后腹腔镜肾切除治疗结核性无功能肾临床分析

目的总结后腹腔镜结核性无功能肾切除的技术要点和方法,探讨后腹腔镜结核性无功能肾切除术的可行性。方法回顾分析2005年3月至2009年12月收治的46例结核性无功能肾患者临床资料,所有患者均经后腹腔镜行肾切除术,观察手术时间、术中出血量、手术并发症、术后患者恢复时间等指标。结果 46例手术均获得成功,无中转开放。手术时间45～240min,平均（102±36.9）min;出血量10～300 mL,平均（59.8±49.6）mL,术后1～3 d肠道功能恢复,术后住院时间5～9 d,平均6.5 d。术后所有患者未出现切口感染及切口不愈合。术后随访6个月至5年,无结核复发。结论后腹腔镜结核肾切除术创伤小、出血少、恢复快,但由于粘连较重,分离较为困难,因此,对有较好腹腔镜操作经验的医生而言,是一种安全、可靠的手术方法。     

前列腺癌继发腹膜后纤维化1例

继发性腹膜后纤维化(RPF)以腹膜后包块为主要表现,发病率低,临床缺乏特征性表现,早期诊断困难,常致误诊误治。本报道继发于前列腺癌的RPF1例。继发于恶性肿瘤的RPF预后差,早期诊治尤为重要。     

Fine-needle aspiration biopsy of the retroperitoneum: a series of 111 cases not including specific organs

We report on our experience in fine-needle aspiration (FNA) biopsy of the retroperitoneum: 111 FNA biopsies performed on 99 patients. Cytologic diagnoses were divided into four groups: nondiagnostic (unsatisfactory samples because of a low cellularity and/or improperly prepared smears) aspirates (20%), benign (16%), suspicious for malignancy (13%), and malignant (50%). There were no known false-positive samples. We had two false-negative diagnoses due to sampling errors. Among diagnostic smears, the procedure showed a sensitivity of 97% and a specificity of 100%. The predictive value of a positive result was 100% and the predictive value of a negative result was 90%. The overall accuracy was 98%. Metastatic carcinomas accounted for the largest number of lesions in the group of malignant tumors. A primary tumor site was known for the majority of the cases before the aspiration was performed. In the remaining cases we were unable to suggest an origin. It is therefore important to emphasize the role of ancillary studies in patients that are at the first assessment of the disease or when a second intercurrent malignancy is suspected. In our limited experience, a suggestion of the correct subtype of retroperitoneal sarcoma was not possible. As in the rest of cytopathology, a multidisciplinary approach is mandatory in this setting to improve patient management.     

Anterior retroperitoneal rami: Until now unnamed direct branches of the abdominal aorta

The aim of the study was to gain a thorough knowledge of the topography and distribution of until now officially unnamed minute direct branches from abdominal aorta, stemming from its ventral and lateral aspects, supplying surrounding tissue, and to comprise it to the existing studies. The study was performed in fixed cadaverous material collected from India ink injections of abdominal aorta samples with large surrounding retroperitoneal tissue. The 25 samples were dissected under magnifying binocular glass, followed by graphic reconstruction; statistical analysis, and the study was preceded with detailed review of branches from abdominal aorta. For systematization of the segmental anatomy of the abdominal aorta and infrarenal segment of inferior vena cava, we defined three levels in this area. The retroperitoneal branches were most frequently situated simultaneously within all three predefined levels according to renal and inferior mesenteric arteries origin. There were 18% of retroperitoneal branches within Level 1, 39% within Level 2 and 43% within Level 3. They were branches not only from the abdominal aorta, but also from the testicular/ovarian artery, common iliac artery and in one case from the right accessory renal artery. Paired arrangement was recorded mainly cranially to the origin of inferior mesenteric artery, unpaired branches were more frequently found caudally. In conclusion, due to the terminological disunity of these arteries in the clinical literature and total absence in the anatomical literature, we propose to denominate them as anterior retroperitoneal branches of abdominal aorta (rami retroperitoneales anteriores aortae abdominalis). Clin. Anat. 27:894–899, 2014. © 2014 Wiley Periodicals, Inc.     

后腹腔镜输尿管切开取石术与微通道经皮肾镜取石术处理嵌顿性输尿管上段结石的效果

目的 比较后腹腔镜输尿管切开取石术(RLUL)与微通道经皮肾镜取石术(mPCNL)处理嵌顿性输尿管上段结石的效果及对患者肾功能的影响.方法 回顾性分析2016年1月至2019年12月我科收治的54例嵌顿性输尿管上段结石行手术治疗患者的临床资料,26例行RLUL治疗(A组),28例行mPCNL治疗(B组),比较两组的治疗...     

