血钙水平与肾癌肿瘤大小、分期的相关性分析

目的分析肾细胞癌患者血钙水平和肿瘤大小与分期的相关性，从而进一步发现与病情相关的规律和了解病情。方法按照血钙水平将肿瘤大小／分期相应地分3组，即降低、正常和升高各3组。利用SPSS10．0软件，对3组不同的肿瘤大小／分期病例进行差异性分析和相关性研究。结果3组不同的肿瘤大小差异性分析（Kruskal-wallisH）显示，X^2=4．768，df=2，P=0．092；Spearman相关分析显示相关系数为．0．166，P=0．029。3组不同的肿瘤分期差异性分析（Kruskal-Wallis H）显示，X^2=4、277，df=2，P=0．118；Spearman相关系数为．0．157，P=-0．039。结论3组不同的肿瘤大小之间差异性无统计学意义，血钙水平与肿瘤大小间存在负相关；3组不同的肿瘤分期之间差异性无统计学意义，血钙水平与肿瘤分期间存在负相关。     

肾癌的CT诊断及分期

肾癌的ＣＴ诊断及分期湖南医科大学附属湘雅医院放射科（４１０００８）彭光春，韩再德，彭仁罗湖南省儿童医院放射科陈桦肾癌的ＣＴ检查不仅可显示肿瘤的部位和范围，还能根据邻近器官的侵犯与转移，进行诊断分期。ＣＴ形态学改变对肾癌的预后评估及制定治疗方案具有重要...     

肾癌预后与病理分期关系的探讨

肾癌预后与病理分期关系的探讨上海第二医科大学附属瑞金医院泌尿科（２０００２５）祝宇，张祖豹，陈其智为探索肾癌手术治疗的效果，作者参照Ｒｏｂｓｏｎ分期法和１９８７年颁布的国际ＴＮＭ分期法［１］，分析我院近８年行肾癌根治手术，并获得长期随访的４５例，发现...     

肾癌组织Notch 1、HIF-1α的表达及其与肿瘤临床分期的相关性

目的:探讨肾癌组织Notch 1、HIF-1α的表达及意义。方法:应用组织芯片、免疫组化染色法比较肾癌(n=60)及正常肾组织(n=30)中Notch 1、HIF-1α蛋白的表达差异,分析二者表达与肿瘤临床分期的相关性。结果:肾癌组织Notch 1、HIF-1α阳性表达率高于正常肾组织(40.0％ vs 13.3％,58.3％ vs 0％,P<0.05);TNM分期Ⅲ~Ⅳ期肾癌组织Notch 1、HIF-1α阳性表达率高于Ⅰ~Ⅱ期(27.5％ vs 65.0％,45.0％ vs 85.0％,P<0.05)。结论:肾癌组织中Notch 1、HIF-1α表达均高于正常肾组织,且与肿瘤临床分期有关,二者对判断临床预后可能具有一定价值。     

肾癌的CT诊断与术前分期的临床意义

本文报告我院近3年来经CT检查,并经手术病理或随访证实的34例肾癌患者,探讨CT对肾癌的诊断和术前分期的临床意义。结果表明:CT对肾癌术前分期整体正确率为85.3％:平扫时肾癌密度与病理类型有关,透明细胞癌多为低密度或近似等密度,颗粒细胞癌多为高密度:肾癌钙化特点为肿块内非边缘性斑点状钙化。     

MSCT对肾癌诊断与分期的临床意义

多层螺旋CT(mutlislice CT,MSCT)扫描具有空间及密度分辨率高的特点,显示病变大小范围、组织密度、与周围器官关系及淋巴结情况,尤其对病变内脂肪、钙化及水成分有特异性,对肾肿块显示率近100.0%。对肾癌诊断的准确率大于95.0%[1]。MSCT扫描速度快,能够进行肾脏的动态扫描。能     

血钙浓度与骨质疏松的相关性研究

目的:探讨血钙浓度与骨质疏松的相关性。方法:检测武汉市某三甲医院390例体检者血钙浓度及骨密度,分析两者之间的关系。结果:血钙浓度为1.99~2.54 mmol.L-1[(2.220±0.077)mmol.L-1],腰椎骨密度为17.378~34.164 g.cm-2[(24.641±2.738)g.cm-2],血钙浓度与骨密度无明显相关性(P>0.05)。结论:血钙浓度与骨密度间没有明显的关系,血钙水平低者不一定骨质疏松症患病率高。     

窒息新生儿心肌酶谱与血钙水平的相关性分析

目的探讨新生儿窒息后心肌酶谱与血钙水平的相关性及其临床意义。方法检测57例窒息新生儿和35例正常新生儿心肌酶谱及血钙值,并进行对比观察。应用全自动生化分析仪检测心肌酶谱及血钙。结果窒息新生儿心肌酶谱明显高于正常对照组,重度窒息组高于轻度窒息组;血钙值水平明显低于正常对照组,重度窒息组低于轻度窒息组;窒息新生儿心肌酶谱与血钙水平呈明显负相关。结论窒息新生儿存在心肌酶谱与血钙水平的异常改变。联合检测心肌酶谱与血钙水平对判断新生儿窒息的病情程度和预后具有一定的临床价值。     

Correlation between coagulation function, tumor stage and metastasis in patients with renal cell carcinoma: a retrospective study

Background  The coagulation function in carcinoma patients is abnormal, but in renal cell carcinoma the extent and relationships of coagulation function remain unclear. This study retrospectively investigated the relationships between coagulation function, clinical stage and metastasis in patients with renal cell carcinoma.

