From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery（ONSS） without renal artery occlusion. We removed the lesions, and the cut edges of th...From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery（ONSS） without renal artery occlusion. We removed the lesions, and the cut edges of the tumors were negative. Thus, we deduced that ultrasound-guided ONSS is suitable for the cases with obscure tumor boundary or multiple lesions. It could achieve the purpose of thoroughly removing lesions, as well as to expand the application range of nephron sparing surgery.展开更多
Objective:The aim of the study was to report the experience of National Cancer Institute(NCI),Cairo University,Egypt,in managing various benign and malignant renal tumors with nephron sparing surgery(NSS),and to asses...Objective:The aim of the study was to report the experience of National Cancer Institute(NCI),Cairo University,Egypt,in managing various benign and malignant renal tumors with nephron sparing surgery(NSS),and to assess its safety and feasibility.Methods:Reviewing the literature for NSS,and records of patients who underwent NSS in the period from January 2000 to December 2009 at National Cancer Institute,Cairo University regarding the patient and tumor related characteristics,the indication for NSS,operative technique,postoperative complications,full histopathological data,and follow up results.Results:The total number of patients was 17.Mean age at surgery was 30.7 years(range 1.5-65 years).Five patients had bilateral tumors during surgery.The mean tumor size was 4.5 cm(range 1-9 cm).All patients had normal preoperative kidney functions.Seven patients had an absolute indication for NSS,6 patients had a relative indication,and 4 patients had an elective indication.All the 5 patients with bilateral tumors underwent bilateral simultaneous surgery.Cold ischemia was used in 8 patients,1 patient was exposed to warm ischemia,manual compression was used in 2 patients,and no vascular control was applied in 6 patients.Complications were encountered in 2 patients,one of them had urinary leakage which needed reoperation,and the other had subcutaneous hematoma which was treated conservatively.Histopathological analysis revealed Wilm's tumor(8 patients),angiomyolipoma(4 patients),renal cell carcinoma(4 patients),and hydatid cyst(1 patient).All patients had negative surgical margin.For patients with Wilm's tumor,the mean follow up was 21.4 months(range 0-94 months),2 patients had local recurrence,and 1 patient had distant metastasis.For patients with RCC,the mean follow up was 15.3 months(5-33 months),no patients had local recurrence or distant metastasis.All patients had normal kidney functions during postoperative and follow up periods.Conclusion:NSS is a feasible safe procedure that can be done with acceptable complications rate and it provides a good solution for patients with bilateral tumors,early localized renal cell carcinoma,and benign tumors.展开更多
