控制性降压在大体积前列腺电切术中的应用

较大体积的前列腺电切术中出血量较多,影响视野,延长手术时间,增加冲洗液吸收量和并发症的发生率.因此,体积＞60 ml的前列腺被视为TURP的禁忌证[1].我们在TURP术中应用控制性降压的方法切除大体积前列腺,以期达到减少出血、缩短手术时间、拓宽TURP手术适应证的目的.     

经尿道等离子前列腺电切术与普通电切治疗前列腺增生的疗效比较

目的：比较经尿道前列腺等离子电切术（TUPKRP）与经尿道前列腺电切术（TURP）治疗良性前列腺增生（BPH）的疗效指标,探讨两种术式的临床疗效。方法回顾性分析2011年1月～2013年6月在本院TUPKRP和TURP治疗的良性前列腺增生的病例资料96例,TUPKP组46例,TURP组50例。通过对两组手术所需时间长短、手术期间出血量大小、切除质量、术后膀胱清洗时间、手术并发症和手术前后3个月的前列腺症状评分、最大尿流率和生活质量进行评分。结果 TUPKRP组手术时间、术中出血量、术后冲洗时间和并发症的发生率明显低于TURP组,前列腺切除质量高于TURP组,差异具有统计学意义（P＜O.05）;术后3项指标I-PSS、Qmax、QOL都较手术前有明显改善,两者差别无统计学意义（P＞0.05）。结论TUPKRP与TURP治疗BPH的疗效相近,但TUPKRP平均手术时间短、术中出血量少、并发症发生率低,具有良好的应用前景。     

经尿道电切、汽化电切及双极等离子电切治疗BPH的比较

目的:比较经尿道前列腺电切(TURP)、经尿道前列腺汽化电切(TUVP)和经尿道双极等离子前列腺电切(TUPKVP)三种不同的电切方式治疗BPH的临床疗效及安全性.方法:在我院经过上述三种手术方式治疗过的600例患者中,按三种术式各随机抽取20例条件具有可比性的患者,就手术时间、术中出血量、术中TURS的发生率、术后膀胱冲洗时间、留置导尿管时间和术后并发症的发生及疗效进行比较.结果:三种术式患者手术前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(MFR)和剩余尿(PVR)比较,均得到显著改善,三组之间相比差异无统计学意义(P>0.05)).手术时间TURP最长,TUVP次之,TUPKVP用时最短.术中出血量TURP最多,TUKVP次之,TUVP最少.术后膀胱冲洗的时间及留置导尿管的时间TUPKVP最短.TUVP次之,TURP最长.术后低钠血症或水中毒的发生率:TUPKVP及TUVP均未发现,TURP则较多.术后并发症的发生短期内的(1个月内)尿失禁见于TURP及TUVP,术后1个月内的继发性出血见于TURP及TUVP,而TUPKVP则未见上述并发症.结论:三种术式治疗效果相同.但TUPKVP安全性好,适应症宽,特别有利于对高龄高危BPH患者进行手术,有较好的发展前景.     

高海拔地区前列腺增生患者行等离子前列腺汽化电切术与经尿道前列腺电切术的比较

目的 比较高海拔地区前列腺增生（BPH）合并高原性疾病患者行经尿道双极等离子前列腺电切术（PKRP）与经尿道前列腺电切术（TURP）治疗效果.方法 对甘孜藏族自治州人民医院2008年6月至2012年3月156例前列腺增生合并高原性疾病患者（PKRP组78例,TURP组78例）进行回顾性研究,比较两组年龄、前列腺体积、病程、前列腺特异抗原（PSA）、手术时间、术中出血量、尿管留置时间、术后膀胱冲洗时间、住院天数、术后血钠浓度、术后并发症、术前及术后国际前列腺症状评分（IPSS）、残余尿（RUV）、最大尿流率（Qmax）、生活质量评分（QOL）等.结果 两组患者年龄、前列腺体积、病程、PSA、术前及术后IPSS评分、残余尿、最大尿流率、生活质量评分、手术时间、住院天数均无统计学差异（P＞0.05）.PKRP组术中出血量、留置尿管时间、术后膀胱冲洗时间、术后并发症发生率均低于TURP组,术后血钠浓度高于TURP组（P＜0.05）.结论 对于高原BPH患者这一特殊群体,TURP、PKRP治疗疗效相当,但对于手术安全性,手术并发症的控制,PKRP术较TURP术有较多优势,对该类患者应优先选择PKRP术.     

经尿道前列腺电切术与绿激光前列腺汽化术术后尿道狭窄发生率比较研究

目的比较经尿道前列腺电切术(TURP)与经尿道选择性绿激光汽化术(PVP)术后尿道狭窄发生率。方法回顾性分析2010年3月至2012年3月由同一组医师连续实施的215例TURP术与237例PVP术,比较2组手术时间、术中出血量、术后留置尿管时间、术后尿路感染发生率,比较2组患者术后尿道狭窄发生率的差异。结果 TURP组手术时间及留置尿管时间长于PVP组,术中出血量多于PVP组,尿路感染发生率、术后尿道狭窄发生率高于PVP组,差异有统计学意义(P0.05)。结论TURP术后尿道狭窄的发生率高于PVP,应借鉴PVP改进TURP,以降低TURP术后尿道狭窄的发生率。     

经尿道前列腺剜除术与电切术疗效比较

目的:探讨普通电切镜下经尿道前列腺剜除术与电切术的疗效.方法:对75例前列腺生患者行经尿道前列腺剜除术治疗(TUEP组),110例经尿道前列腺电切术治疗(TURP组).结果:TUEP组术中出血量(前列腺重量<0 g)、手术时间均明显少于TURP组(P<0.05),增生腺体切除重量明显高于TURP组(P<0.05).术后12个月,最大尿流率、国际前列腺症状评分,生活质量评分等组间比较差异无统计学意义(P>0.05).结论:TUEP术与TURP术相比较,TUEP手术安全性更好,术中出血量少(前列腺重量<0 g)手术时间快、切除增生腺体更彻底.     

