带蒂皮瓣、膀胱黏膜、颊黏膜治疗尿道修复手术失败的尿道下裂患者的疗效及并发症分析

目的：研究尿道下裂患者尿道修复手术失败后采用不同组织材料、方法进行二次治疗的临床效果。方法回顾性分析本院进行二次治疗的46例尿道下裂患者的临床资料,作为二次手术组,另选取46例同期、同年龄段健康男性体检资料作为健康对照组。16例阴茎、阴囊皮肤局部条件允许者,或尿道外口出现裂开,但远端尿道板的条件允许者,予以带蒂皮瓣卷管实施尿道成形术；30例阴茎皮肤无法利用、大段尿道狭窄者,予以真皮脱细胞基质生物补片、颊黏膜、膀胱黏膜实施尿道成形术。随访12个月。观察患者手术时间、术中出血量、下床活动时间、住院时间、并发症发生情况,观察对比患者治疗前后的疼痛评分、生活质量评分,并对比本组患者治疗后与健康对照组最大尿流率、平均尿流率。结果本组手术均顺利完成,手术时间(74.47±10.22)min、术中出血量(15.12±5.18)ml、下床活动时间(2.79±0.53)d、住院时间(12.12±2.28)d。1例单发尿瘘,3个月后予以瘘修补术治疗,3例尿道狭窄,3个月后予尿道扩张,并发症发生率为8.7%。治疗后患者疼痛评分、生活质量评分与治疗前比较,差异具有统计学意义(P<0.05)。治疗后患者最大尿流率、平均尿流率与健康对照组比较,差异无统计学意义(P>0.05)。结论尿道下裂患者尿道修复手术失败后采用不同组织材料、方法进行二次治疗,应依据患者个体化差异选择合理的手术方式,从而减少手术的次数,防止并发症发生。     

儿童嗜酸性膀胱炎的诊断和治疗（附2例报告）

目的：探讨儿童嗜酸性膀胱炎的鉴别诊断和治疗方法方法：回顾性分析2例儿童嗜酸性膀胱炎患者临床资料：2例患儿均以膀胱下尿路刺激症状就诊,超声及CT检查可见膀胱壁增厚。膀胱镜检查并活检确诊为嗜酸性膀胱炎。1例经电切后静脉点滴甲泼尼龙及口服酮替芬,1例静脉点滴青霉素、甲泼尼龙及口服西替利嗪。结果：2例患者均治愈。随访12个月未见复发。结论：嗜酸性膀胱炎的确诊需依靠膀胱镜检查并组织活检。治疗上需消除病因,联合应用抗组胺药、皮质类固醇激素和抗生素的治疗方法。     

腔静脉滤器辅助治疗肾血管平滑肌脂肪瘤并下腔静脉瘤栓（附2例报告并文献复习）

目的：良性的肾血管平滑肌脂肪瘤（angiomyolipoma．AML）很少呈现侵犯肾静脉,下腔静脉和心房。报道2例良性肾脏AML并下腔静脉瘤栓,探讨AML的恶性特征及治疗方法。方法：两侧患者均行介入下腔静脉滤器置入,并右肾根治性切除和腔静脉瘤栓取出术。结果：术后病理证实为血管平滑肌脂肪瘤。患者术后无不适症状,术后复诊未见肿瘤复发转移。结论：良性的肾血管平滑肌脂肪瘤可侵犯肾静脉及下腔静脉,呈现恶性肿瘤特征。鉴于肿瘤栓子进入心脏和肺的风险,应及时手术处理肾AML及下腔静脉栓子。     

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.     

下尿路机械性梗阻导致上尿路扩张的尿动力变化

为探讨下尿路机械性梗阻导致上尿路扩张的尿动力学变化 ,我们分析了下尿路梗阻患者尿动力学检查结果。1 .临床资料 :1 1 0例下尿路梗阻患者中经B超或逆行肾盂造影证实上尿路扩张组有 41例。男 37例 ,女 4例 ,年龄1 2～ 71岁 ,平均 51岁。良性前列腺增生2 6例 ,膀胱颈口挛缩 6例 ,尿道断裂术后狭窄 5例 ,后尿道瓣膜 3例 ,尿道炎性狭窄 1例。无上尿路扩张组 69例。男 55例 ,女 1 4例 ,年龄 1 3～ 82岁 ,平均 57岁。良性前列腺增生 47例 ,膀胱颈口挛缩或后唇抬高 1 3例 ,尿道断裂术后狭窄 5例 ,后尿道瓣膜 2例 ,尿道炎性狭窄 2例。使用Dantec…     

