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| 1 | 肾转移瘤的CT诊断及鉴别诊断显示文摘目的:分析肾转移瘤的CT表现,以提高其CT诊断及鉴别诊断能力。方法:回顾性分析13例经穿刺活检或手术病理证实的肾转移瘤的临床及CT资料,所有病例术前均行CT平扫及增强扫描。结果:13例肾转移瘤单发8例,多发5例,共发现19个病灶:呈圆形或椭圆形16个,不规则形3个;囊实性11个,囊性6个,实性2个;直径2.2~8.7cm,<3.0cm 12个,3.0~5.0cm 5个,5.0~10.0cm 2个;位于肾皮质且突出肾皮质引起肾轮廓改变1个,位于肾实质16个(病灶中心多位于皮髓交界处),位于肾窦2个;增强扫描皮髓交界早期呈中等强化,实质期持续强化,17个病灶呈环状强化,环壁较厚,环外壁光整,内壁模糊,病灶内部强化不均,2个实性病灶隐约可见环状强化,病灶内部强化较均匀。结论:结合肾转移瘤的临床及CT双期增强表现,有助于该病的诊断和鉴别诊断. | 赵美华 周建军 | 2013 | 放射学实践2013，28，2： | 8 |
| 2 | 肾继发性肿瘤的临床诊治及预后分析显示文摘目的探讨肾继发性肿瘤的临床特点、诊治方法及预后。方法回顾性分析2000年1月至2014年1月收治的31例肾继发性肿瘤患者的临床资料。男23例,女8例。年龄38~75岁,平均56岁。31例的原发肿瘤为肺癌14例,淋巴瘤5例,结直肠癌和胃癌各3例,乳腺癌2例,食管癌、甲状腺癌、宫颈癌和膀胱癌各1例。同时伴有其他器官或淋巴结转移者22例(71.0%),仅肾转移者9例(29.0%)。确诊原发肿瘤同时发现肾转移者5例(16.1%),余26例于确诊原发肿瘤9~72个月,平均30个月后发现肾转移。5例(16.1%)有临床症状。彩色多普勒超声检查示20例(65.6%)为低回声灶,11例(34.4%)为回声不均匀。cT检查24例(77.4%)为等密度,7例(22.6%)为稍低密度影,多数为内生性,增强后轻度强化。双侧肾转移10例(32.3%);单侧肾转移21例(67.7%),其中单侧肾多发转移6例(19.4%),单侧肾单发转移15例(48.4%)。肾转移灶直径0.9~6.8cm,平均2.7cm。本组31例中,4例放弃治疗,余27例按原发肿瘤行综合治疗。9例单纯肾转移者按晚期原发肿瘤的治疗方案行化疗或靶向治疗,其中6例行肾部分切除术或根治性肾切除术治疗。结果6例单纯肾转移行手术治疗者术后恢复良好,术后病理证实为原发肿瘤肾转移。本组31例随访2~60个月,平均(22.6±18.4)个月。31例的总生存时间为1~51个月,平均(13.2±13.2)个月。22例多发转移患者中,4例放弃治疗,平均生存时间(2.0±1.4)个月,余18例平均生存时间(11.1±4.7)个月,差异有统计学意义(P〈0.05)。9例单纯肾转移患者中,3例未行手术治疗者平均生存时间(10.3±4.0)个月,6例行手术治疗者平均生存时间(26.2±18.6)个月,差异有统计学意义(P〈0.05)。结论肾继发性肿瘤临床上少见,多数为孤立病灶。肾继发性肿瘤是原发肿瘤的晚期表现,采用晚期原发肿瘤的综合治疗方案可延长生存期。单纯肾转移者可手术切除病灶后再行综合治疗。 | 肖英明 陈东 周芳坚 廖洪 | 2016 | 中华泌尿外科杂志2016，37，5： | 3 |
| 3 | 行根治性肾切除术治疗肾转移性恶性肿瘤六例显示文摘目的为进一步提高肾转移性恶性肿瘤的诊治水平提供参考。方法回顾性分析6例肾转移性恶性肿瘤患者的诊断和治疗情况,男4例,女2例,年龄43~65岁,平均年龄为(53±10)岁。原发肿瘤分别为支气管肺鳞癌3例、胃腺癌1例、急性粒细胞性白血病1例和肝癌1例,分别于原发病手术治疗后5~41个月内经B超检查偶然发现肾脏转移性病灶,病程中患者均无肉眼血尿和其他不适症状。6例患者均行根治性肾切除术,术前均经B超、CT或磁共振(MRI)检查,均未行细针穿刺活组织检查(FNAB)。肿瘤大小为3.5cm×4.2cm至6.0cm×8.5cm。其中1例患者B超检查示肾脏实性低回声占位;CT检查示肾脏等密度影,增强期明显强化,可见假包膜影;术前诊断为肾癌。5例患者B超检查示肾脏区边界不清楚的团块,呈低回声,内部回声不均匀;CT检查示肾脏肿块多数呈少或无外凸,弥漫浸润生长,密度不均,边界不清,增强后出现轻度强化,并与周围肾脏组织边界不清,无包膜,有"毛刺样"改变;术前诊断为肾转移性鳞癌。结果手术过程均顺利,术中出血量50~800mL,平均出血量为(250±173)mL,均未输血。6例患者术后均诊断为肾转移性恶性肿瘤,均无手术并发症发生,于术后7~10d出院。除1例肝癌患者外,其余5例患者均根据原发病行相应的化疗。随访2~36个月,1例急性粒细胞性白血病肾转移患者失访,3例支气管肺鳞癌和1例胃腺癌患者均死亡(术后存活时间为7~15个月),1例肝癌肾转移患者术后2个月尚在随访中。结论虽然恶性肿瘤患者一旦出现肾转移,其生存期相当有限,但对于原发性肿瘤的转移仅局限于肾脏的患者,采取根治性肾切除术治疗并进一步明确肾脏肿瘤的性质还是具有一定意义的。 | 王辉清 刘亚巍 许传亮 杨波 张振声 高旭 侯建国 汤昊 孙颖浩 | 2013 | 上海医学2013，36，7： | 1 |
