肉瘤样肾细胞癌的临床诊治及预后分析

目的探讨肉瘤样肾细胞癌的临床特点及治疗效果。方法回顾分析2000～2007年本院诊治的肉瘤样肾细胞癌6例病历资料。6倒均经CT扫描初步诊断为肾脏恶性肿瘤,并行根治性肾切除手术,标本送病理及免疫组化检查。术后均经IL-2治疗．术后2个月内全面复查,长期随访。结果标本见肿瘤直径5．5～17cm,镜检均为癌和肉瘤样成分共同组成,免疫组化粢色EMA（＋）4例,CK（4-）5例,Vimentin（＋）6例。肿瘤分期T2N0M01例,T4N0M01例,T4N1M04倒。1例（T2N0M0）痊愈出院,已随访1年4个月未见复发。术后2个月内复查,5例T4期患者皆出现肿瘤复发或转移,术后生存期117～225d,平均171d。结论肉瘤样肾细胞癌是一种临床少见的高度恶性肿瘤,具有体积大、分期高、转移早、进展快、预后差的特点,确诊需要依赖组织病理学及免疫组织化学检查。临床上对疑似患者宜全面检查并积极行根治性肾切除手术治疗。     

雷帕霉素用于我国肾移植患者临床疗效的Meta分析

目的 探讨我国肾移植患者应用雷帕霉素进行免疫抑制治疗的有效性和安全性.方法 收集国内外关于雷帕霉素用于我国肾移植患者术后免疫抑制治疗的随机对照研究文献,对结果进行统计荟萃分析(Meta分析).评价比较疗效及差异的指标采用优势比(OR)及95%可信区间(95% CI).统计学分析采用Stata软件.结果 共收集国内外4个随机对照研究,其中国内4篇,国外0篇.Meta分析结果显示:应用雷帕霉素预防移植肾发生急性排斥反应的疗效优于空白对照组[OR值为0.20,95% CI为(0.05,0.86),P=0.03],应用雷帕霉素组术后移植肾功能延迟恢复发生率与空白对照组比较差异无统计学意义[OR值为2.06,95% CI为(0.37,11.59),P=0.41],雷帕霉素组术后高脂血症发生率高于空白对照组[OR值为3.38,95% CI为(1.39,8.22),P=0.007].结论 雷帕霉素用于我国肾移植患者可有效降低急性排斥反应的发生率,对患者术后移植肾功能恢复无不良影响,但其副作用主要表现为血脂升高.     

老年活体供肾移植术后供者安全性及受者移植效果的分析

Objective To investigate the safety for donors and the effectiveness for recipients of living-related donor (LRD) kidney transplantation from elder donors. Methods 251 cases of LRD kidney transplantation were reviewed. According to the age of LRDs, the patients were divided into 2 groups:≥55 years group (group A) and <55 years (group B). The parameters studied included serum creatinine (Cr), glomerular filtration rate (GFR), creatinine clearance (Ccr), perioperative complications, average hospital stay, and acute rejection rate of LRDs and recipients were compared. Results (1)There was no significant difference in serum Cr between groups A and B at different time points (P>0.05). (2)There was no significant difference in Ccr between two groups pre-donation (P = 0.45). But at the 10th day after the donor nephrectomy, Ccr level in group A was significant lower than in group B (P<0.01). (3)Total GFR pre-donation, remaining renal GFR, and remaining renal GFR on the day 10 after donation had no significant difference in both groups A and B (P>0.05). Remaining renal GFR on the day 10 before and after donation had no significant difference in group A (P>0.05), but on the day 10 after donation that was significantly increased in group B as compared with that pre-donation (P<0.01). (4) The serum Cr of recipients at different time points after transplantation had no significant difference between two groups (P>0.05). (5) The mean hospital stay after donation of LRDs and recipients had no significant difference between two groups. (6) The incidence of recipients" acute rejection was 6.50 % (5/77) in group A, and 5.75%(10/174) in group B within 6 months after operation (P = 0.95). Conclusion Transplantations performed from the elderly donors will yield similar results from younger donors if the eider donors are evaluated or assessed as the standards.     

口服供者脾细胞诱导成年大鼠心脏移植存活期延长

目的:利用口服供者脾细胞延长受者大鼠的心脏移植存活时间,并探讨口服耐受的形成机制。方法:以纯系SD大鼠为供者,纯系Wistar大鼠为受者,行异体心脏移植,将16只受者大鼠随机分为A组(对照组,单纯行心脏移植)和B组(口服抗原组),于心脏移植前7 d开始每日接受供者脾细胞5×10⁷个,导管灌胃,7 d后观察体外混合淋巴细胞培养(MLC)、体内的迟发型超敏反应(DTH),并行心脏移植,观察移植心脏的存活时间。 结果:口服抗原后,体外混合淋巴细胞培养及体内的DTH反应均出现明显的抗原特异性降低,口服抗原组的心脏移植存活时间达到(12.1±1.9)d,而对照组为(7.0±0.8)d,两组比较差异有显著性(P<0.01)。 结论:口服抗原可以引起受者对异基因抗原的特异性免疫反应降低,使受者的心脏移植存活期延长。     

嗜铬细胞瘤诊断和治疗的进展

近年来对嗜铬细胞瘤病因学认识不断提高 ,诊断和治疗方法也在不断改进 ,使手术死亡率大大下降。本文总结了嗜铬细胞瘤诊断和治疗方面的一些进展。     

Madigan前列腺切除术的疗效评价

目的：评价Ｍａｄｉｇａｎ前列腺切除术（ＭＰＣ）的疗效。方法：对２１例接受ＭＰＣ的前列腺增生症（ＢＰＨ）患者术前及术后分别进行症状评分及压力－流率测定,客观评价其手术疗效,并与２２例耻骨上经膀胱前列腺切除术（ＳＰＰＣ）患者结果对比。结果：ＭＰＣ术后症状评分明显降低、各项压力－流率测定参数及诊断梗阻的百分率明显改善,但改善程度不及ＳＰＰＣ,且残留梗阻率高于ＳＰＰＣ;ＭＰＣ的手术并发症、出血量、血尿时间     

手助腹腔镜活体供肾切取术1例

我院于 2 0 0 1年 12月 6日成功开展手助腹腔镜活体供肾切取术 (Ｈａｎｄ -ａｓｓｉｓｔｅｄｌａｐａｒｏｓｃｏｐｉｃｌｉｖｅｄｏｎｏｒｎｅｐｈｒｅｃｔｏｍｙ ,ＨＬＤＮ) 1例 ,结果满意 ,现报告如下。1　临床资料和方法1.1　一般资料肾移植活体供者 ,女性 ,5 1岁。既往身体健康。经检查 ,与受者 -供者之子组织配型良好。左肾功能正常 ,血管无畸形 ,静脉长于右肾静脉 ,故决定切取左侧供肾。1.2　术前准备同开放手术。备皮时需注意脐部清洁 ,术前放置胃、尿管。1.3　手术设备2 5°广角腹腔镜及其配套设备、Ｈａｎｄ -ＰｏｒｔＳｙｓ ｔｅ…