Sporadic gastrinoma with refractory benign esophageal stricture:A case report

BACKGROUND Gastrinoma is characterized by an excessive release of gastrin,leading to hypersecretion of gastric acid,subsequently resulting in recurrent peptic ulcers,chronic diarrhea,and even esophageal strictures.This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture(RBES).Additionally,it highlights the persistent challenges that gastroenterologists encounter in managing RBES.CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy,multiple endoscopic bougie dilations and endoscopic incisional therapy(EIT).CONCLUSION It is essential to diagnose gastrinoma as early as possible,as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures.In patients with esophageal strictures causing complete luminal obstruction,blind reopening EIT presents challenges and carries a high risk of perforation.

Expression of Beta-Human Chorionic Gonadotropin Genes in Renal Cell Cancer and Benign Renal Disease Tissues

To study the expression of beta-human chorionic gonadotropin (βhCG) genes in renal cell carcinomas (RCC) and benign renal disease tissues, nested reverse transcription-polymerase chain reaction (RT-PCR) and restriction endonuclease analysis were employed to detect the expression of βhCG genes in 44 cases of RCC tissues and 24 cases of benign renal disease tissues It was found that 52% RCC samples revealed positive for βhCG mRNA expression Positive rate in advanced stage and poorly differentiated RCC was higher, but there was no significant difference The positive rate of βhCG mRNA expression was 54% in 24 cases of benign renal tissues, including 3 cases out of 6 polycystic kidneys, 7 cases out of 13 renal atrophies, 2 cases out of 2 oncocytomas and 1 case out of 2 pyonephrotic kidneys β7 was most frequently transcribed subtype gene independent on the histology These findings suggested βhCG gene transcription is not only involved in RCC but also in benign renal diseases

KAI1/CD82 gene expression in benign prostatic hyperplasia and late-stage prostate cancer in Chinese

Aim: To evaluate KAII/CD82 expression in Chinese patients with benign prostatic hyperplasia (BPH) and late-stage carcinoma of prostate (CaP). Methods: Thirty Chinese patients with benign prostatic hyperplasia and 34 withCaP (adenocarcinoma clinical stage C and D) were analyzed by means of immunohistochemical methods. Results:The KAII/CD82 expression in BPH tissue was all positive, which was uniformly located on the glandular cell mem-brane at the cell-to-cell borders, but KAII/CD82 expression in metastasis CaP tissues was either significantly lower thanthat of BPH or negative, and the immunostaining pattern was not continuous. In late-stage CAP KAII/CD82 expressionwas correlated inversely to the pathological grade ( P < 0.05), but not to clinical stage ( P > 0.05). Conclusion:The authors believe that decreased and negative KAII/CD82 expression in late-stage CaP may be related to tumor pro-gression and metastasis, and appears to be a prognostic marker.

Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm

AIM:To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy(LSPDP)with autologous islet transplantation(AIT)for benign tumors of the pancreatic body-neck.METHODS:Three non-diabetic,female patients(age37,44 and 35 years,respectively)were declared candidates for surgery,between May and September 2011,because of pancreatic body/neck cystic lesions.The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm.Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin.Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery.RESULTS:The procedure was performed successfully in all the three cases,and the spleen was preserved along with its vessels.Mean operation time was 283±52 min and average blood loss was 133±57 mL.Residual pancreas weights were 33,22 and 30 g,and105.200,40.390 and 94.790 islet equivalents were isolated,respectively.Surgical complications occurred in one patient(grade A pancreatic fistula).Postoperative stays were 6,6 and 7 d,respectively.Histopathological evaluation revealed mucinous cystic neoplasm in cases1 and 3,and serous cystic neoplasm in patient 2.No postoperative insulin administration was required.One patient developed a transient partial portal thrombosis2 mo after islet infusion.Patients are insulin independent at a mean follow up of 8±2 mo.CONCLUSION:Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.

