环切入路包皮阴茎皮肤成形术治疗隐匿阴茎

目的 探讨环切入路包皮阴茎皮肤成形术治疗隐匿阴茎的疗效。方法 回顾性分析2010～2013年行环切入路包皮阴茎皮肤成形术治疗29例隐匿阴茎患者的临床资料。患儿年龄3～18（9．2±2．7）岁。术前测量阴茎外露长度0．5～3．2（1．8 ± 0．6）cm ,其中重度13例,中度16例。合并包茎者23例,明显肥胖者16例。结果 环切入路包皮阴茎皮肤成形术治疗隐匿阴茎术后阴茎外露增加长度为（2．5 ± 0．3）cm ,龟头外露良好,无术后顽固性阴茎皮肤水肿现象。结论 隐匿阴茎的形成与阴茎皮肤浅筋膜发育异常有关。环切入路,包皮阴茎皮肤成形术是行之有效并能预防术后包皮顽固性水肿的简易方法。     

nm23—H1基因在肾母细胞瘤中表达的意义

为探讨ｎｍ２３Ｈ１在肾母细胞瘤中的表达变化及临床意义，采用免疫组织化学方法对５６例肾母细胞瘤标本中的ｎｍ２３Ｈ１基因表达情况进行检测。结果：ｎｍ２３Ｈ１低表达率为５５．４％，按ＮＷＴＳⅢ分期，Ⅲ、Ⅳ期肾母细胞瘤ｎｍ２３Ｈ１低表达率８２．３％，显著高于Ⅰ、Ⅱ期４３．６％，Ｐ＜０．０５；有转移肿瘤ｎｍ２３Ｈ１低表达率８７．５％，显著高于无转移肿瘤的４２．５％，Ｐ＜０．０１。表明ｎｍ２３Ｈ１低表达在肾母细胞瘤的演进和转移中起重要作用。     

吡柔比星膀胱内灌注预防经尿道膀胱肿瘤切除术后肿瘤复发

膀胱癌是泌尿系统最常见的恶性肿瘤 ,术后复发率较高 ,预防肿瘤复发在膀胱癌治疗中具有重要意义。吡柔比星(THP)是新一代蒽环类抗癌药。 1998年 8月— 2 0 0 0年 12月 ,我院采用THR对 32例浅表性膀胱癌患者行经尿道膀胱肿瘤切除 (TUR -Bt)术后膀胱灌注化疗预防肿瘤复发 ,疗效满意 ,报告如下。1　资料和方法1.1.　一般资料　本组 32例 ,男 2 3例 ,女 9例。Ta期 11例 ,T1期 18例 ,T2 期 3例 ,年龄 5 0～ 76岁。膀胱镜检查 :单发2 5例 ,多发 7例 ;位于三角区 9例 ,侧壁 2 3例。病理结果均为膀胱移行细胞癌Ⅱ～Ⅲ级。1.2　膀胱内灌注化疗…     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.     

汽化电切良性前列腺增生症尿动力学检查研究

目的通过尿动力学检查，观察其临床指标，对良性前列腺增生症汽化电切术(TUVP)后的疗效进行监测和研究。方法37例良性前列腺增生(BPH)症患者，均施行经尿道前列腺汽化电切术，以手术时间为标志，分别在术前1月和术后3个月、6个月施行国际前列腺症状评分和尿动力学检查。结果与术前相比，最大尿流率由8．714ml／秒上升至17．52ml／秒，最大尿流率时膀胱逼尿肌压力由81．45cmH2O下降至37．51ml／CmH2O，膀胱顺应性由19．63ml／cmH2O上升至37．07ml／cmH2O，出现最大排尿愿望时的膀胱容量由240．1ml上升至353．59ml，国际前列腺症评分显示所有病例综合评分由24．41分下降至12．93分；术后3个月与6个月检查结果显示TUVP对尿道外口括约肌有短期的、可逆的损害。结论本研究提示经尿道前列腺汽化电切术可有效改善排尿症状和膀胱功能，尿动力学检查是一种有效的检查方法。     

输尿管镜钬激光碎石术治疗老年输尿管结石疗效及对肾功能的影响观察

目的：探讨输尿管镜钬激光碎石术治疗老年输尿管结石的疗效及对肾功能的影响。方法选取在我院接受治疗的老年输尿管结石患者121例,根据手术方式的不同分为对照组60例,观察组61例,对照组行输尿管镜气压弹道碎石术治疗,观察组行输尿管镜钬激光碎石术治疗。比较2组临床疗效及肾功能改善情况。结果术后观察组肾功能各指标均低于对照组,差异具有统计学意义（P<0.05）;观察组碎石成功率、结石排净率均高于对照组,差异具有统计学意义（P<0.05）。结论对老年输尿管结石患者给予输尿管镜钬激光碎石术治疗,可有效提高碎石成功率、结石排净率,改善患者肾功能。     

多层螺旋CT检查在肾癌分期及分型中的应用价值

目的 探讨多层螺旋CT(SCT)检查在肾癌分期分型中的应用价值.方法 回顾性分析64例肾癌患者术前肾脏SCT资料和术后病理结果.男44例,女20例.年龄33～78岁,平均54岁.通过平扫期、皮髓期CT值及强化模式,依据2005年CUA制定标准对肾癌进行分期分型,并与术后病理结果 进行对比.结果 SCT检查发现透明细胞癌38例、乳头状癌14例、嫌色细胞癌12例,病理结果 为透明细胞癌40例、乳头状癌16例、嫌色细胞癌8例.肾癌SCT与病理分型和分期结果 差异无统计学意义(P＞0.05),SCT分型准确性为88%,分期准确性为89%.平扫期以CT值40 HU为标准鉴别乳头状癌与透明细胞癌和嫌色细胞癌的敏感性、特异性和准确性分别为75%、79%和78%;皮髓期以CT值90 HU为标准鉴别透明细胞癌与乳头状癌和嫌色细胞癌的敏感性、特异性和准确性分别为90%、88%、89%;均匀强化在嫌色细胞癌的比率显著高于透明细胞癌及乳头状癌.结论 多层SCT检查诊断肾癌准确性较高,是术前评估肾癌分型和分期较理想的手段之一.

