同时性双侧肾脏肿瘤是肾脏肿瘤中少见而复杂的一种情况,发病率为1.8%~11.0%。对于双侧肾脏肿瘤患者,进行手术治疗需要综合考虑肿瘤位置、大小和解剖复杂性、患者的身体状况和目前所患基础疾病、围手术期风险、外科医生的专业知识和技能...同时性双侧肾脏肿瘤是肾脏肿瘤中少见而复杂的一种情况,发病率为1.8%~11.0%。对于双侧肾脏肿瘤患者,进行手术治疗需要综合考虑肿瘤位置、大小和解剖复杂性、患者的身体状况和目前所患基础疾病、围手术期风险、外科医生的专业知识和技能等多方面因素。经评估后可手术治疗的患者应首选保留肾单位的手术(NSS),以尽可能保护肾功能,并降低心血管疾病发病率和全因死亡率。然而,目前国际指南对此类患者的治疗未提出正式的建议,学界对于同期双侧肾脏肿瘤的理想治疗方法尚未形成明确一致的共识,特别是术前是否行肾活检、是行同期手术还是分期手术、先治疗哪一侧的肿瘤等问题仍存在许多争议。为了解决上述存在争议的问题,优化双侧肾肿瘤患者的管理和手术治疗策略,该研究收集并回顾性分析了2008年6月至2019年6月期间接受部分肾切除术(PN)或根治性肾切除术(RN)治疗双侧肾肿瘤的41例患者的资料,对患者人口学和肿瘤学相关特征、手术方式(同期或分期,开放手术或机器人手术)等进行分析。在41例患者中,37例(90.2%)行双侧PN,3例(7.3%)行PN+RN,1例(2.5%)行双侧RN。最常见的肿瘤组织学类型为透明细胞肾细胞癌(62.1%),双侧肿瘤组织学一致率为81.5%。分别有17例患者(41.4%)和24例患者(58.6%)接受了同期和分期手术治疗。分期手术患者的中位手术时间(310比240 min, P =0.01)、热缺血时间(18比10 min, P =0.01)和住院时间(10比6 d, P =0.01)显著长于同期手术患者。而同期与分期手术患者的基线、术后3个月和末次随访的估算肾小球滤过率(eGFR)中位数的差异均无统计学意义( P >0.05)。生存分析表明两组之间的无病生存率差异无统计学意义(82.4%比95.8%, P =0.14)。本研究的结果表明,对于同时性双侧肾脏肿瘤患者,同期和分期手术治疗都是可行和安全的。展开更多
Objectives: (1) To determine a normal range for urinary citrate for term babi es. (2) To compare urinary citrate measured in ex preterm babies at term with th is normal range. (3) To evaluate whether urinary citrate w...Objectives: (1) To determine a normal range for urinary citrate for term babi es. (2) To compare urinary citrate measured in ex preterm babies at term with th is normal range. (3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronic Lung Disease (CLD) in these ex preterm bab ies. Study design: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41weeks) at amean postnatal age of 3 days ( 1- 5 days) and in 53 ex preterm babies ( < 32 weeks gestation at birth) at term . These preterm babies were part of a larger study on NC in which two renal ultr asound scans were performed at 1 month and term. Results: The normal range for u rinary citrate in term babies was 0.025- 2.97 (mean 1.03) mmol/l and citrate/cr eatinine ratio 0.0011- 0.852 (mean 0.27). In the ex- preterm urinary citrate w as not significantly different (mean 1.1 vs. 1.03, p=0.7232)- but urine citrate /creatinine ratio was significantly higher (mean 1.27 vs. 0.27, p=0.0005). There was no significant difference in urinary citrate or ratios of citrate/creatinin e and calcium/citrate in the 11 (20.7% ) with NC or in the 17 (32% ) babies wi th CLD. There was no significant relationship found between duration of TPN and urinary citrate measured at term. Conclusion: We have determined a normal range for urinary citrate in healthy term babies in the first week of life. The range was very wide. Ex preterm babies had similar values at term and there was no ass ociation between urinary citrate and NC or CLD.展开更多