Clinicopathological characteristics and typing of multilocular cystic renal neoplasm of low malignant potential

BACKGROUND Up until now,no research has been reported on the association between the cli-nical growth rate of multilocular cystic renal neoplasm of low malignant potential(MCRNLMP)and computed tomography(CT)imaging characteristics.Our study sought to examine the correlation between them,with the objective of distin-guishing unique features of MCRNLMP from renal cysts and exploring effective management strategies.AIM To investigate optimal management strategies of MCRNLMP.METHODS We retrospectively collected and analyzed data from 1520 patients,comprising 1444 with renal cysts and 76 with MCRNLMP,who underwent renal cyst decom-pression,radical nephrectomy,or nephron-sparing surgery for renal cystic disease between January 2013 and December 2021 at our institution.Detection of MC-RNLMP utilized the Bosniak classification for imaging and the 2016 World Health Organization criteria for clinical pathology.RESULTS Our meticulous exploration has revealed compelling findings on the occurrence of MCRNLMP.Precisely,it comprises 1.48%of all cases involving simple renal cysts,5.26%of those with complex renal cysts,and a noteworthy 12.11%of renal tumors coexisting with renal cysts,indicating a statistically significant difference(P=0.001).Moreover,MCRNLMP constituted a significant 22.37%of the patient po-pulation whose cysts demonstrated a rapid growth rate of≥2.0 cm/year,whereas it only represented 0.66%among those with a growth rate below 2.0 cm/year.Of the 76 MCRNLMP cases studied,none of the nine patients who underwent subsequent nephron-sparing surgery or radical nephrectomy following renal cyst decompression experienced recurrence or metastasis.In the remaining 67 patients,who were actively monitored over a 3-year postoperative period,only one showed suspicious recurrence on CT scans.CONCLUSION MCRNLMP can be tentatively identified and categorized into three types based on CT scanning and growth rate indicators.In treating MCRNLMP,partial nephrectomy is preferred,while radical nephrectomy should be minimi-zed.After surgery,active monitoring is advisable to prevent unnecessary nephrectomy.

Systematic review of ablative therapy for the treatment of renal allograft neoplasms

BACKGROUND To date,there are no guidelines on the treatment of solid neoplasms in the transplanted kidney.Historically,allograft nephrectomy has been considered the only reasonable option.More recently,nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected cases.AIM To review outcomes of AT for the treatment of renal allograft tumours.METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 Checklist.PubMed was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA),cryoablation (CA),microwave ablation (MWA),high-intensity focused ultrasound (HIFU),and irreversible electroporation (IRE) of solid tumours of the kidney allograft.Only original manuscripts describing actual cases and edited in English were considered.All relevant articles were accessed in full text.Additional searches included all pertinent references.Selected studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa scale.Data on recipient characteristics,transplant characteristics,disease characteristics,treatment protocols,and treatment outcomes were extracted and analysed.Given the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series),a descriptive summary was provided.RESULTS Twenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 patients.Recipient age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 mo.Most of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical reasons.Preferred diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan,and magnetic resonance imaging.Main tumour types were: papillary renal cell carcinoma (RCC) and clear cell RCC.Maximal tumour diameter ranged from 5 to 55 mm.The vast majority of neoplasms were T1a N0 M0 with only 2 lesions staged T1b N0 M0.Neoplasms were managed by RFA (n = 78),CA (n = 15),MWA (n = 3),HIFU (n = 3),and IRE (n = 1).Overall,3 episodes of primary treatment failure were reported.A single case of recurrence was identified.Follow-up ranged from 1 to 81 mo.No cancer-related deaths were observed.Complication rate was extremely low (mostly < 10%).Graft function remained stable in the majority of recipients.Due to the limited sample size,no clear benefit of a single procedure over the other ones could be demonstrated.CONCLUSION AT for renal allograft neoplasms represents a promising alternative to radical nephrectomy and NSS in carefully selected patients.Properly designed clinical trials are needed to validate this therapeutic approach.

Robot-Assisted Nephrotomy as a Nephron-Sparing Approach for Completely Intraparenchymal Renal Tumors

Introduction: The diagnosis of small renal masses and the endophytic tumor approach have become challenging. This study aims to describe exclusively robot-assisted surgery as an alternative nephron-sparing approach for renal intraparenchymal tumors. Patients and Methods: We retrospectively analyzed all patients with completely endophytic tumors undergoing robot-assisted partial nephrectomy, treated under the Da Vinci System®, aided by intraoperative ultrasound. The patients’ demographic characteristics, perioperative and oncological outcomes were assessed. Results: From a total of 13 partial nephrectomies performed between 06/2010 and 10/2021, all patients underwent nephrotomy. The patients’ mean age was 52 years and the tumor measured mean 2.6 cm. Warm ischemia time was 24 minutes and histopathological analysis revealed that 12 patients had renal cell carcinoma. In a mean 36-month follow-up, no significant renal function alterations were found and no local or systemic recurrences occurred. Conclusion: Robot-assisted access is a safe and effective option for the nephron-sparing technique in completely intraparenchymal renal tumors.