经尿道前列腺选择性绿激光手术与经尿道前列腺电切术的疗效比较

目的评价经尿道前列腺选择性绿激光手术（greenlight photoselective vaporization of prostate,PVP）与经尿道前列腺电切术（transurethral prostatectomy,TURP）的临床疗效。方法将178例良性前列腺增生（benign prostatic hyperplasia,BPH）患者随机分为两组,95例行PVP术（PVP组）,83例行TURP术（TURP组）,比较两种术式的平均手术时间、术中出血量、输血量、近期疗效及并发症等情况。结果 PVP组和TURP组平均手术时间分别为（47.4±5.1）min和（61.7±6.2）min,前者显著低于后者,PVP组术中出血量、输血量、术后膀胱冲洗时间、留置尿管时间及住院时间均显著少于TURP组,PVP组近期并发症发生率明显小于TURP组,两组术后前列腺国际症状评分（IPSS）、生活质量评分（QOL）、最大尿流率、剩余尿量较术前均有显著改善。结论 PVP是一种安全有效的治疗BPH的理想微创术式,具有手术时间短、创伤小、出血少、恢复快、并发症发生率低等特点。     

经尿道选择性绿激光前列腺汽化术与前列腺电切术治疗重度良性前列腺增生的对比研究

目的 比较经尿道选择性绿激光前列腺汽化术与前列腺电切术治疗重度良性前列腺增生症的临床疗效.方法 将63例重度良性前列腺增生症患者随机分为经尿道选择性绿激光前列腺汽化术(PVP)组32例和前列腺电切术(TURP)组31例,分别行PVP术与TURP术.观察两组患者手术时间、住院时间、保留导尿管时间、手术出血量、IPSS评分、最大尿流率、前列腺体积的变化及并发症.结果 所有手术均成功,无严重手术并发症发生.TURP组电切综合征、输血病例各2例,PVP组无该并发症.PVP组手术出血量、输血率、住院时间及留置导尿管时间明显少于TURP组(P>0.05),然而,PVP组的手术时间、术后感染控制时间、早期急性尿潴留发生率及残留腺体体积明显大于TURP组.两组术后IPSS评分下降率、最大尿流率差异、感染发生率及逆行射精发生率差别均无显著性(P>0.05).结论 治疗重度良性前列腺增生时,PVP手术具有一定的局限性,可作为TURP的一种补充手术方法应用于高危患者的治疗,而不作重度良性前列腺增牛的首选治疗方法.     

前列腺钬激光剜出术与电切术安全性及疗效比较

目的比较研究经尿道钬激光前列腺剜除术(HoLEP)与经尿道前列腺电切术(TURP)的安全性及疗效.方法337例良性前列腺增生(BPH)患者分为2组,185例行HoLEP术,152例行TURP术;测定术中冲洗液吸收量、出血量;比较2组术中冲洗液吸收量、出血量、前列腺切除重量、手术时间、导尿管留置时间、术后住院天数、手术并发症.随访3个月,比较2组最大尿流率(Qmax)、剩余尿量(PVR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等指标的变化.结果HoLEP组、TURP组术中冲洗液吸收量、出血量、前列腺切除重量、手术时间、导尿管留置时间、术后住院天数分别为(604.8±97.6)ml及(1095.0±209.8)ml、(124.3±24.1)ml及(330.3±36.9)ml、(17.4±2.2)g及(25.2±3.4)g、(54.9±20.0)min及(45.1±18.0)min、(2.2±0.2)d及(3.4±0.3)d、(5.2±1.1)d及(8.8±1.3)d,组间比较差异有显著性意义(P＜0.05).HoLEP组术中1.6%(3/185)需输血;TURP组11.8%(18/152)需输血.HoLEP组术后需要膀胱持续冲洗者占6.5%(12/185),TURP组占95.4%(145/152).TURP组有55.3%(84/152)出现术后低血钠,其中5.3%(8/152)发生严重的低钠血症;HoLEP组无低钠血症发生,但有4例使用Morcellator粉碎前列腺组织时损伤膀胱黏膜致出血者.组织病理检查结果HoLEP组均为良性前列腺增生;TURP组有6例前列腺偶发癌、5例前列腺上皮内瘤(PIN).术后3个月152例HoLEP患者和106例TURP患者获随访,Qmax,PVR,IPSS,QOL较术前均有改善,差异有显著性意义(P＜0.01);组间比较差异无显著性意义(P＞0.05).结论HoLEP术与TURP术相比,手术安全性更好,疗效相似;组织标本获得率的下降可能影响前列腺偶发癌的检出率.     

影响钬激光前列腺剜除术中出血的多因素分析

目的:评价经尿道钬激光前列腺剜除术(HoLEP)术中出血量的情况,探讨影响出血量的相关因素.方法:回顾性分析299例良性前列腺增生(BPH)患者的临床资料,其中268例行HoLEP,31例行经尿道前列腺电切术(TURP).在手术前和术后第1天晨测量血红蛋白和红细胞比容,并记录术后的输血情况.分析年龄、糖尿病、高血压病、...     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。