或内脏器官的转移无影响（4／29 vs 9／61,P〉0．05）;当肾癌浸润肾包膜时,如无进一步的肾包膜穿透,则肿瘤转移显著减少（6／11 vs 4／29,P〈0．01）。结论：就诊时腰痛主诉提示肾癌可能尚为局限性病变,对于较大的肾脏占位,如无腰痛主诉,则肿瘤可能已穿透。肾包膜肾包膜侵犯状况与肾癌的临床症状和病理分期有关联。肾包膜浸润在肾癌中比较常见,尤其对于较大的肿瘤,但穿透肾包膜的肿瘤很少。仅仅肾包膜浸润而不穿透不增加肾癌诊断时出现转移的概率,肾包膜的存在一定程度上减少了肿瘤的转移,在限制肿瘤扩散中有一定的保护性作用。     

Comparison of the morphology of renal cysts and cystic renal tumors

Renal tumors appear uncommonly with cystic changes. They may develop due to necrosis though well-formed real cysts are also known. Such lesions may present problems in distinguishing them from benign renal cysts. Conditions leading to cyst formation are not known, however cell proliferation, altered extracellular matrix production and oncoprotein expression have been reported in cystic renal disorders. In the present study, we analysed the morphological features of 23 cystic renal tumors in comparison with 16 benign cysts using immunohistochemical and lectin binding methods. By our knowledge there has not been any piblication on such studies. The cystic renal tumors were represented predominantly in males and the size of the cysts was slightly larger than that of benign cysts. Tumorous cysts shared similar morphological appearance to solitary and multilocular cysts. They all showed strong epithelial membrane antigen reactivity on the luminal surface of the cells indicating distal tubular origin. Cell proliferation and p53 expression proved to be low excluding their role in the formation of the cysts. The amount of extracellular matrix and basement membrane was increased with an elevated type IV collagen and reduced fibronectin content. Polycystic kidney disease is different from tumorous cysts as cell proliferation, p53 oncoprotein expression and the composiition of extracellular matrix proved to be the opposite. As renal cell tumors arise from proximal tubules, neoplastic or metaplastic differentiation toward distal tubular direction seems to be the key even in cyst formation. Altered cell-matrix or cell-cell contact can modulate this transformation providing a basis for further results.     

Surgery of metastatic renal cell carcinoma and use of renal infarction

Surgery can play an important role in selected patients with metastatic renal cell carcinoma although nephrectomy alone neither promotes regression of metastases nor improves survival. However, nephrectomy preceded by renal infarction and followed by medroxyprogesterone acetate produced ten complete responses, nine partial responses, and 22 stabilizations among 145 patients (CR + PR = 13%; overall response rate = 28%). Only patients with parenchymal pulmonary metastases without adenopathy, pleural effusion, or other organ involvement responded consistently (23% objective, 41% overall), and we currently recommend this combination therapy only for this group. However, infarction alone is an easy way to palliate symptoms due to primary or secondary tumors.     

非同步处理肾蒂血管技术在后腹腔镜复杂性肾癌肾盂癌根治术中的应用探讨

目的:探讨经后腹腔入路行腹腔镜复杂性肾癌肾盂癌根治术肾蒂血管非同步处理技巧。方法:2010年1月至2018 年 4月就诊于我科的109例肾癌、肾盂癌患者接受腹膜后入路腹腔镜根治性肾切除术。根据肾蒂血管处理方式的差异分别纳入非同步组和同步组。非同步组患者61例,其中肾癌43例,肾盂癌18例;同步组患者48例,其中肾癌33例,肾盂癌15例;均采用3套管技术,从腹膜后入路,显露肾蒂,非同步组优先处理肾动脉,游离肾脏,最后结扎肾静脉。同步组先游离出肾动脉及肾静脉予以结扎,最后游离肾脏。分别对两组患者的手术时间、术中失血量进行统计分析。结果:非同步组1例男性患者因左肾肉瘤浸润腰大肌、腹膜及结肠,粘连严重转为开放手术,予以排除,两组其余患者均顺利完成手术。非同步组与同步组手术时间分别为:肾癌（94.3±28.1）min vs （113.3±40.3）min,肾盂癌（135.2±43.3）min vs （168.2±37.2）min;术中出血量分别为:肾癌（68.4±56.8）ml vs （100.7±93.1）ml,肾盂癌（105.4±37.3）ml vs （131.3±36.3）ml。比较两组患者病种间手术时间及术中出血量均有统计学差异（P<0.05）。结论:肾蒂血管的处理是复杂性肾癌、肾盂癌经后腹腔镜根治切除的关键,术中灵活的肾血管处理应对尤为重要,非同步肾蒂血管处理技巧有助于减少术中出血量,缩短手术时间,增加手术安全性。     

