单纯性肾囊肿的治疗(附121例分析)

目的总结单纯性肾囊肿的治疗经验。方法回顾性分析了121例单纯性肾囊肿患者的临床资料,其中69例行经皮囊肿穿刺抽液无水酒精注射法,33例行开放手术(其中22例行小切口肾囊肿去顶减压术),19例行腹腔镜肾囊肿去顶减压术。总结不同方法的治疗效果。结果各组均取得满意的治疗效果,并发症发生率低。穿刺组住院费用低,小切口手术组在治疗效果和住院费用上有优势。结论不同的治疗方法各有优缺点,根据患者的情况选择治疗方法能够取得满意的效果。     

经腹膜后腹腔镜囊肿去顶术治疗肾囊肿的初步体会

目的：总结经腹膜后腹腔镜囊肿去顶术治疗单纯性肾囊肿的经验，讨论手术适应证和手术要点，方法：采用经腹膜后腹腔镜囊肿去顶术治疗肾囊肿患者32例，结果：31例手术成功，1例转为开放手术，微小并发症发生率为16％，技术熟练后无并发症发生，1例术后3个月复发，术后平均住院3天，结论：经腹膜后腹腔镜囊肿去顶术创伤小，患者康复快，宜为肾囊肿外科治疗的首选术式。     

单纯性肾囊肿的个体化治疗方案探讨

目的根据肾囊肿的部位个体化选择治疗方案,以提高单纯性肾囊肿的外科治疗效果。方法回顾性分析398例单纯性肾囊肿患者的临床资料,分析患者全身情况、囊肿位置及囊肿大小等特点与成功治疗肾囊肿的相关性。结果接受经皮穿刺引流并反复注射无水乙醇或联合生物蛋白胶的患者225例,接受经腹腔镜肾囊肿去顶减压术联合生物蛋白胶治疗的患者158例,接受输尿管镜下内切开引流术者15例。其中有效率99.5%,治愈率94.0%,无其他脏器损伤、感染性休克、化学性肾盂肾炎等严重并发症。结论单纯性肾囊肿患者应根据肾囊肿部位、个体化选择治疗方法。     

多房囊性肾细胞癌与复杂性肾囊肿的CT鉴别

目的:探讨多房囊性肾细胞癌(MCRCC)与复杂性肾囊肿(CRC)的CT特点,为疾病的鉴别诊断提供依据。方法:回顾性分析66例MCRCC与CRC患者的CT特征,包括肿物直径、分隔、钙化、结节等。结果:17.4%的MCRCC、46.5%的CRC显示钙化(P=0.038);69.5%的MCRCC、21.1%的CRC有分隔(P=0.000);26.1%的MCRCC、4.7%的CRC有结节(P=0.032);38.1%的MCRCC、10.5%的CRC有囊壁强化(P=0.029);MCRCC组肿物直径CRC组(P=0.007);logistic回归显示多分隔(P=0.011)、囊壁强化(P=0.039)为独立预测因子。结论:钙化、分隔、结节、肿物直径在两组鉴别上具有意义;多分隔、囊壁强化是两组鉴别最有价值的特征。     

Collecting duct carcinoma presenting as a bleeding complicated renal cyst

Collecting duct carcinoma is a rare type of renal cell carcinoma. It is usually diagnosed pathologically and carries a poor prognosis. Renal cell carcinoma arising within a cyst is also rare. We report a case of collecting duct carcinoma presenting as a giant, bleeding complicated renal cyst with minimal solid component. The patient had a relatively long survival after nephrectomy.      

Mucinous cystadenoma mimicking simple renal parenchymal cyst in a horseshoe kidney

We report a case of mucinous cystadenoma in a horseshoe kidney which radiologically resembled a simple renal cyst. In the published literature, three cases of mucinous cystadenoma of renal origin have been reported. Although these tumors are believed to originate from the renal pelvis, the cyst in the present case originated from renal parenchyma. The significance of this particular case is the radiological features, which mimic a simple renal parenchymal cyst and contribute to the histopathological definition of an extremely rare disease.     

Papillary renal cell carcinoma within the wall of a solitary renal cyst

We report a case of a papillary renal cell carcinoma within the wall of a solitary renal cyst. Radiographic findings were not suspicious for malignancy, but histopathological examination revealed a papillary renal cell carcinoma.     