Abstract：

Objective To analyze the value of multi-slice spiral CT (SCT) scan in staging and subtyping of renal cell carcinoma (RCC). Methods The preoperative kidney SCT data and postoperative pathology results of 64 patients with RCC were retrospectively analyzed. The patients′ ages ranged from 33-78 years (average 54 years). There were 44 males and 20 females in the study group. According to the CUA Guidelines, the staging and subtyping of RCC were performed through the combined information of preoperative SCT attenuation in unenhanced, corticomedullary phase and enhancement pattern. The results were compared with the postoperative histopathological results. Results The SCT results showed 38 cases were clear cell RCC, 14 cases were papillary RCC and 12 cases were chromophobic cell RCC. Histopathological results showed that 40 cases were clear cell RCC, 16 cases were papillary RCC and 8 cases were chromophobic cell RCC. According to the standard of 40 HU of CT attenuation value, the sensitivity, specificity and accuracy were 75%, 79% and 78% for diagnosis of papillary RCC in the unenhanced phase. The sensitivity, specificity and accuracy by the standard of 90 HU of CT attenuation value was 90%, 88% and 89% for diagnosis of clear cell RCC in the corticomedullary phase. In chromophobic RCC, homogeneous enhancement was more common than in papillary RCC and clear cell RCC. There was no significant difference of staging and subtyping of RCC between SCT and pathological results (P>0.05). The accuracy of SCT in staging and subtyping of RCC was 88% in staging, and 89% in subtyping. Conclusions SCT is a useful preoperative tool to stage and subtype RCC     

Krüppel样因子8及高迁移率族蛋白A2在膀胱尿路上皮癌组织的表达水平及其与预后的相关性

目的 探讨膀胱尿路上皮癌组织Krüppel样因子8（KLF8）以及高迁移率族蛋白A2（HMGA2）表达水平及其与预后的相关性。方法 选取2012年1月-2013年10月在郑州大学第五附属医院就诊的74例膀胱尿路上皮癌患者的肿瘤组织作为研究组,另选取同期在本院行膀胱切开取石术或开放前列腺切除术患者23例的膀胱黏膜作为对照组。采用免疫组化方法检测两组标本组织中KLF8和HMGA2蛋白表达水平。采用Cox回归分析KLF8及HMGA2蛋白的表达水平与患者生存预后的关系。结果 研究组KLF8和HMGA2表达水平均高于对照组,差异有统计学意义（t=3.872,P=0.002;t=4.593,P=0.001）。膀胱尿路上皮癌患者临床分期与KLF8和HMGA2表达水平均呈正相关,差异有统计学意义（rs=0.489、0.561,P＜0.05）。患者均随访至2015年4月,67例患者在随访截止时存活,总生存率为90.5%。多元Cox回归分析结果显示,临床病理分期、KLF8和HMGA2表达水平是膀胱尿路上皮癌患者生存预后的影响因素（P＜0.05）。结论 膀胱尿路上皮癌组织KLF8及HMGA2蛋白的高水平表达是患者生存预后的危险因素。     

新型导尿套管的临床应用研究

目的:比较一种新型专利产品“导尿套管”和传统导尿管的临床应用效果。方法:选择患有不同疾病需留置导尿管的病人632例作为实验组,应用新型导尿套管留置导尿,同时随机抽样428例与实验组疾病种类相同的病人作为对照组,使用传统球囊导尿管留置导尿。结果:与对照组相比,实验组病人的尿流率(ml/秒)(13.15±1.63比7.01±0.03 P<0.01)、导向强度(kg/mm~3)(0.64±0.06比0.025±0.003,P<0.01)和凝血块体积(mm~3)(16.8±1.15比5.7±0.51,P<0.01)显著增加,而膀胱造瘘手术率明显降低(1.7％:35.7％,P<0.01),气囊承压、气囊容量和管壁承压没有显著性差异。结论:新型导尿套管的导尿成功率和尿液冲洗引流效果均明显优于传统气囊尿管。     

膀胱癌患者细胞色素氧化酶P450 2C19基因多态性分析

目的:探讨膀胱癌患者细胞色素氧化酶P450 2C19(CYP2C19)基因多态性.方法:采用PCR-RFLP基因分析技术,对108例膀胱癌患者和112例非肿瘤同期住院对照患者CYP2C19基因2个常见突变位点m1和m2的多态性进行检测,并分析其与膀胱癌易感性的关系.结果:与对照组相比,膀胱癌组中强代谢型(EMs)频率高于弱代谢型(PMs)(x2=4.508,P＜0.05).吸烟、职业暴露、嗜食肉食为膀胱癌发病的危险因素.CYP2C19 EMs与吸烟、职业暴露和嗜食肉食3个环境因素存在基因-环境交互作用,影响膀胱癌的发病.结论:CYP2C19 EMs基因型与膀胱癌易感性有关.