Objective：To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods： From August 1 997 to October 2008, 48 cases of small renal cell carcinomas were conf...Objective：To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods： From August 1 997 to October 2008, 48 cases of small renal cell carcinomas were confirmed by surgery and pathology, and reviewed retrospectively. Of the 48 cases, there was 1 patient with bilateral tumors, 8 with solitary kidney tumors, 1 with unilateral tumor and a damaged contralateral kidney, and 38 with unilateral tumors and a normal contralateral kidney; 9 underwent tumor enucleation and the remaining patients received partial nephrectomy. Results：There were no local tumor recurrences and/or tumor metastasis at a mean followup of 60 months. Conclusion： Confirming conclusions from other centers, we have found that nephron-sparing surgery is an effective treatment for small renal cell carcinomas.展开更多
Background Current surgical practice for nephron sparing surgery allows at least 1 cm margin of normal tissue around the tumour. However, recent studies show that the width of the margin is not important, even simple ...Background Current surgical practice for nephron sparing surgery allows at least 1 cm margin of normal tissue around the tumour. However, recent studies show that the width of the margin is not important, even simple enucleation is as effective as partial nephrectomy. We explored whether margin size has significant impacts on clinical outcomes in nephron sparing surgery for renal cell carcinoma of 4 cm or less. Methods Between 1998 and 2006, 115 patients with sporadic, pathologically confirmed, renal cell carcinoma 4 cm or less （Tla） and normal contralateral kidney were treated by nephron sparing surgery using a margin less than 5 mm. The surgical margin status was evaluated from frozen and permanent paraffin sections. Results Mean and median tumour diameter were 3.3 cm and 3.5 cm （range 1.0-4.0）. The mean margin width was 2.2 mm （median 2.0, range 0-6）. In addition, 114 cases had margins 5 mm or less （99.1%）, 97 cases （84.3%） had margin 3 mm or less, and 26 cases had margin zero （22.6%）. None of the patients had positive surgical margins. No patients died during follow-up （mean 65 months）. There were no any major surgical complications and no distant metastasis was detected. Local recurrence was detected in one case （0.9%） at a different site of the kidney. Conclusions For early localized renal cell carcinoma of 4 cm or less, as long as tumour is completely excised, the size of margin in nephron sparing surgery is not important. Nephron sparing surgery with 5 mm margin is enough for tumour control. It provides excellent renal function preservation, favourable long term progression free survival and is not associated with an increased risk of local recurrence.展开更多
Objective： To observe the change of nephron damaged by chemotherapy and to evaluate the effect of Baoshen Mixture （保肾合剂, BSM） in protecting and treating damaged nephrons. Methods： Four hundred tumor patients w...Objective： To observe the change of nephron damaged by chemotherapy and to evaluate the effect of Baoshen Mixture （保肾合剂, BSM） in protecting and treating damaged nephrons. Methods： Four hundred tumor patients with normal renal function and ready to receive chemotherapy were randomly assigned to two groups. Both groups received one cycle of chemotherapy program of 28-30 days with conventional hydratization, alkalization and chloridization. To the 200 cases in the treated group BSM was given orally thrice a day, 150 mL every time for 15 successive days