Renal cell carcinoma with hemorrhagic cyst formation in a 4-year-old boy

We report on a case of renal cell carcinoma (RCC) with hemorrhagic cyst formation in a 4-year-old boy. The patient presented with asymptomatic macrohematuria. Abdominal ultrasound, computed tomography and magnetic resonance imaging demonstrated a left renal complicated cyst, 18 mm in diameter. Renal malignancy was suspected, and left radical nephrectomy was performed. Pathological diagnosis was a complicated cyst filled with bloody clots, with a wall composed of RCC. No metastases to the regional lymph nodes or other organs were found. This is an extremely rare occurrence of such a small RCC that developed a hemorrhagic cyst in a boy of this young age. The boy is being followed-up without any additional treatment.     

Renal cell carcinoma originating in a renal cyst in a 12-year-old girl

We report a 12-year-old girl with renal cell carcinoma originating in a cyst of the left kidney. Ultrasonography revealed 2 small hyperechoic masses in the luminal side of a cyst. Although hypervascularity was not detected in the cyst by computed tomography, the possibility of malignancy could not be ruled out because of the presence of 2 solid masses. Therefore, partial left nephrectomy was performed. On histopathologic examination, the 2 solid masses within the cyst were found to be renal cell carcinoma. This patient remains disease-free at 4 years after partial nephrectomy.     

Prevalence of renal cysts in a Middle-Eastern population: an evaluation of characteristics and risk factors

OBJECTIVE

To assess the prevalence of renal cysts in a large Middle‐Eastern population presenting for a health‐screening programme, evaluating cyst characteristics and risk factors for their development.

PATIENTS AND METHODS

The reported prevalence of renal cysts detected by ultrasonography (US) in the general population is 5.0–20.8%, and their development has been linked to several factors. The electronic charts of 8551 patients (from eight nations, predominantly Egypt and Yemen) presenting for the ‘check‐up’ programme at the author’s institution during 2005 were retrospectively reviewed. The presence and characteristics of renal cysts on abdominal US were noted, as were any associated renal pathologies. Various risk factors were evaluated for renal cyst development, i.e. age, gender, hypertension, diabetes mellitus and serum creatinine levels, and hyperlipidaemia and a history of bilharziasis were also assessed.

RESULTS

The prevalence of renal cysts was 4.2%, ranging from 0.6% for patients in their third decade, to a third of those aged >80 years. Cysts were detected in 4.8% of men and 2.8% of women (P < 0.001). The mean serum creatinine level was 1.02 mg/dL in those with cysts and 0.88 mg/dL in those without (P < 0.001). On univariate analysis, hypertension, diabetes and hyperlipidaemia had a significant influence on the occurrence of renal cysts, but not in the multivariate model. Of the 361 patients with renal cysts, 58 (16.1%) had bilateral and 26 (7.2%) had multiple unilateral cysts, with a mean (range) size of 26 (4–104) mm. The vast majority of cysts were classified as Bosniak I simple cysts; seven were Bosniak II and there was one Bosniak IV cyst. Associated renal pathologies included renal stones in 39 patients, hydronephrosis in nine, increased parenchymal echogenicity in 18, small atrophic kidneys in three, haematuria (not associated with other imaging abnormalities) in six, and a renal mass in one patient.

CONCLUSIONS

The prevalence of renal cysts detected by US in a health‐screened population from the Middle East was 4.2%. Increasing age, male gender and a higher serum creatinine level were significant independent risk factors for cyst development. There was also a relatively high prevalence of associated renal pathologies (increased parenchymal echogenicity and stones).     

后腹腔镜肾囊肿去顶术与开放性手术的比较

目的　比较后腹腔镜肾囊肿去顶术与开放手术的优越性。方法　采用后腹腔镜行肾囊肿去顶 36 例,并回顾性分析比较31例开放性肾囊肿去顶术。结果　腹腔镜手术用时20~75 min,平均45 min,术后恢复快。对比开放手术,腹腔镜手术的手术时间、术后并发症及术后住院时间均明显减少。结论　后腹腔镜肾囊肿去顶术治疗单纯性肾囊肿的疗效明显优于传统开放性手术,值得推广。     

