目的：热缺血时间对肾部分切除术后肾功能的影响仍然存在争议,探讨热缺血时间对肾部分切除术后长期肾功能的影响.方法：回顾性研究海德堡大学医学院泌尿外科1984年8月~2011年7月收治75名孤立肾患者实施的83例肾部分切除术,评估热缺血时...目的：热缺血时间对肾部分切除术后肾功能的影响仍然存在争议,探讨热缺血时间对肾部分切除术后长期肾功能的影响.方法：回顾性研究海德堡大学医学院泌尿外科1984年8月~2011年7月收治75名孤立肾患者实施的83例肾部分切除术,评估热缺血时间、术前肾功能基线水平、切除的正常肾组织体积对术后长期肾功能水平和变化的影响.结果：平均术前肾功能57.41 ml/mi n per 1.73 m2,平均热缺血时间为18.04 mi n ,平均切除的正常肾组织体积为18.79 c m3,平均随访时间69.39个月.多因素分析不同术前肾功能基线水平的各组在术后12个月时差异有统计学意义(P ＝0.01)；围手术期的急性肾衰竭事件明显而持续影响术后的肾功能水平(12个月 P ＝0.001,60个月 P ＝0.03)；而热缺血时间各分组和切除的正常肾组织体积与术后肾功能水平无关联.围手术期急性肾衰竭事件在术后12个月时明显影响术后肾功能的变化(P ＜0.01),切除的正常肾组织体积各组在整个随访期均保持显著差异(12个月 P ＝0.03,36个月 P ＜0.01,60个月 P ＜0.01).结论：术前肾脏质量和术后肾脏的体积是最重要的术后长期肾功能危险因素,术前肾功能基线水平决定术后肾功能的水平,术后存留的肾脏体积决定术后肾功能恢复的能力；围手术期急性肾衰竭事件是新发现的术后长期肾功能的风险因子；热缺血时间虽然与术后长期肾功能无直接关联,但可以通过增加围手术期急性肾衰竭事件的风险间接影响术后肾功能的水平和恢复能力.展开更多
Objectives: To evaluate treatment and prognosis of collecting duct renal cell carcinoma (CDRCC) in three institutions. Methods: The data of CDRCC patients were collected retrospectively from 3 participating institutio...Objectives: To evaluate treatment and prognosis of collecting duct renal cell carcinoma (CDRCC) in three institutions. Methods: The data of CDRCC patients were collected retrospectively from 3 participating institutions. Results: A total of 24 patients were identified in 3 institutions with an incidence of 0.5% - 0.6%. Among them, the median age was 63.0 years and male gender was predominant (66.7%). At least 45.7% (11/24) of the patients were symptomatic at presentation. Moreover, distant metastasis at initial diagnosis was present in 13 patients (54.2%) and 6 patients (25.0%) developed distant metastasis during the course of disease. Almost all these patients were at high stage (87.5%) and poorly differentiated (79.2%). Besides, nodal involvement and major vein extension were observed in 14 (58.3%) and 10 (41.7%) patients, respectively. All the patients in this cohort underwent surgery with a median cancer specific survival of 11.3 months. Of the 14 patients with chemotherapy, gemcitabine/cisplatin was dominantly given in 6 patients (42.9%). Conclusions: CDRCC is rarely seen. Most of CDRCC patients had advanced stage, high nuclear grade, regional nodal involvement, distant metastasis at presentation and consequent poor prognosis. To date, no standard protocol for the treatment of CDRCC exists. Current standard in systemic therapy of CDRCC is chemotherapy with gemcitabine and cisplatin.展开更多
文摘目的：热缺血时间对肾部分切除术后肾功能的影响仍然存在争议,探讨热缺血时间对肾部分切除术后长期肾功能的影响.方法：回顾性研究海德堡大学医学院泌尿外科1984年8月~2011年7月收治75名孤立肾患者实施的83例肾部分切除术,评估热缺血时间、术前肾功能基线水平、切除的正常肾组织体积对术后长期肾功能水平和变化的影响.结果：平均术前肾功能57.41 ml/mi n per 1.73 m2,平均热缺血时间为18.04 mi n ,平均切除的正常肾组织体积为18.79 c m3,平均随访时间69.39个月.多因素分析不同术前肾功能基线水平的各组在术后12个月时差异有统计学意义(P ＝0.01)；围手术期的急性肾衰竭事件明显而持续影响术后的肾功能水平(12个月 P ＝0.001,60个月 P ＝0.03)；而热缺血时间各分组和切除的正常肾组织体积与术后肾功能水平无关联.围手术期急性肾衰竭事件在术后12个月时明显影响术后肾功能的变化(P ＜0.01),切除的正常肾组织体积各组在整个随访期均保持显著差异(12个月 P ＝0.03,36个月 P ＜0.01,60个月 P ＜0.01).结论：术前肾脏质量和术后肾脏的体积是最重要的术后长期肾功能危险因素,术前肾功能基线水平决定术后肾功能的水平,术后存留的肾脏体积决定术后肾功能恢复的能力；围手术期急性肾衰竭事件是新发现的术后长期肾功能的风险因子；热缺血时间虽然与术后长期肾功能无直接关联,但可以通过增加围手术期急性肾衰竭事件的风险间接影响术后肾功能的水平和恢复能力.
文摘Objectives: To evaluate treatment and prognosis of collecting duct renal cell carcinoma (CDRCC) in three institutions. Methods: The data of CDRCC patients were collected retrospectively from 3 participating institutions. Results: A total of 24 patients were identified in 3 institutions with an incidence of 0.5% - 0.6%. Among them, the median age was 63.0 years and male gender was predominant (66.7%). At least 45.7% (11/24) of the patients were symptomatic at presentation. Moreover, distant metastasis at initial diagnosis was present in 13 patients (54.2%) and 6 patients (25.0%) developed distant metastasis during the course of disease. Almost all these patients were at high stage (87.5%) and poorly differentiated (79.2%). Besides, nodal involvement and major vein extension were observed in 14 (58.3%) and 10 (41.7%) patients, respectively. All the patients in this cohort underwent surgery with a median cancer specific survival of 11.3 months. Of the 14 patients with chemotherapy, gemcitabine/cisplatin was dominantly given in 6 patients (42.9%). Conclusions: CDRCC is rarely seen. Most of CDRCC patients had advanced stage, high nuclear grade, regional nodal involvement, distant metastasis at presentation and consequent poor prognosis. To date, no standard protocol for the treatment of CDRCC exists. Current standard in systemic therapy of CDRCC is chemotherapy with gemcitabine and cisplatin.