and the other 200 cases in the control group were treated by chemotherapy alone. The clinical efficacy was compared after treatment, and the changed condition of damaged nephrons were monitored dynamically and compared at different time points （the 3rd, 7th, 14th and 21st day after chemotherapy） by measuring the micro-globulin 132 （13 2-MG）, albumin （AIb） and immunoglobulin G （IgG） levels in urine with radioimmunoassay （RIA）. Results： （1） The effective rates in the treated group at the 4 time points of observation were all higher than those in the control group respectively （P〈0.05 or P〈0.01）; （2） Less occurrence of abnormal 132-M, AIb and IgG levels on the 14th and 21st day in the treated group took place compared to that in the control group （P〈0.01）; （3） Urinary levels of 13 2-MG, AIb and IgG reached the peak on the 7th day in both groups, and then, they came down gradually and returned to the normal level on the 21 st day. However, comparison between the two groups showed that all the three parameters in the treated group on day 3, 14 and 21 were lower than the respective one at the corresponding time points in the control group （P〈0.05 or P〈0.01）. Conclusion： The chemotherapy damage on nephron is regular in time, and reversible when treated suitably. TCM shows a marked effect in protecting and treating the damage on nephron caused by chemotherapy.展开更多
目的探讨铥激光辅助与传统腹腔镜下保留肾单位手术治疗外生性肾血管平滑肌脂肪瘤(AML)的临床疗效及安全性,为该疾病的治疗提供参考。方法回顾性分析2022年1月—2024年11月中国科学技术大学附属第一医院收治的43例外生性AML患者的病例资...目的探讨铥激光辅助与传统腹腔镜下保留肾单位手术治疗外生性肾血管平滑肌脂肪瘤(AML)的临床疗效及安全性,为该疾病的治疗提供参考。方法回顾性分析2022年1月—2024年11月中国科学技术大学附属第一医院收治的43例外生性AML患者的病例资料,其中铥激光组10例,传统腹腔镜组33例。铥激光组术中均未阻断肾动脉,传统腹腔镜组常规阻断肾动脉。比较两组患者的一般资料、围手术期资料,以评估手术效果。结果43例患者的保留肾单位手术均成功完成,术后病理诊断为AML,无严重并发症发生。两组患者手术时间、术中出血量、术后第1天血红蛋白下降值、术后引流管留置时间及术后住院时间差异均无统计学意义。铥激光组较传统腹腔镜组的热缺血时间更短[0 min vs.(21.88±3.84)min,P<0.01],术后3个月估算肾小球滤过率(eGFR)下降值更少[(0.62±2.42)mL/(min·1.73 m^(2))vs.(5.74±4.84)mL/(min·1.73 m^(2)),P<0.01]。随访4~34个月,所有患者肿瘤均无复发。结论铥激光辅助腹腔镜下保留肾单位手术治疗外生性肾AML安全可行,术中无需阻断肾动脉,对患者肾功能的保护可能有一定优势。展开更多
目的对比研究经腹入路和后腹腔入路腹腔镜下肾部分切除术治疗R.E.N.A.L.评分≥7的肾肿瘤的安全性和可行性,评价手术疗效,对比研究其临床应用价值。方法收集2012年1月至2014年3月R.E.N.A.L.评分≥7的肾肿瘤行经腹入路(32例,经腹组)和后...目的对比研究经腹入路和后腹腔入路腹腔镜下肾部分切除术治疗R.E.N.A.L.评分≥7的肾肿瘤的安全性和可行性,评价手术疗效,对比研究其临床应用价值。方法收集2012年1月至2014年3月R.E.N.A.L.评分≥7的肾肿瘤行经腹入路(32例,经腹组)和后腹腔入路(30例,后腹腔组)腹腔镜下肾部分切除术患者临床资料,观察和记录手术相关参数、术后情况,评价手术疗效,记录并发症,所有患者常规随访。比较两种手术方法的手术时间、术中估计失血量、热缺血时间、术中并发症、输血率、恢复进食时间、住院时间、切缘阳性率等。结果经腹组1例患者转为开放手术,后腹腔组3例转为开放手术,其余患者手术均顺利完成,两组手术在年龄、体重指数、ASA评分,Charlson并发症指数、肿瘤最大径、肾肿瘤R.E.N.A.L评分等方面差异无统计学意义(P>0.05));两组在术中估计失血量、热缺血时间、术中并发症、输血率、切缘阳性率等方面差异无统计学意义(P>0.05);经腹组手术时间较后腹腔组时间较短(210.4±59.2 min vs 252±58.3 min),两者差异有统计学意义(P>0.05)。经腹组恢复进食时间(47±10 h vs 23±6 h)和住院时间(8.4±1.9 d vs 6.5±1.6 d)较后腹腔组时间较长(P<0.05)。结论两种手术入路腹腔镜下肾部分切除术均是治疗R.E.N.A.L.评分≥7的一种安全有效的方法。经腹入路操作空间大,容易暴露和手术操作;腹膜后入路术后恢复较快。展开更多
文摘From January 2008 to January 2013, 11 patients with central renal tumors underwent ultrasound-guided open nephron sparing surgery（ONSS） without renal artery occlusion. We removed the lesions, and the cut edges of the tumors were negative. Thus, we deduced that ultrasound-guided ONSS is suitable for the cases with obscure tumor boundary or multiple lesions. It could achieve the purpose of thoroughly removing lesions, as well as to expand the application range of nephron sparing surgery.