外阴良性肿瘤的病理特征及临床分析

目的 探讨外阴良性肿瘤的临床特点、病理特征及治疗预后,总结相关的临床诊治经验。方法 收集2018年1月至2022年12月因外阴肿物收入首都医科大学附属北京妇产医院妇科微创中心住院治疗的24例经病理检查证实为外阴良性肿瘤患者的临床及病理资料进行回顾性分析。探讨发病年龄、临床症状体征、肿物性状特点、病理类型、治疗及转归情况。结果 24例患者中仅2例(8.3%)为多发病灶,其余患者均为单发。发病年龄为14~78岁,中位发病年龄为38岁,围绝经期患者2例(8.3%)。所有患者表现为自触和/或在妇科检查时发现外阴肿物,有2例伴异味及破溃;病程为2周~70年;3例表现为外阴囊性肿物,21例表现为外阴实性肿物(包括8例外阴皮赘),包块大小为0.5~8 cm。术后病理诊断为外阴软纤维瘤者8例,平滑肌瘤4例,外阴皮内痣、纤维瘤、乳头状汗腺腺瘤、血管肌纤维母细胞瘤各2例,多发鳞状细胞乳头状瘤、脂肪瘤、细胞性血管纤维瘤、孤立性纤维性肿瘤各1例。除1例外阴多发鳞状细胞乳头状瘤患者行单纯外阴切除术,其余患者均采用局部病灶切除术。术后随访3个月~5年,均未见复发。结论 外阴良性肿瘤多为单发,实性肿物多见,常无明显自觉症状,病理类型呈多样性,预后较好,建议尽早手术切除,术后加强随访。

MSCT对乏脂肾血管平滑肌脂肪瘤与非透明细胞肾癌的鉴别诊断

目的分析乏脂肾血管平滑肌脂肪瘤(乏脂AML)与非透明细胞肾癌(肾乳头状细胞癌、嫌色细胞癌)的CT特征,提高病变的鉴别诊断效能。方法回顾性分析经手术病理证实乏脂AML19例、肾乳头状细胞癌(PRCC)16例及肾嫌色细胞癌(ChRCC)22例。测量肿瘤四期(平扫期、皮髓质期、实质期及排泄期)相同ROI的CT值及健侧肾皮质CT值,计算肿瘤强化百分比、多期相净增值、相对强化比并进行统计学分析。结果乏脂AML在平扫期及皮髓质期CT值高于PRCC与ChRCC的CT值,差异均有统计学意义(均P<0.05),在实质期及排泄期,乏脂AML与两者比较差异无统计学意义(均P>0.05)。乏脂AML在皮髓质期、实质期和排泄期的强化百分比高于PRCC、ChRCC,差异均有统计学意义(均P<0.05)。乏脂AML与PRCC、ChRCC在皮髓质期及实质期多期相净增值、相对强化比的差异均有统计学意义(均P<0.05),在排泄期差异无统计学意义(P>0.05)。结论乏脂AML与非透明细胞癌平扫及增强扫描有其特征性CT表现,强化百分比、多期相净增值、相对强化比可进一步提高AML与非透明细胞肾癌的诊断及鉴别诊断能力。