Methods  A total of 350 consecutive patients admitted to our Urology Department from 2004 to 2010 were diagnosed with renal cell carcinoma by histolopathologic examination and were included in this study. A total of 231 cases of renal benign tumors were considered as the control group. Fibrinogen, prothrombin time, activated partial thromboplastin time and international normalized ratio were evaluated in all subjects. Tumor size, clinical stage, lymph node metastasis, and distant metastasis were evaluated using radiologic imaging, intraoperative findings, and histological studies.

Results  The preoperative plasma fibrinogen levels of patients with renal cell carcinoma ((383.9±146.7) mg/dl) were significantly higher than those of the control group ((316.7±62.0) mg/dl) (P <0.01). We divided the renal cell carcinoma group into stages Ia, Ib, II, III, and IV. The fibrinogen values were (315.6±64.6) mg/dl, (358.3±91.1) mg/dl, (465.6±164.7) mg/dl, (500.0±202.1) mg/dl, and (585.8±179.7) mg/dl, respectively. There were no significant differences in fibrinogen values between stage Ia and control groups. However, results of other stages showed significant differences when compared to control group values (P <0.01). Using the cutoff value of 440 mg/dl, which defines hyperfibrinogenemia, plasma fibrinogen levels had a positive predictive value of 39.8% and a negative predictive value of 93.3% for predicting distant metastasis, with a sensitivity of 64.7% and specificity of 83.3%.

Conclusions  Preoperative plasma fibrinogen levels are elevated in patients with renal cell carcinoma with distant metastasis or lymph node metastasis. Potential metastasis is more likely if the tumor size larger than 4 cm. Increased preoperative plasma fibrinogen levels, especially hyperfibrinogenemia, may be an indicator of metastasis.

     

肾癌伴瘤栓的高危因素分析

目的:探讨肾癌伴发瘤栓的高危因素。方法:回顾性分析112例术后病理诊断为肾恶性肿瘤伴肾静脉或腔静脉瘤栓患者的临床资料,随机抽取112例肾癌不伴发瘤栓的患者作为对照组。分析评价患者性别、年龄、血压、吸烟史、肿瘤大小、病理类型、Fuhrman分级及血浆纤维蛋白原与瘤栓发生的关系。采用单因素和多因素Logistic回归分析肾癌伴发瘤栓的高危因素。结果:单因素分析结果表明,吸烟史、肿瘤大小、血浆纤维蛋白原、Fuhrman分级与肾癌伴发瘤栓有关（P＜0.05）。多因素Logistic回归分析显示,吸烟史、肿瘤大小、血浆纤维蛋白原及Fuhrman分级是肾癌伴发瘤栓的高危因素。结论:有吸烟史或肿瘤体积大或血浆纤维蛋白原升高会增加肾癌患者伴发瘤栓的风险。     

系统性红斑狼疮患者血脂水平与肾脏并发症相关性探究

目的：探讨系统性红斑狼疮患者血脂水平与肾脏并发症的相关性及意义。方法：收集系统红斑狼疮患者121例,根据是否伴有肾脏并发症分为甲组（患有狼疮性肾炎）42例和乙组（未患有狼疮性肾炎）79例,另选取60例健康体检者作为对照组,检测三组患者血清总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDLC）、低密度脂蛋白（LDLC）水平,SPSS19.0统计学软件分析上述指标之间的差异,分析与肾脏疾病进展的相关性。结果：甲组 TC, TG,LDLC 含量高于对照组,HDLC 含量低于对照组;乙组与对照组 TC、TG、LDLC、HDLC 含量差异无统计学意义;甲组 TC,TG 含量高于乙组,HDLC 含量低于乙组,TG,TC,LDLC 是系统性红斑狼疮患者并发肾炎的危险因素。结论：系统性红斑狼疮患者血脂水平与肾脏并发症的发生密切相关,TG、TC、LDLC 水平异常增高是系统性红斑狼疮患者并发肾炎的独立危险因素。     

Ipsilateral synchronous renal pelvic transitional cell carcinoma, squamous cell carcinoma and adenocarcinoma

Reports of multiple synchronous primary renal neoplasms in the literature are rare. Although primary renal tumors of 2 distinctively dissimilar origins have been sporadically described, to our knowledge there have been no reported cases of triple primary renal neoplasms in the same kidney. Here we report a very rare case of ipsilateral synchronous renal pelvic transitional cell carcinoma, squamous cell carcinoma and adenocarcinoma with marked hydronephrosis and multiple stones in thesame kidney.     