文摘Objective:The aim of the study was to report the experience of National Cancer Institute(NCI),Cairo University,Egypt,in managing various benign and malignant renal tumors with nephron sparing surgery(NSS),and to assess its safety and feasibility.Methods:Reviewing the literature for NSS,and records of patients who underwent NSS in the period from January 2000 to December 2009 at National Cancer Institute,Cairo University regarding the patient and tumor related characteristics,the indication for NSS,operative technique,postoperative complications,full histopathological data,and follow up results.Results:The total number of patients was 17.Mean age at surgery was 30.7 years(range 1.5-65 years).Five patients had bilateral tumors during surgery.The mean tumor size was 4.5 cm(range 1-9 cm).All patients had normal preoperative kidney functions.Seven patients had an absolute indication for NSS,6 patients had a relative indication,and 4 patients had an elective indication.All the 5 patients with bilateral tumors underwent bilateral simultaneous surgery.Cold ischemia was used in 8 patients,1 patient was exposed to warm ischemia,manual compression was used in 2 patients,and no vascular control was applied in 6 patients.Complications were encountered in 2 patients,one of them had urinary leakage which needed reoperation,and the other had subcutaneous hematoma which was treated conservatively.Histopathological analysis revealed Wilm's tumor(8 patients),angiomyolipoma(4 patients),renal cell carcinoma(4 patients),and hydatid cyst(1 patient).All patients had negative surgical margin.For patients with Wilm's tumor,the mean follow up was 21.4 months(range 0-94 months),2 patients had local recurrence,and 1 patient had distant metastasis.For patients with RCC,the mean follow up was 15.3 months(5-33 months),no patients had local recurrence or distant metastasis.All patients had normal kidney functions during postoperative and follow up periods.Conclusion:NSS is a feasible safe procedure that can be done with acceptable complications rate and it provides a good solution for patients with bilateral tumors,early localized renal cell carcinoma,and benign tumors.
文摘Objective：To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods： From August 1 997 to October 2008, 48 cases of small renal cell carcinomas were confirmed by surgery and pathology, and reviewed retrospectively. Of the 48 cases, there was 1 patient with bilateral tumors, 8 with solitary kidney tumors, 1 with unilateral tumor and a damaged contralateral kidney, and 38 with unilateral tumors and a normal contralateral kidney; 9 underwent tumor enucleation and the remaining patients received partial nephrectomy. Results：There were no local tumor recurrences and/or tumor metastasis at a mean followup of 60 months. Conclusion： Confirming conclusions from other centers, we have found that nephron-sparing surgery is an effective treatment for small renal cell carcinomas.
文摘Background Current surgical practice for nephron sparing surgery allows at least 1 cm margin of normal tissue around the tumour. However, recent studies show that the width of the margin is not important, even simple enucleation is as effective as partial nephrectomy. We explored whether margin size has significant impacts on clinical outcomes in nephron sparing surgery for renal cell carcinoma of 4 cm or less. Methods Between 1998 and 2006, 115 patients with sporadic, pathologically confirmed, renal cell carcinoma 4 cm or less （Tla） and normal contralateral kidney were treated by nephron sparing surgery using a margin less than 5 mm. The surgical margin status was evaluated from frozen and permanent paraffin sections. Results Mean and median tumour diameter were 3.3 cm and 3.5 cm （range 1.0-4.0）. The mean margin width was 2.2 mm （median 2.0, range 0-6）. In addition, 114 cases had margins 5 mm or less （99.1%）, 97 cases （84.3%） had margin 3 mm or less, and 26 cases had margin zero （22.6%）. None of the patients had positive surgical margins. No patients died during follow-up （mean 65 months）. There were no any major surgical complications and no distant metastasis was detected. Local recurrence was detected in one case （0.9%） at a different site of the kidney. Conclusions For early localized renal cell carcinoma of 4 cm or less, as long as tumour is completely excised, the size of margin in nephron sparing surgery is not important. Nephron sparing surgery with 5 mm margin is enough for tumour control. It provides excellent renal function preservation, favourable long term progression free survival and is not associated with an increased risk of local recurrence.