具有低度恶性潜能的多房囊性肾肿瘤的临床病理特征及预后

目的:分析具有低度恶性潜能的多房囊性肾肿瘤(multilocular cystic renal neoplasm of low malignant potential,MCRNLMP)患者的临床病理特征与预后,对比接受不同手术方式的具有低度恶性潜能的多房囊性肾肿瘤患者的临床病理特征。方法:回顾性收集2010年1月至2023年9月北京大学第三医院收治的行根治性肾切除术或者保留肾单位手术且术后病理明确为具有低度恶性潜能的多房囊性肾肿瘤患者的临床资料,获取其基本临床特征、术后病理结果及预后。根据手术方式将患者分为根治性肾切除术组及保留肾单位手术组,并比较两组患者的临床病理特征差异。结果:共纳入35例患者,诊断时的中位年龄为53.0(39.0~62.0)岁,其中23例为男性(65.7%),12例为女性(34.3%)。9例患者接受了根治性肾切除术(25.7%),26例患者接受了保留肾单位手术(74.3%)。35例患者的临床T分期均未超过T2a期。中位手术时间145.0 min,中位估计术中出血量20.0 mL。术后中位住院天数6.0 d。术后病理结果均未提示肾窦侵犯、肉瘤样变、肾上腺侵犯及淋巴结侵犯。将患者根据手术方式分为保留肾单位手术组和根治性肾切除术组,并对两组的临床病理特征进行对比,差异均无统计学意义。除1例患者失访外,其余患者均获随访,随访时间8~111个月,中位随访时间70.5个月,仅1例患者因非肿瘤原因死亡,其余患者均无肿瘤转移或复发。结论:具有低度恶性潜能的多房囊性肾肿瘤患者的预后较好;对于具有低度恶性潜能的多房囊性肾肿瘤,接受保留肾单位手术和根治性肾切除术的患者临床病理学特征差异无统计学意义。

单孔腹腔镜与传统腹腔镜肾切除术治疗局限性肾癌的疗效比较:术后随访至少10年的配对研究

目的比较单孔腹腔镜根治性肾切除术(LESS-RN)与传统腹腔镜根治性肾切除术(CL-RN)后至少10年的局限性肾癌患者肿瘤疗效和肾功能结局。方法选取2009-2012年在海军军医大学(第二军医大学)第一附属医院接受LESS-RN或CL-RN治疗的T1a~T2a期局限性肾癌患者,按患者年龄、BMI、肿瘤大小进行倾向评分匹配,共纳入31对患者,分析患者的基线特征、手术数据、病理结果和随访信息,以评估LESS-RN和CL-RN的长期预后差异。结果LESS-RN组与CL-RN组患者在手术时间[(179.7±43.0)min vs(172.6±50.9)min,P=0.349]、估计失血量[100(50,200)mL vs 100(50,150)mL,P=0.871]、住院时间[6(5,7)d vs 7(6,9)d,P=0.080]方面差异均无统计学意义。LESS-RN组有1例患者发生术中并发症,没有患者发生术后并发症;CL-RN组有1例患者发生术中并发症,3例患者发生术后并发症。LESS-RN组随访时间为(138.0±9.0)个月,CL-RN组为(137.8±9.8)个月(P=0.730)。LESS-RN组与CL-RN组患者总生存率(80.6%vs 74.2%,P=0.181)、肿瘤特异性生存率(93.6%vs 96.8%,P=0.554)、血肌酐变化水平[32(17,45)μmol/L vs 20(5,47)μmol/L,P=0.098]和估算的肾小球滤过率[(60.2±20.9)mL·min^(-1)·(1.73 m^(2))^(-1) vs(66.7±27.8)mL·min^(-1)·(1.73 m^(2))^(-1),P=0.342]差异均无统计学意义。结论LESS-RN是一种安全、可行的治疗局限性肾癌的手术方法,其长期肿瘤疗效和肾功能结局与CL-RN相当。

增强CT中病灶皮质衰减比在小肾肿瘤良恶性鉴别诊断中的应用研究

目的提出全新参数—病灶皮质衰减比;并讨论其在增强CT中小肾肿瘤(病灶直径<4cm)的良恶性鉴别诊断中的临床应用价值。方法回顾性收集我院及四川省人民医院肾脏肿瘤患者的术前多期增强CT 70例。由两名有临床诊断经验的放射科医生采用双盲法分别记录肾脏肿瘤增强CT中的典型影像征象(边缘形态、强化类型、血管侵犯、肾周脂肪侵犯等)。并于肿瘤及邻近肾皮质区域分别选取感兴趣区域,计算病灶皮质衰减比。观察以上指标在小肾脏肿瘤不同良恶性亚型(肾嗜酸细胞腺瘤、平滑肌瘤、透明状细胞癌、乳头状细胞癌)间的表现。结果不同于恶性肾脏肿瘤,本研究中全部的良性肾脏肿瘤均呈现边缘清晰、无血管或肾周脂肪侵犯。肾嗜酸细胞腺瘤的病灶皮质衰减比与透明状细胞癌(P<0.05)和乳头状细胞癌(P<0.05)均有统计学差异。结论肾脏增强CT中病灶皮质衰减比可将有代表性的肾细胞癌(肾透明状细胞癌)与良性肿瘤(肾嗜酸细胞腺瘤)显著分层。具有临床应用价值。

