重复肾是泌尿系统常见的先天性畸形疾病,常合并异位输尿管末端囊肿、上位肾积水及输尿管扩张等.完全性重复肾畸形合并同侧肾盂癌及异位输尿管末端囊肿临床少见.我科收治了1例完全性重复肾合并同侧肾盂癌及异位输尿管末端囊肿患者,现报道如下.

Objective:To investigate the expression of human cartilage glycoprotein 39 (YKL-40) in renal clear cell carcinoma and peripheral blood, and to analyze its correlation with prognosis.Methods:A total of 110 patients who underwent radical nephrectomy were enrolled as the observation group, and 50 patients with normal physical examination results were enrolled as the control group. The renal clear cell carcinoma tissues and adjacent tissues were taken after operation, and the expression level of YKL-40 mRNA was detected by real-time fluorescent quantitative polymerase chain reaction (FQ-PCR).Results:The level of YKL-40 [(186.9±15.7) μg/L] in the peripheral blood of the observation group before surgery was significantly higher than that of the control group [(115.1±12.5) μg/L] and after surgery [(146.3±13.5) μg/L, t=20.565, 28.478, P<0.05]. There was a correlation between YKL-40 in peripheral blood and lymph node metastasis ( t=5.047, P<0.05). A total of 98 patients were followed up. The success rate was 89.1%, the median follow-up time was 47.5 months, and the 3-year survival rate was 62.34%. Patients with elevated YKL-40 in peripheral blood had shorter OS than patients with reduced blood YKL-40 ( χ2=6.296, P<0.05), while there was no significant difference in YKL-40 in cancer tissues and OS ( χ2=0.030, P>0.05). Multivariate Cox analysis showed that Fuhrman classification [ OR(95% CI): 2.335(1.359-10.656)], lymph node metastasis [ OR(95% CI): 1.854(1.289-7.659)] and peripheral blood YKL-40 [ OR(95% CI): 1.335(1.185-6.987)] were independent factors of OS ( P<0.05). Conclusion:The level of YKL-40 in peripheral blood of patients with renal clear cell carcinoma is elevated and closely related to OS, which may be a prognostic marker. There was no increase in the level of YKL-40 in cancer tissues, and serum YKL-40 may not be derived from cancer cells.

经尿道膀胱肿瘤切除术是非肌层浸润性膀胱癌重要的诊断方法,同时也是主要的治疗手段[1].经典手术方法是膀胱肿瘤电切除,此手术方式有诱发闭孔反射可能,特别是侧壁肿瘤电切过程中强烈的闭孔反射可以导致膀胱穿孔[2-3];另外普通电切存在出血、电切深度不易掌控、标本碎片化不利于病理分期等弊端.我们从2016年受等离子前列腺剜除术的启发,开始尝试做等离子膀胱肿瘤整块剜除术,对于膀胱侧壁肿瘤,辅助闭孔神经阻滞麻醉,最终发现此手术方法安全有效.现报告如下.

肾盂肾盏肿瘤的常见症状为肉眼血尿[1],出现此症状时可以引起临床医生的足够重视.而对于临床症状为非肉眼血尿者,特别是患者同时合并有腰疼,影像学检查又提示有结石、积液时,容易漏诊.我院泌尿外科 2015 年 3 月至 2017年 8 月期间共收治非肉眼血尿为首发症状的肾盂肾盏肿瘤4例,现报告如下.

未分类肾细胞癌(unclassified renal cell carcinoma,URCC)是一类相当罕见的肾脏恶性肿瘤,指病理学上不能将其归类为任何已知病理类型的肾细胞癌.有学者最早在1997年提出URCC这一概念,而后2004年WHO正式将其定义为一种单独病理类型的肾细胞癌[1].武汉协和医院泌尿外科2017年收治1例URCC,现报告并讨论如下.