文摘Objective： To observe the change of nephron damaged by chemotherapy and to evaluate the effect of Baoshen Mixture （保肾合剂, BSM） in protecting and treating damaged nephrons. Methods： Four hundred tumor patients with normal renal function and ready to receive chemotherapy were randomly assigned to two groups. Both groups received one cycle of chemotherapy program of 28-30 days with conventional hydratization, alkalization and chloridization. To the 200 cases in the treated group BSM was given orally thrice a day, 150 mL every time for 15 successive days and the other 200 cases in the control group were treated by chemotherapy alone. The clinical efficacy was compared after treatment, and the changed condition of damaged nephrons were monitored dynamically and compared at different time points （the 3rd, 7th, 14th and 21st day after chemotherapy） by measuring the micro-globulin 132 （13 2-MG）, albumin （AIb） and immunoglobulin G （IgG） levels in urine with radioimmunoassay （RIA）. Results： （1） The effective rates in the treated group at the 4 time points of observation were all higher than those in the control group respectively （P〈0.05 or P〈0.01）; （2） Less occurrence of abnormal 132-M, AIb and IgG levels on the 14th and 21st day in the treated group took place compared to that in the control group （P〈0.01）; （3） Urinary levels of 13 2-MG, AIb and IgG reached the peak on the 7th day in both groups, and then, they came down gradually and returned to the normal level on the 21 st day. However, comparison between the two groups showed that all the three parameters in the treated group on day 3, 14 and 21 were lower than the respective one at the corresponding time points in the control group （P〈0.05 or P〈0.01）. Conclusion： The chemotherapy damage on nephron is regular in time, and reversible when treated suitably. TCM shows a marked effect in protecting and treating the damage on nephron caused by chemotherapy.
文摘目的探讨铥激光辅助与传统腹腔镜下保留肾单位手术治疗外生性肾血管平滑肌脂肪瘤(AML)的临床疗效及安全性,为该疾病的治疗提供参考。方法回顾性分析2022年1月—2024年11月中国科学技术大学附属第一医院收治的43例外生性AML患者的病例资料,其中铥激光组10例,传统腹腔镜组33例。铥激光组术中均未阻断肾动脉,传统腹腔镜组常规阻断肾动脉。比较两组患者的一般资料、围手术期资料,以评估手术效果。结果43例患者的保留肾单位手术均成功完成,术后病理诊断为AML,无严重并发症发生。两组患者手术时间、术中出血量、术后第1天血红蛋白下降值、术后引流管留置时间及术后住院时间差异均无统计学意义。铥激光组较传统腹腔镜组的热缺血时间更短[0 min vs.(21.88±3.84)min,P<0.01],术后3个月估算肾小球滤过率(eGFR)下降值更少[(0.62±2.42)mL/(min·1.73 m^(2))vs.(5.74±4.84)mL/(min·1.73 m^(2)),P<0.01]。随访4~34个月,所有患者肿瘤均无复发。结论铥激光辅助腹腔镜下保留肾单位手术治疗外生性肾AML安全可行,术中无需阻断肾动脉,对患者肾功能的保护可能有一定优势。
文摘目的对比研究经腹入路和后腹腔入路腹腔镜下肾部分切除术治疗R.E.N.A.L.评分≥7的肾肿瘤的安全性和可行性,评价手术疗效,对比研究其临床应用价值。方法收集2012年1月至2014年3月R.E.N.A.L.评分≥7的肾肿瘤行经腹入路(32例,经腹组)和后腹腔入路(30例,后腹腔组)腹腔镜下肾部分切除术患者临床资料,观察和记录手术相关参数、术后情况,评价手术疗效,记录并发症,所有患者常规随访。比较两种手术方法的手术时间、术中估计失血量、热缺血时间、术中并发症、输血率、恢复进食时间、住院时间、切缘阳性率等。结果经腹组1例患者转为开放手术,后腹腔组3例转为开放手术,其余患者手术均顺利完成,两组手术在年龄、体重指数、ASA评分,Charlson并发症指数、肿瘤最大径、肾肿瘤R.E.N.A.L评分等方面差异无统计学意义(P>0.05));两组在术中估计失血量、热缺血时间、术中并发症、输血率、切缘阳性率等方面差异无统计学意义(P>0.05);经腹组手术时间较后腹腔组时间较短(210.4±59.2 min vs 252±58.3 min),两者差异有统计学意义(P>0.05)。经腹组恢复进食时间(47±10 h vs 23±6 h)和住院时间(8.4±1.9 d vs 6.5±1.6 d)较后腹腔组时间较长(P<0.05)。结论两种手术入路腹腔镜下肾部分切除术均是治疗R.E.N.A.L.评分≥7的一种安全有效的方法。经腹入路操作空间大,容易暴露和手术操作;腹膜后入路术后恢复较快。