IDEAL-IQ序列在乳腺肿块良恶性鉴别诊断中的应用价值探究

目的 探讨非对称回波最小二乘估算法迭代水脂分离序列(iterative decomposition of water and fat with echo asymmetrical and least-squares estimation quantitation sequence, IDEAL-IQ)来源的R2^(*)值在乳腺良恶性肿瘤鉴别诊断中的价值,并与传统多回波T2^(*)梯度回波(gradient recalled echo, GRE)序列来源的R2^(*)值进行比较。材料与方法 回顾性分析2021年9月至2023年10月在中国医科大学附属第一医院连续收治的42名患者的50个良性肿瘤病灶,在本院影像归档和通信系统(picture archiving and communication systems, PACS)中使用倾向性评分匹配方法匹配肿瘤所在最大层面的最长径,按1∶3的比例纳入150名患者的150个恶性肿瘤病灶。将恶性肿瘤根据预后因子[雌激素受体(estrogen receptor, ER)、孕激素受体(progesterone receptor, PR)以及人表皮生长因子受体2(human epidermal growth factor receptor 2, HER-2)]的阳性/阴性表达情况进行分组。所有患者均接受包含IDEAL-IQ和多回波T2*GRE序列的多参数MRI,测量以下定量参数:IDEAL-IQ序列R2^(*)值(R2^(*)IDEAL)、多回波T2*GRE序列R2^(*)值(R2^(*)GRE)、表观扩散系数(apparent diffusion coefficient, ADC)及肿瘤长径。根据原始资料类型的不同,分别利用单因素分析(独立样本t检验、Mann-Whitney U检验等方法)对比分析各参数的差异。采用Spearman相关性分析R2^(*)IDEAL与R2^(*)GRE及二者与ADC的相关性。采用配对样本t检验比较R2^(*)IDEAL与R2^(*)GRE的差异。采用logistic回归分析建立联合诊断模型,并使用受试者工作特征(receiver operating characteristic, ROC)曲线及曲线下面积(area under the curve,AUC)分析单独及联合参数鉴别乳腺肿瘤良恶性的效能。结果 相关性分析显示乳腺肿瘤患者的R2^(*)IDEAL与R2^(*)GRE呈中度相关(r=0.763,P<0.001),二者与ADC值均呈负性弱相关[r=-0.300(R2^(*)IDEAL),-0.306(R2^(*)GRE),P<0.001]。良性组与恶性组中,R2^(*)IDEAL与R2^(*)GRE均呈中度相关(r=0.745、0.680,P<0.001),二者与ADC均无相关性。两种序列所得的R2^(*)值差异有统计学意义(P<0.001)。R2^(*)IDEAL在良恶性组间差异有统计学意义(P<0.001),管腔HER-2阴性型R2^(*)值最高。对于单一参数,ADC值鉴别良恶性的AUC最高(0.857);对于联合参数,R2^(*)IDEAL+ADC鉴别良性组与管腔阴性组的AUC最高(0.927);差异均有统计学意义(P<0.05)。结论 IDEAL-IQ序列生成的R2^(*)值可用于区分良恶性乳腺肿块,可能成为除ADC外辅助乳腺肿瘤良恶性鉴别的又一无需对比剂参数。

肾血管平滑肌脂肪瘤合并肾静脉瘤栓行保肾手术治疗1例并文献复习

目的 探讨肾血管平滑肌脂肪瘤合并肾静脉瘤栓行肾部分切除术加瘤栓取出术的治疗效果。方法 总结合肥市滨湖医院2021年10月收治的1例肾血管平滑肌脂肪瘤合并肾静脉瘤栓病人的手术治疗方案。结果 病人术前行腹部增强磁共振加三维重建提示左肾占位(大小约51 mm×36 mm×55 mm)、左肾静脉瘤栓,考虑血管平滑肌脂肪瘤。于2021年10月21日行左肾部分切除术+肾静脉瘤栓取出术,病人术后第1天复查肾功能肌酐提示113μmol/L,术后4 d拔出肾周引流管,1周后拆线出院。病理结果:左肾肿瘤及肾静脉瘤栓均为血管平滑肌脂肪瘤。术后3个月复查肾功能提示69μmol/L。结论 合并静脉瘤栓的肾错构瘤病人通过个体化治疗,制定详细手术方案,可行保肾手术,病人受益更大。