经腹膜后腹腔镜囊肿去顶术治疗肾囊肿35例临床体会

目的 探讨经腹膜后腹腔镜囊肿去顶术治疗单纯肾囊肿的疗效,并讨论手术适应症和手术要点。 方法 对我科在2005年10月~2010年9月采用经腹膜后腹腔镜囊肿去顶术治疗肾囊肿35例的临床资料进行回顾性分析。 结果 32例手术成功,术中出血量50~250ml（平均80ml）,平均住院时间为7d。在手术开展早期有3例中转开放手术,其中1例膈肌损伤,2例腹膜损伤,技术熟练后无并发症发生。所有患者随访6个月,仅有1例复发。术后恢复快。 结论 经腹膜后腹腔镜囊肿去顶术具有安全、疗效好、创伤小、恢复快的优点,宜作为单纯性肾囊肿外科治疗的首选术式。     

Proliferating trichilemmal cyst with malignant transformation

A proliferating trichilemmal cyst is a rare but morphologically distinctive tumour usually occurring in the scalp of elderly women. The even rarer malignant proliferating trichilemmal cyst has been reported in about 30 patients until now. A case of such a malignant tumour occurring on the ear of a 79 year-old male is presented. The clinical presentation, histological appearance, treatment and differential diagnosis is presented and discussed.     

Hand-assisted laparoscopic radical nephrectomy using intraoperative ultrasonography for left renal cell carcinoma involving a level I renal vein tumor thrombus

This report concerns two male patients, 65 (case 1) and 72 (case 2) years old, with a left renal tumor involving a level I renal vein tumor thrombus, who underwent hand-assisted laparoscopic radical nephrectomy using intraoperative ultrasonography. With the patient in the flank position, a midline supraumbilical hand port and two other ports were placed. Intraoperative ultrasonography identified the extent of the tumor thrombus. After hilar control, complete resection with intact removal was performed. Surgery lasted 305 min for case 1 and 237 min for case 2, with respective estimated blood loss of 410 mL and 572 mL. No postoperative complications occurred. Pathological examination showed a clear cell carcinoma with a level I tumor thrombus and negative surgical margins. Because the ultrasound probe can be easily inserted and the specimen can be extracted safely and intact, hand-assisted laparoscopic radical nephrectomy is practicable and effective for left renal cell carcinoma involving a level I renal vein tumor thrombus.     

单人双通道后腹腔镜治疗单纯性肾囊肿的疗效评价

目的:比较与评价传统三通道后腹腔镜与单人双通道后腹腔镜治疗单纯性肾囊肿的疗效,以探讨肾囊肿的微创治疗技术。方法:自2012年10月~2013年6月将临床确诊为单纯性肾囊肿的44例患者随机分为两组,试验组23例,进行单人双通道后腹腔镜肾囊肿去顶术,对照组21例,进行传统三通道后腹腔镜肾囊肿去顶术,对手术相关指标进行统计分析。结果:试验组由单人完成,对照组由双人完成。试验组中1例因手术操作困难,术中更改为对照组手术方式,两组手术时间、术中出血量、留置血浆引流管例数、住院时间、术后并发症差异均无统计学意义(P0.05)。结论:单人双通道后腹腔镜手术治疗单纯性肾囊肿与传统三通道术式在手术相关指标统计上无明显差异,因其由单人操作且减少一个切口,故值得临床推广;但当手术难度较大时,其操作成功率明显不如传统术式,我们认为该术式值得推广,但需不断熟悉操作技巧。     

Dicer is down-regulated in clear cell renal cell carcinoma and in vitro Dicer knockdown enhances malignant phenotype transformation

