泌尿男生殖系统肿瘤1课件.ppt
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- 泌尿 生殖系统 肿瘤 课件
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1、1泌尿男生殖系统肿瘤 厦门大学附属中山医院2Kidney Cancer What is a kidney and what function does it serve? What is kidney cancer? How common is kidney cancer and who gets it? How is kidney cancer diagnosed? Does kidney cancer run in families? How is kidney cancer treated? 肾癌 肾脏及其功能 肾癌的概念 肾癌的流行病学 肾癌的诊断 肾癌的家族性相关因素 肾癌的治疗3
2、What is a kidney and what function does it serve? Normally people have two kidneys located in the upper back on the right and left side. The typical adult kidney weighs 150 grams in men and the 135 grams in women. 肾脏及其功能正常情况下,人的腰背部左右两侧各有一个肾脏。成年人的一个肾脏在男性重约150克,在女性重约135克。4 The kidneys primary function
3、 is filtration of excess water, salt and waste products from the blood stream. The kidneys play an important role in regulating blood pressure and controlling the supply of calcium. 肾脏的主要功能是将机体中多余的水份、盐分与代谢废物滤除。肾脏在调节血压与维持钙质的吸收方面也起着重要作用。5 In addition, the kidney makes a factor, called erythropoetin, r
4、esponsible for stimulating production of red blood cells. 另外,肾脏还能分泌一种促红细胞生成素(EPO)的因子,对刺激红细胞的生成起着重要作用。6What is kidney cancer? Most commonly kidney tumors are malignant or cancerous. Kidney cancer occurs when normal kidney cells begin to grow uncontrollably. 肾癌的概念肾癌的概念 大部分常见的肾脏肿瘤是恶性的或癌性的。肾癌的出现是由于肾脏细胞的
5、生长无法受到控制。7 There are four main types of kidney cancer; clear cell, sarcomatoid, chromophobe and papillary. Clear cell is the most common type of kidney cancer and sarcomatoid is the most aggressive (the most likely to spread beyond kidney to other parts of the body). 肾癌主要可分为四种类型,透明细胞癌、肉瘤样癌、嫌色细胞癌及乳头状
6、癌。透明细胞癌时肾癌最常见的类型。而肉瘤样癌的恶性程度最高(其最有可能扩散至肾脏以外身体其他部位)。8 Benign tumors include: angiomyolipoma and oncocytoma. These non-cancerous tumors are considered benign since they do not have the capacity to grow beyond the kidney to other sites in the body. 肾脏良性肿瘤包括:肾血管平滑肌脂肪瘤与肾瘤细胞瘤。这些非癌性肿瘤被认为是良性的,因为它们的生长仅限于肾脏内部。
7、9How common is kidney cancer and who gets it? It is estimated that in the United States during the year 2001, 30,000 people will be diagnosed with kidney cancer. Kidney cancer is the 8th and 10th most common non-skin cancer among American men and women, prospectively. Kidney cancer accounts for 2 -
8、3% of all cancer-related deaths in the United States.肾癌的流行病学肾癌的流行病学 据估计在2001年,美国约有30000例新发的肾癌病例。在非皮肤性恶性肿瘤中,肾癌的患病率在美国男性中居第八位,在美国女性中居第十位。美国约23的癌症相关死亡病例是由肾癌引起。10How is kidney cancer diagnosed? Common symptoms related to kidney cancer include; hematuria (blood in the urine), a mass and/or pain in the fl
9、ank, newly developed left-sided varicocele (swelling of veins around the testicle). 肾癌的诊断肾癌的诊断 与肾癌相关的常见症状包括:血尿、腰胁部肿块与疼痛、新发的进行性的左侧精索静脉曲张(睾丸周围的静脉出现肿胀)11 Although these symptoms can be caused by kidney cancer they are all non-specific and are usually associated with non-cancerous processes. Typically,
10、patients with kidney cancer have no symptoms and are detected incidentally by a radiographic imaging study of the abdomen obtained for unrelated reasons. 尽管上述症状可由肾癌引起,但它们是非特异性的,而且常常与非癌性病理过程有关。经常遇到的情况是,肾癌患者并无自觉症状,只是因为其他原因行腹部影像学检查偶然发现患病的。12 The best test to diagnose kidney cancer is a contrasted CT sc
11、an of the abdomen. MRI and ultrasound exams are other commonly used tests. Since these radiographic studies are so good at diagnosing kidney cancer a biopsy of the tumor is rarely indicated. 诊断肾癌最好的检查是腹部增强CT。其他常用的检查有MRI和B超。因影像学检查对肾癌有较高诊断价值,故很少需要活检。13Does kidney cancer run in families? Patients who a
12、re affected with Von Hippel Lindau disease, hereditary papillary renal cell carcinoma or Birt Hogg Dube are far more likely to get kidney cancer. These people typically develop multiple tumors in both kidneys. 肾癌的家族相关性因素肾癌的家族相关性因素 脑视网膜血管瘤病患者,家族中有乳头状肾细胞癌患者或Birt Hogg- Dube综合征患者患肾癌的可能性远远增大。而且这些患者往往是双侧肾