Current considerations for the surgical management of gallbladder adenomas

Gallbladder adenomas are rare lesions(0.5%)associated with potential malignant transformation,particularly with gallbladder adenomas that are≥1 cm in size.Early detection and management are crucial for preventing lethal carcinoma de-velopment.These polyps can often be distinguished from the more often nonneo-plastic cholesterol pseudopolyps(5%-10%),which are benign.Ultrasonography is the first-line tool for initial diagnosis and follow-up when indicated.The question is whether cholecystectomy is always necessary for all adenomas.The manage-ment of gallbladder adenomas is determined according to the size of the tumor,the growth rate of the tumor,the patient’s symptoms and whether risk factors for malignancy are present.Adenomas≥1 cm in size,an age>50 years and a familial history of gallbladder carcinoma are indications for immediate laparoscopic chole-cystectomy.Otherwise,ultrasound follow-up is indicated.For adenomas 6-9 mm in size,the absence of≥2 mm growth at 6 months,one year,and two years,as well as an adenoma sized<5 mm without existing risk factors indicates that no further surveillance is required.However,it would be preferable to individualize the management in doubtful cases.Novel interventional modalities for preserving the gallbladder need further evaluation,especially to determine the long-term outcomes.

超声灰阶比值鉴别≤4 cm的肾透明细胞癌和肾血管平滑肌脂肪瘤的价值

目的:探讨超声灰阶比值(UGSR)鉴别≤4 cm的肾透明细胞癌(ccRCC)和肾血管平滑肌脂肪瘤(RAML)的价值。方法:回顾分析≤4 cm的101例ccRCC和98例RAML超声影像资料,采用RADinfo系统测量病灶、肾皮质、肾窦的灰阶值,计算c-UGSR(病灶灰阶值/肾皮质灰阶值)和s-UGSR(病灶灰阶值/肾窦灰阶值)。构建受试者工作特征(ROC)曲线,计算c-UGSR、s-UGSR最佳阈值并分析联合诊断的诊断效能。评估两名研究者间UGSR一致性。结果:ccRCC和RAML病灶的c-UGSR分别为1.170(0.890,1.430)和1.840(1.458,2.283)(Z=-8.666,P<0.05),s-UGSR分别为0.680(0.500,0.825)和1.090(0.878,1.248)(Z=-8.585,P<0.05)。c-UGSR、s-UGSR诊断ccRCC的ROC曲线下面积(AUC)分别为0.856和0.852,最佳阈值分别为1.67和0.85,敏感度和特异度分别为92.1%和63.3%、80.2%和78.6%。两者联合诊断ccRCC的AUC为0.884,敏感度和特异度分别85.2%和80.6%。与c-UGSR、s-UGSR相比,两者联合诊断效能最大(Z=2.016、2.467,P均<0.05)。两名研究者间c-UGSR、s-UGSR一致性较好(ICC=0.810、0.845,P均<0.05)。结论:UGSR能更客观、准确评价≤4 cm的ccRCC和RAML,且可重复性较强。

大体积肾癌经腹入路与经后腹腔入路腹腔镜根治性切除术的效果比较

目的:比较经腹入路与经后腹腔入路腹腔镜手术在大体积肾癌中的效果。方法:选取大体积肾癌病人60例,分为经腹腔入路手术组(经腹腔组)和经后腹腔入路手术组(经后腹腔组),比较2组病人临床指标及术后并发症发生率。结果:经腹腔组的手术时间、术后通气时间、术后住院时间均短于经后腹腔组,术后24 h疼痛评分低于经后腹腔组,但出血量高于经后腹腔组,差异均有统计学意义(P<0.05~P<0.01),2组术后并发症差异无统计学意义(P>0.05)。结论:2种手术方式在治疗大体积肾癌中均安全、有效。但经腹入路的的手术时间更短,术后更早通气,恢复更快,值得选择。