ObjectivesAlthough emerging evidence has shown that the deregulation of micro-ribonucleic acid (RNA) biogenesis machinery is involved in various human malignancies, this role has not been investigated in clear cell renal cell carcinoma (ccRCC). This study aims to determine whether Dicer, a key enzyme responsible for biogenesis of microRNA, is deregulated in ccRCC. The biological roles of Dicer in vitro are also determined.Materials and methodsThe expression of Dicer at messenger RNA and protein levels was detected by real-time quantitative polymerase chain reaction and western blot, respectively, in human kidney tubule epithelial cell line, nonmetastatic 786-O ccRCC cell line, and metastatic ACHN ccRCC cell line, as well as in 42 cases of ccRCC surgical specimens including 14 cases with distant metastasis and their corresponding adjacent normal renal tissues. Dicer expression levels in specimens were also measured by immunohistochemical staining. Knockdown of Dicer expression in 786-O and ACHN ccRCC cell lines was achieved by transfecting short interfering RNA against Dicer. The effects of Dicer on cell proliferation, migration, and invasion were detected by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium, inner salt (MTS) assay, flow cytometric analyses, and Boyden chamber Transwell assay, respectively.ResultsCompared with human kidney tubule epithelial cell line, Dicer expression levels were significantly down-regulated in 786-O and ACHN ccRCC cell lines, with the metastatic ACHN ccRCC cell line having even lower levels. Meanwhile, Dicer expression levels were significantly down-regulated in ccRCC surgical specimens compared with adjacent normal renal tissues, with the metastatic ones further reduced, and Dicer messenger RNA levels were significantly correlated with overall tumor-node-metastasis stage of ccRCC. In vitro, the knockdown of Dicer significantly promoted cell proliferation, migration, and invasion.ConclusionsReduced expression of Dicer may play a role in the tumorigenesis of ccRCC and further decline may be associated with distant metastasis of ccRCC.     

Adult Wilms'' tumor mimicking hemorrhagic renal cyst

A 36-year-old man presented with macroscopic hematuria associated with right flank pain. Examination of the patient revealed a cystic mass in the right kidney. Because the mass had increased in size, enucleation of the mass was performed. Histopathological findings revealed nephroblastoma, therefore, radical nephrectomy was performed. We believe the pathogenesis of the cystic formation to be a process in which a tumor that had developed in the pericalyceal region spontaneously ruptured, exuding urine into the perinephric space, forming a cystic mass. The patient is alive with no evidence of disease 24 months after the operation.     

肾癌误诊为肾囊肿11例

目的 提高对囊肿相关性肾癌的诊治水平。方法 回顾性分析误诊为肾囊肿的11例肾癌的临床特点、影像学、病理学特征。结果 11例患者平均误诊3.0年,其中实质性肾癌3例,囊性肾癌8例,术中活检2例。均行根治性肾切除术。结论 肾癌影像学复杂多变,重视体检发现的肾囊肿的随访,警惕漏诊肾癌。     

Incidence and growth pattern of simple cysts of the kidney in patients with asymptomatic microscopic hematuria

BACKGROUND: We examined the incidence and natural history of simple renal cysts found by ultrasonography (US) in patients referred for asymptomatic microscopic hematuria. METHODS: Among the 906 patients aged 18-78 years, 743 patients who had undergone US were included in the present study. The natural history of simple renal cysts was investigated in 55 patients who underwent periodical US examinations for more than 3 years. RESULTS: The incidence of simple renal cysts was 4.3% for ages 29 years or younger, 15.3% for ages 30-39, 21.8% for ages 40-49, 23.3% for ages 50-59 and 32.6% for ages 60 years or older; thus the incidence increased in older age groups (P = 0.0005 for men, P = 0.0020 for women). Men tended to have a higher incidence than women. The degree of hematuria did not influence the incidence of renal cysts (P = 0.9044). The annual growth rate of the mean maximum diameter was 4.2% during a 3-year follow-up period in 55 patients and 5.1% during a 6-year follow-up in 31 patients. CONCLUSION: Since the diameter of a renal cyst may increase by 5% annually, the diameter of the cyst may increase by 1.6 times in 10 years. The scheduling of follow-up examinations depends on the size at the time of disclosure, the effects on calyceal systems, or the suspicion of a concurrent malignant disease. However, the most simple renal cysts may be followed-up at an interval of more than 10 years, once a diagnosis has been established.     

后腹腔镜肾囊肿去顶减压术治疗孤立肾肾囊肿

目的探讨后腹腔镜肾囊肿去顶减压术对孤立肾肾囊肿手术的治疗方法和疗效。方法回顾性分析本院2005年12月至2009年8月共12例经手术和病理证实为孤立肾肾囊肿的临床资料。结果 12例手术均获成功,术中无中转开放手术,无并发症出现;手术时间30~90min（平均50min）;术中出血为5~35mL,平均15mL;术后住院日2~3d,平均2.1d。12例患者术后随访3~48个月,平均28个月,未发现囊肿复发。结论后腹腔镜囊肿去顶减压术是一种微创且安全有效的孤立肾肾囊肿治疗方法。