Metastatic renal cell carcinoma without evidence of a primary renal tumour

Although metastases are common in patients with renal cell carcinoma (rcc), it is extremely rare for patients to present with metastatic rcc (mrcc) without evidence of a primary mass in the kidney. Two cases of mrcc with no detectable primary renal mass are reported here. Both patients had bilateral native kidneys in situ and no significant prior urologic history. The first patient presented with a hip fracture and was found to have multiple radiologic bony and lung metastases. Biopsy of a mass involving the pubic bone demonstrated clear cell mrcc. Multiple scans by computed tomography (ct) and confirmatory imaging by magnetic resonance demonstrated no renal mass. This first patient had disease stabilization for 18 months on sunitinib and was still alive at last follow-up. The second patient was diagnosed with clear-cell mrcc after thickened synovium was discovered and biopsied during a knee arthroplasty. Multiple scans by ct in this second patient demonstrated no primary renal mass. Sunitinib and radiotherapy to the knee lesion were initiated, but unfortunately, the patient deteriorated clinically and passed away from disease progression shortly after diagnosis. Because of the rare nature of these cases, a standardized course of action has not yet been established. However, we hypothesize that it is reasonable to manage metastases in these patients by following established mrcc protocols.     

Clinical efficacy of super-selective renal artery embolization for rupture of renal angiomyolipoma

Objective  

To evaluate the efficacy of selective transcatheter arterial embolization (TAE) in renal angiomyolipoma (AML) spontaneous ruptures with hemorrhage.     

Treatment of renal tuberculosis

Three groups of parameters of 4 tuberculostatics effects on tuberculosis of the kidneys and general condition were singled out basing on comparative efficacy of 3 and 4 mycobacterial drugs: more effective, equally effective and negative. Higher efficacy manifested with greater number of cases of leukocyturia elimination and conversion of cultivable mycobacteria into uncultivable ones, more obvious morphological signs of tuberculous inflammation involution. Equal efficacy of 3 and 4 drugs was characterized by the same rate of mycobacteriuria continuation and detection of mycobacteria in caverns from the removed tuberculous kidney. The negative effect of medication consisted in increased intolerance of the drugs, involvement of the liver and kidneys, toxico-allergic reactions. Indications for initial use of 4 mycobacterial drugs in new cases of tuberculosis are early forms of tuberculosis of the kidneys in normal nitrogen-excretory function and absence of hepatic insufficiency. This treatment must be recommended with caution for old patients. The conclusion is made that WHO recommendation to use initially four drugs for treatment of urogenital tuberculosis is not well grounded and physicians should decide on the treatment regimen after consideration individual characteristics of the patients.     

Genetics of renal tumours

The two main renal tumours, Wilms' tumour and renal cell carcinoma, are associated with distinct molecular genetic abnormalities. The genes involved behave as Knudson oncosuppressor genes. Further dissection of the molecular biology pathways involving WT1 and VHL genes is providing fascinating insight into the biology of these genes, the development and cell biology of the kidney and its tumours.     

Classification of renal failure

The authors analyze the data available in the literature on acute and chronic renal failure (ARF and CRF, respectively). The mechanisms of their development (common and distinctive) are pathogenetically assessed and the functional reserve of the kidneys is determined. The phasic character of development of renal failure (compensation, subcompensation and decompensation) is pathogenetically substantiated. ARF and CRF are shown to be two forms of renal failure development which have both pathogenetic and distinctive characteristics in its mechanisms.     

A renal cell carcinoma mimicking a multilocular renal cyst

A 38-year old man was admitted to the hospital for an investigation of abnormal ultrasonographic findings of the left kidney. Ultrasonography demonstrated multiple, fluid-filled masses separated by a highly echogenic septa and CT revealed a large cystic mass and a thick, irregular wall in the upper and middle poles. Selective, left renal arteriography showed a hypovascular mass. Thus, a presumptive diagnosis was made of multilocular renal cysts. Taking into accounted the possibility of a renal cell carcinoma. Surgical exploration and a left nephrectomy was performed. Microscopically, a multiloculated renal cell carcinoma thus was diagnosed, A definite, preoperative diagnosis is very difficulty to make in most cases, and surgical exploration is considered to be the only way to achieve an accurate diagnosis. Treatment for a multiloculated cystic renal mass containing multilocular renal cysts is a total or partial nephrectomy.