| 4 | Hepatocellular carcinoma in patients with renal dysfunction: Pathophysiology, prognosis, and treatment challenges显示文摘The population of patients with hepatocellular carcinoma(HCC)overlaps to a high degree with those for chronic kidney disease(CKD)and end-stage renal disease(ESRD).The degrees of renal dysfunction vary,from the various stages of CKD to dialysis-dependent ESRD,which often affects the prognosis and treatment choice of patients with HCC.In addition,renal dysfunction makes treatment more difficult and may negatively affect treatment outcomes.This study summarized the possible causes of the high comorbidity of HCC and renal dysfunction.The possible mechanisms of CKD causing HCC involve uremia itself,long-term dialysis status,immunosuppressive agents for postrenal transplant status,and miscellaneous factors such as hormone alterations and dysbiosis.The possible mechanisms of HCC affecting renal function include direct tumor invasion and hepatorenal syndrome.Finally,we categorized the risk factors that could lead to both HCC and CKD into four categories:Environmental toxins,viral hepatitis,metabolic syndrome,and vasoactive factors.Both CKD and ESRD have been reported to negatively affect HCC prognosis,but more research is warranted to confirm this.Furthermore,ESRD status itself ought not to prevent patients receiving aggressive treatments.This study then adopted the well-known Barcelona Clinic Liver Cancer guidelines as a framework to discuss the indicators for each stage of HCC treatment,treatment-related adverse renal effects,and concerns that are specific to patients with pre-existing renal dysfunction when undergoing aggressive treatments against CKD and ESRD.Such aggressive treatments include liver resection,simultaneous liver kidney transplantation,radiofrequency ablation,and transarterial chemoembolization.Finally,focusing on patients unable to receive active treatment,this study compiled information on the latest systemic pharmacological therapies,including targeted and immunotherapeutic drugs.Based on available clinical studies and Food and Drug Administration labels,this study details the drug indications,side effects,and dose adjustments for patients with renal dysfunction.It also provides a comprehensive review of information on HCC patients with renal dysfunction from disease onset to treatment. | Hsuan Yeh Chung-Cheng Chiang Tzung-Hai Yen | 2021 | World Journal of Gastroenterology2021，27，26： | 1 |
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