文摘同时性双侧肾脏肿瘤是肾脏肿瘤中少见而复杂的一种情况,发病率为1.8%~11.0%。对于双侧肾脏肿瘤患者,进行手术治疗需要综合考虑肿瘤位置、大小和解剖复杂性、患者的身体状况和目前所患基础疾病、围手术期风险、外科医生的专业知识和技能等多方面因素。经评估后可手术治疗的患者应首选保留肾单位的手术(NSS),以尽可能保护肾功能,并降低心血管疾病发病率和全因死亡率。然而,目前国际指南对此类患者的治疗未提出正式的建议,学界对于同期双侧肾脏肿瘤的理想治疗方法尚未形成明确一致的共识,特别是术前是否行肾活检、是行同期手术还是分期手术、先治疗哪一侧的肿瘤等问题仍存在许多争议。为了解决上述存在争议的问题,优化双侧肾肿瘤患者的管理和手术治疗策略,该研究收集并回顾性分析了2008年6月至2019年6月期间接受部分肾切除术(PN)或根治性肾切除术(RN)治疗双侧肾肿瘤的41例患者的资料,对患者人口学和肿瘤学相关特征、手术方式(同期或分期,开放手术或机器人手术)等进行分析。在41例患者中,37例(90.2%)行双侧PN,3例(7.3%)行PN+RN,1例(2.5%)行双侧RN。最常见的肿瘤组织学类型为透明细胞肾细胞癌(62.1%),双侧肿瘤组织学一致率为81.5%。分别有17例患者(41.4%)和24例患者(58.6%)接受了同期和分期手术治疗。分期手术患者的中位手术时间(310比240 min, P =0.01)、热缺血时间(18比10 min, P =0.01)和住院时间(10比6 d, P =0.01)显著长于同期手术患者。而同期与分期手术患者的基线、术后3个月和末次随访的估算肾小球滤过率(eGFR)中位数的差异均无统计学意义( P >0.05)。生存分析表明两组之间的无病生存率差异无统计学意义(82.4%比95.8%, P =0.14)。本研究的结果表明,对于同时性双侧肾脏肿瘤患者,同期和分期手术治疗都是可行和安全的。
文摘Objectives: (1) To determine a normal range for urinary citrate for term babi es. (2) To compare urinary citrate measured in ex preterm babies at term with th is normal range. (3) To evaluate whether urinary citrate was related to presence of nephrocalcinosis (NC) and chronic Lung Disease (CLD) in these ex preterm bab ies. Study design: Urinary citrate was measured in 38 healthy term babies (mean birth weight 3.52 kg, mean gestation 41weeks) at amean postnatal age of 3 days ( 1- 5 days) and in 53 ex preterm babies ( < 32 weeks gestation at birth) at term . These preterm babies were part of a larger study on NC in which two renal ultr asound scans were performed at 1 month and term. Results: The normal range for u rinary citrate in term babies was 0.025- 2.97 (mean 1.03) mmol/l and citrate/cr eatinine ratio 0.0011- 0.852 (mean 0.27). In the ex- preterm urinary citrate w as not significantly different (mean 1.1 vs. 1.03, p=0.7232)- but urine citrate /creatinine ratio was significantly higher (mean 1.27 vs. 0.27, p=0.0005). There was no significant difference in urinary citrate or ratios of citrate/creatinin e and calcium/citrate in the 11 (20.7% ) with NC or in the 17 (32% ) babies wi th CLD. There was no significant relationship found between duration of TPN and urinary citrate measured at term. Conclusion: We have determined a normal range for urinary citrate in healthy term babies in the first week of life. The range was very wide. Ex preterm babies had similar values at term and there was no ass ociation between urinary citrate and NC or CLD.