IgG4-related inflammatory abdominal aortic aneurysm associated with autoimmune pancreatitis

An association between autoimmune pancreatitis (AIP) and inflammatory abdominal aortic aneurysm (AAA) has never been reported. Reported herein is a case of IgG4-related inflammatory AAA accompanying metachronous AIP. A 77-year-old man presented with malaise and intermittent lower abdominal pain. Radiological examination showed inflammatory AAA and right hydronephrosis caused by retroperitoneal fibrosis. Surgical correction of the AAA was performed, but high levels of systemic inflammatory markers persisted. Four months after surgery, the patient presented with epigastric pain, backache, and jaundice. His serum IgG4 concentration was high (571 mg/mL), and he was diagnosed with AIP, based on clinical and radiological findings. Corticosteroid therapy resulted in improvement of the clinical findings and lowered his serum IgG4 levels. Subsequent histological examination of a specimen from the aortic wall showed irregular proliferation of fibroblastic and myofibroblastic cells, severe lymphoplasmacytic infiltration, and obliterative phlebitis in the adventitia. Furthermore, on immunohistochemistry many plasma cells within the lesion were found to be positive for IgG4. These findings suggest that inflammatory AAA has a pathological process similar to that of AIP, and that some cases of inflammatory AAA and retroperitoneal fibrosis may be aortic and periaortic lesions of an IgG4-related sclerosing disease.     

腹膜后纤维化患者腹腔镜和开放输尿管松解术的回顾性分析(附23例报告)

目的比较腹膜后纤维化患者行腹腔镜与开放输尿管松解术的临床效果。方法回顾性分析腹腔镜下输尿管松解术(LS组)10例及开放输尿管松解术(OS组)13例患者的临床资料,对两组手术准备时间、手术时间、术中出血量、肠功能恢复时间、下地活动时间、术后住院天数、住院总天数及并发症等进行比较。结果 LS组的术中出血量、肠功能恢复时间、术后住院天数、住院总天数(分别为59.50ml、2.70±0.82d8、.70±1.42d、17.40±5.64d)均少于OS组(分别为100.00ml、3.85±1.07d、11.62±3.18d2、3.38±5.45d,P<0.05);LS组手术准备时间(29.25±11.43min)长于OS组(19.85±7.36min,P<0.05);两组的手术时间和下地活动时间差异无统计学意义(P>0.05)。两组均无输血病例,无严重并发症发生,随访18个月,无原位复发及再次梗阻出现。结论与开放手术相比,腹腔镜输尿管松解术具有术中出血量少、术后肠功能恢复快、住院时间短等优点,是治疗腹膜后纤维化安全、有效的手术方式。     

超声检查诊断特发性腹膜后纤维化的应用价值

目的：探讨特发性腹膜后纤维化（IRPF）的超声图像特点及其诊断价值。材料和方法：回顾性分析11例IRPF患者的声像图表现。结果：11例患者均表现为腹主动脉周围低回声肿块,包绕腹主动脉。其中,4例包绕下腔静脉,3例病变延伸及髂动脉,9例伴肾积水。结论：IRPF具有特征性声像图表现,超声检查在该症的发现及定性诊断方面具有重要的作用。     

原发性腹膜后肿瘤114例手术治疗分析

目的总结原发性腹膜后肿瘤(PRPT)的临床特征、诊断及治疗经验、教训。方法对我院114例经手术和病理证实的原发性腹膜后肿瘤的临床表现、辅助检查、病理类型及外科治疗等临床资料进行回顾分析。结果首发症状及体征多数为腹痛及腹部包块。B超及CT的诊断率分别为91.6%,94.2%。其中良性肿瘤44例,占38.6%,恶性肿瘤70例,占61.4%。本组良性肿瘤切除率95.5%,恶性肿瘤切除率85.7%。术后良性肿瘤复发4例,行根治术;恶性肿瘤复发31例,26例行根治术,5例行部分切除术。结论B超、CT等影像学检查是诊断PRPT的重要手段。完整切除肿瘤是治疗PRPT的关键和影响其预后的重要因素。对侵犯脏器者应采用将累及脏器一并切除,不能切除和切除后再发者宜探查活检和再次手术切除。     

Primary gastrointestinal stromal tumor in the retroperitoneum

Abstract  Gastrointestinal stromal tumor (GIST) is the most frequent non-epithelial neoplasm in the gastrointestinal tract. GIST has received much attention both for its clinical significance and biological nature, while the retroperitoneal condition identical to GIST has been rarely described. Presented herein is a case of GIST arising from the retroperitoneum in a 67-year-old man. The solid tumor measuring 4 cm was uncovered in the retroperitoneum, between the abdominal aorta and inferior vena cava, on computed tomography. The patient underwent surgical excision of the tumor. Histological examination showed proliferating spindle cells in the clearly demarcated tumor; immunoreactivity for Kit and CD34 in tumor cells confirmed the diagnosis of GIST. The histological origin of GIST is suggested to be gastrointestinal pacemaker cells, because they share specific immunoreactivity for CD117/Kit, which is also relevant to pathogenesis of GIST. The present case was a rare primary GIST in the retroperitoneum with typical immunopathological features.