Ipsilateral synchronous renal pelvic transitional cell carcinoma, squamous cell carcinoma and adenocarcinoma

Reports of multiple synchronous primary renal neoplasms in the literature are rare. Although primary renal tumors of 2 distinctively dissimilar origins have been sporadically described,1-6 to our knowledge there have been no reported cases of triple primary renal neoplasms in the same kidney. Here we report a very rare case of ipsilateral synchronous renal pelvic transitional cell carcinoma, squamous cell carcinoma and adenocarcinoma with marked hydronephrosis and multiple stones in the same kidney.     

不同血清钙水平对终末期肾脏病患者血管钙化及心血管原因死亡的影响

Objective: To investigate the correlation between serum calcium and the vascular calcification and cardiovascular mortality in patients with end-stage renal disease (ESRD). Methods: Clinical data of 160 cases of ESRD patients with regular hemodialysis were included. All cases were divided into three groups based on the serum calcium level: lower than normal (2.0 mmol/L＜Ca＜2.25 mmol/L), normal(2.25 mmol/L≤Ca≤2.75 mmol/L), higher than normal (Ca ＞2.75 mmol/L). All the clinical data including age, gender, serum calcium, vascular calcification rate and cardiac event occurrence rate were recorded. The vascular calcification was measured using X-rays. And the cardiac event occurrence rates in two years of all cases with different serum calcium levels were recorded. Kaplan-Meier methods were used to compute the survival rate. Results: There were 147 patients enrolled in the study at last, with a mean age of (57.76±13.43) years old, and 72 of them were male (48.9%). The degree of vascular calcification and serum calcium levels were positively correlated. The occurrences of cardiovascular event for the three groups had significance differences (P＜0.05）. The cardiovascular mortalities in 24 months for the three groups had significance differences（P=0.012）. Conclusion: The level of serum calcium may influence the vascular calcification and cardiovascular mortality in end-stage renal disease patients to some degree.     

后腹腔镜下肾部分切除术在早期肾肿瘤治疗中的应用

目的: 评估经后腹腔镜下保留肾单位手术在早期肾细胞癌治疗中的可行性和临床疗效。方法: 对53例早期肾细胞癌患者实施后腹腔镜肾部分切除术。术前均行CT扫描和彩色超声检查,肿瘤直径最大不超过3 cm,且距离集合系统不小于10 mm。结果: 53例手术均顺利完成,无中转开放手术者。平均手术时间为96 (75~110) min;平均热缺血时间为15 (10~21) min,平均术中出血量70 (40~120) mL。术后平均住院4.2 (3~6) d。术中及术后无出血、漏尿等并发症。病理检查示1例患者肾透明细胞癌切缘阳性,余切缘均为阴性。平均随访39个月,所有患者未见肿瘤局部复发及转移。结论: 后腹腔镜肾部分切除术治疗早期肾肿瘤安全可行,并且可以获得良好的治疗效果。     

T1b期肾细胞癌保留肾单位手术的临床价值

 目的   探讨T1b期肾细胞癌 (renal cell carcinoma,RCC) 行各种保留肾单位手术 (nephron sparing surgery,NSS)的安全性与可行性。方法   回顾性分析2011年1月至2013年12月复旦大学附属中山医院 50 例行开放、腹腔镜及机器人辅助下NSS的T1b期RCC患者临床资料及随访情况。结果   50例患者均成功行NSS,手术时间 (70～210) min,平均 (122.8±44.1) min。阻断肾血流38例,热缺血时间 (20~47) min,平均 (29.0±8.5) min。术中出血量 30～1 100 mL,平均 (196.6±212.8) mL,肿瘤RENAL评分4～10,平均7.3±1.6,术前血肌酐42～150 μmol/L,平均 (77.4±22.0) μmol/L;术后住院5～46天,平均 (8.4±6.5)天。术后病理示:透明细胞癌45例,嫌色细胞癌3例,乳头状癌2例。50例患者术后1周、3个月和6个月肾功能复查,肌酐分别为 (87.3±11.6)μmol/L、 (82.5±10.8)μmol/L和(79.7±12.1)μmol/L,血尿素氮分别为 (5.7±1.6) mmol/L、 (5.2±1.3) mmol/L和(5.1±1.2) mmol/L,与术前比较差异无统计学意义。结论   NSS既能有效切除肿瘤,又能保留部分肾单位,是一种有效的治疗T1b期RCC可行的选择,尤其对双侧肾肿瘤或者孤立性肾脏肾肿瘤。     

囊性肾癌的诊治(附13例报告)

目的探讨囊性肾癌影像学特点及临床诊断.方法回顾我院1991～2001年经手术证实的13例囊性肾癌,分析其影像学特点、术中所见、术后病理.结果本组4例为多囊性肾癌,9例为单囊性肾癌.术前CT诊断8例,超声诊断肾癌7例.6例术前诊断不明确,行手术探查,病理证实为肾细胞癌.结论囊性肾癌术前诊断有一定难度,影像学检查有较高的诊断价值,但部分病人尚需手术探查.