13、脏出现多发性肿瘤。14 There is also a familial form of kidney cancer in which several family members develop the typical form of kidney cancer. Otherwise kidney cancer is not inherited and most patients with kidney cancer are not likely to pass it on to their offspring. 肾癌的家族遗传性也可表现为几个家族成员均患有同一常见类型的肾癌。但是肾癌并非遗
14、传性疾病,而且大部分肾癌患者的后代不大可能再患该病。15How is kidney cancer treated? Since conventional chemotherapy and radiation are not effective for kidney cancer the only curative therapy involves surgical removal of the tumor. Historically the standard treatment for kidney cancer was radical nephrectomy (removal of the
15、entire kidney and adrenal gland). 肾癌的治疗肾癌的治疗 由于传统的放化疗对肾癌起效不大,唯一有效的治疗方法是手术切除肿瘤。历史上肾癌的标准治疗方法是肾癌根治术(切除整个肾脏及其肾上腺)。16 Today the adrenal gland is only removed for tumors that are located in the upper portion of the kidney or involve the adrenal gland。 Tumors that are smaller that 4 centimeters can usually
16、 be treated with a partial nephrectomy (removal only the portion of kidney that contains the tumor while leaving the remainde of the unaffected kidney intact ). 如今,只有肿瘤累及肾上腺或肿瘤位于肾脏上极时才在手术中将肾上腺切除。而对于小于4cm的肿瘤通常是行肾脏部分切除术(仅切除受肿瘤累及的那部分肾脏)。17 For patients with a solitary kidney or kidney failure, a partia
17、l nephrectomy is performed for tumors larger than 4 cm when a sufficient amount of unaffected kidney can be preserved. 当患者出现肾衰或孤立肾等情况时,对于直径大于4cm的肿瘤也可行肾脏部分切除术,以保留一定数量的未受累及的肾实质。18 Today most radical nephrectomies are performed by a laparoscopic technique. During laparoscopic procedures, surgeons opera
18、tes using a camera and instruments placed through small holes in the patients abdomen. 当今,大部分肾根治切除术是通过腹腔镜技术来完成的。在腹腔镜操作过程中,医生将器械与摄像头通过腹部上的小孔置入患者体内进行手术。19 The surgical team views the procedure on a televisions screen. The kidney specimen can be removed after placing it in a protective bag and breaking
19、 it up into multiple small pieces. 手术小组通过观看电视屏幕来实施手术。病变的肾脏在置入一个保护袋后被切下,而后其被绞碎为多个小块。20 Alternatively, the intact specimen can be removed through a small non-muscle cutting incision. The advantage of laparoscopic kidney removal to the patient over standard open radical nephrectomy include; less pain,
20、shorter recovery time and better cosmesis (i.e. much smaller scar). 或者,被切下的肾脏也可而通过一个未切断肌层的小切口完整地从体内移出。腹腔镜下肾脏切除术与标准的开放性肾癌根治术相比较,其优势在于:患者痛楚少,术后恢复快且伤口较为美观。21 Typically patients stay in the hospital 1 - 2 days following laparoscopic nephrectomy and return to normal activity within 2 - 3 weeks. Several s
21、tudies have shown that laparoscopic nephrectomy for kidney cancer provides the same opportunity for cure as does conventional open radical nephrectomy. 通常,患者在腹腔镜手术后仅需住院12天,而且23周内即可恢复正常活动。已有一些研究表明在对肾癌的治愈机会上,腹腔镜下肾切除术与传统的开放性肾癌根治术所取得的效果是一致的。22 The standard treatment for metastatic kidney cancer (kidney
22、cancer that has spread beyond the kidney to other parts of the body) is immunotherapy (induces the body to fight off cancer in the same way that it fights off infection). 对转移性肾癌(肿瘤已累及肾脏以外身体其他部位)的标准治疗方案是免疫治疗(诱导机体像抵抗感染一样发挥抗肿瘤作用)。23 The most effective and commonly used form of immunotherapy is IL2. Oth
23、er therapies including interferon gamma are used alone or in combination with IL2. It is believed that in most cases immunotherapy is more effective after the primary kidney tumor has been surgically removed. 最有效以及最常用的免疫治疗方法是使用IL-2。其他治疗方案包括使用干扰素-,可单独使用也可联合IL-2一起使用。目前认为,将原发的肾脏肿瘤手术切除后再予免疫治疗疗效更为明显。24Bl
24、adder Cancer Who gets bladder cancer and what causes it? What is bladder cancer? How is bladder cancer diagnosed? How is bladder cancer treated? Prevention 膀胱癌膀胱癌 流行病学与病因学 组织病理学 诊断 治疗 预防2526Who gets bladder cancer and what causes it?(1)It is estimated that in 2001, 54,300 people (39,200 men and 15,1
25、00 women) will be diagnosed with, and 12,400 people (8,300 men and 4,100 women) will die from bladder cancer in the United States. Bladder cancer is the 4th most common non-cutaneous malignancy among men in the United States, and the 8th most common cancer among women. 流行病学与病因学(流行病学与病因学(1)在美国,于2001年
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