肾脏小乏脂血管平滑肌脂肪瘤的MSCT特征分析

目的:分析肾脏小乏脂血管平滑肌脂肪瘤(AML)的多层螺旋CT(MSCT)影像学特征,以提高术前诊断准确率。方法:回顾性分析20例经手术病理证实的肾脏小乏脂型AML患者的影像资料,所有患者均接受MSCT平扫及增强检查。由2名高年资影像诊断医师对所有患者的MSCT图像进行分析,总结肾脏小乏脂AML的影像学特征。结果:20例均为单肾发病,其中1例为右肾多发病灶。平扫期19例(95%)病灶相较于周围正常肾实质呈稍高密度。病灶实质的平均CT值为(47.88±12.11)HU,周围正常肾实质的平均CT值为(32.83±11.58)HU,两者间的差异具有统计学意义(P<0.05)。病灶在皮质期及实质期的平均CT值分别为(103.77±23.12)HU、(115.32±27.32)HU,两者间没有统计学差异(P>0.05)。13例(65%)病灶实质呈明显强化,15例(75%)病灶实质呈持续性强化,4例(20%)病灶实质呈渐进性强化,仅1例(5%)病灶实质呈“快进快出”的强化方式。14例(70%)可见“劈裂征”,16例(80%)可见“皮质掀起征”,12例(60%)两征同时出现。结论:小乏脂AML在MSCT图像上平扫密度显著高于周围正常肾实质、增强扫描呈持续强化的特点,以及病灶边缘的“劈裂征”、“皮质掀起征”等有助于定性诊断。

多模态超声鉴别诊断肾实性肿块良恶性的临床价值

目的应用CDFI、超微血管成像(SMI)、超声造影(CEUS)鉴别诊断肾实性肿块良恶性,探讨多模态超声的临床应用价值。方法选取我院病理证实的肾实性肿块患者59例,均为单发病灶,其中良性13例,恶性46例,均行CDFI、SMI及CEUS检查,比较各方法及多模态超声鉴别诊断肾实性肿块良恶性的灵敏度、特异度、准确率。绘制受试者工作特征(ROC)曲线分析各方法及多模态超声对肾实性肿块良恶性的鉴别诊断效能。结果59例患者中,CDFI诊断良性25例,恶性34例,灵敏度67.39%,特异度76.92%,准确率69.49%;SMI诊断良性20例,恶性39例,灵敏度80.43%,特异度84.62%,准确率81.36%;CEUS诊断良性28例,恶性31例,灵敏度60.87%,特异度76.92%,准确率64.41%;多模态超声诊断良性13例,恶性46例,灵敏度93.48%,特异度76.92%,准确率89.83%。ROC曲线分析结果显示,CDFI、SMI、CEUS鉴别诊断肾实性肿块良恶性的曲线下面积(AUC)分别为0.722、0.825、0.689,多模态超声鉴别诊断的AUC为0.852。结论多模态超声对肾实性肿块良恶性的鉴别诊断具有一定的临床应用价值。

超声造影对局灶性睾丸病变诊断价值的meta分析

目的系统评价超声造影(contrast-enhanced ultrasound,CEUS)对局灶性睾丸病变的诊断价值。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方、维普(VIP)数据库,收集从建库至2023年8月10日发表的关于CEUS诊断局灶性睾丸病变的相关文献,根据纳入和排除标准筛选文献、提取数据,并行文献质量评价,采用RevMan5.4、Meta disc1.4及Stata15.0软件分析CEUS在睾丸肿瘤与肿瘤样病变、肿瘤良恶性两个方面的诊断效能。结果最终纳入13篇文献共712个病灶。Meta分析结果显示,CEUS诊断睾丸肿瘤与肿瘤样病变的合并敏感度、特异度、阳性似然比、阴性似然比分别为0.95(95%CI:0.87~0.98)、0.84(95%CI:0.73~0.91)、5.8(95%CI:3.3~10.2)、0.06(95%CI:0.02~0.17),合并受试者工作特征曲线下面积为0.94(95%CI:0.92~0.96);CEUS诊断睾丸良恶性病变的合并敏感度、特异度、阳性似然比、阴性似然比分别为0.95(95%CI:0.85~0.99)、0.81(95%CI:0.65~0.90)、4.9(95%CI:2.5~9.6)、0.06(95%CI:0.02~0.20),合并受试者工作特征曲线下面积为0.96(95%CI:0.94~0.97)。结论CEUS对局灶性睾丸病变具有较高的诊断价值,能为临床诊疗提供参考。