尿液修饰核苷检测在膀胱尿路上皮癌预后监测中的应用价值

目的 探索膀胱癌患者预后监测的新方法.方法 选取病理证实为膀胱尿路上皮癌患者85例.临床分期T(is)～T1期55例,T2～T4期30例;组织学分级G1 27例,G2 40例,G3 18例.膀胱肿瘤电切术后随访1年,每3个月复查.术后第3个月均未复发.术后6个月复发20例,9个月复发18例,术后12个月复发19例,共57例设为复发组.28例术后1年内未复发者设为未复发组.复发组T(is)～T1期35例,T2～T4期22例,未复发组分别为20例,8例.健康对照组50例.应用高效液相色谱/电喷雾-四极杆-飞行时间质谱技术检测各组尿液修饰核苷1-甲基腺苷(M1A)和1-甲基次黄苷(1 -MeI)的水平.统计学比较尿修饰核苷水平与膀胱癌生物学行为的关系.结果 术后3个月未复发组尿液修饰核苷水平(M1A:3.24±0.40,1 -M eI:5.73±0.67)明显低于术前(M1 A:4.34±0.98,1-MeI:14.22±4.05,P＜0.005),其后维持在低水平状况.术后3个月复发组(M1A:3.31±0.33,1 -MeI:5.67±0.55)低于术前(M1A:4.32±1.19,1-MeI:14.31±4.12,P＜0.005),其后呈上升趋势并接近术前水平.未复发组和复发组术前尿液修饰核苷水平均高于对照组(M1A:2.91±0.84,1-MeI:5.56±1.25,P＜0.01).复发组术后6、9、12个月尿修饰核苷水平(M1A分别为4.04±0.48、4.11±0.47、4.09±0.53;1-MeI分别为11.46±1.34、12.14±1.22、12.33±1.27)均高于未复发组和对照组(P＜0.01).病理分级间与临床分期间尿液修饰核苷水平差异无统计学意义(P＞0.01).复发组T(is) ～T1期患者尿液修饰核苷水平(M1A:5.92±1.28,1-MeI:20.01±8.53)高于未复发组(M1A:4.02±1.22,1-MeI:11.21±6.45,P＜0.05),T2～T4中亦如此.结论 尿液修饰核苷检测对于膀胱癌术后患者预后判断有一定的临床应用价值.     

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.     

腹腔镜囊肿去顶治疗成人型多囊肾

目的：探讨经腹腔途径腹腔镜下囊肿去顶治疗成人多囊肾的临床疗效。方法：50例（67侧）均行腹腔镜下囊肿去顶术,其中17例双侧（5例一次同期完成,12例分期完成）囊肿去顶术,33例单侧去顶术。观察术后临床症状及肾功能改善情况。结果：50例（67侧）手术均获成功,无中转开放手术。手术顺利,平均手术时间85min,平均术中出血量45ml。术后2例出现肾周引流漏尿,每天引流量200～600ml,10天后消失;余48例恢复顺利,未发生明显外科并发症。术后病理均为多囊肾,未见恶性变。42例术后平均随访12（6～30）个月,腰痛减轻26／31例;血压正常10／22例,较术前有所下降12／22例;BUN及Cr正常8／18例,较术前有所下降10／18例;复查彩超肾脏术后体积较术前均明显缩小。结论：经腹腹腔镜下多囊肾去顶减压视野清晰、创伤小、恢复快,可延缓疾病发展、改善肾功能,是治疗成人多囊。肾较理想的方法。     

尿苷二磷酸葡萄糖醛酸转移酶1A7基因多态性与膀胱癌易感性的关系

目的 探讨尿苷二磷酸匍萄糖醛酸转移酶1A7(UGT1A7)基因多态性与膀胱癌易感性的关系.方法 以病例对照研究方法,应用半巢式PCR(SN-PCR)和等位基因特异性PCR(AS-PCR)分别检测208例膀胱癌患者和205例非肿瘤患者的UGT1A7基因多态性,对各基因型和等位基因单独或联合吸烟行为进行统计学分析.结果 膀胱癌组变异纯合基因型[~*x/~*x(x=~*2,~*3,~*4)]的频率(20.7%)高于对照组(12.2%),差异有统计学意义[P<0.05,OR=2.16(1.18～3.96)].膀胱癌组携带变异等位基因~*3的频率(27.9%)高于对照组(20.5%),差异有统计学意义[P=0.009,OR=1.56(95%CI:1.12～2.18)].吸烟人群中,变异杂合基因型[~*1/~*x(x=~*2,~*3,~*4)]或变异纯合基因型者与野生型者相比,膀胱癌组和对照组间差异有统计学意义,OR(95%CI)值分别为2.16(1.07～4.36)、2.64(1.02～6.80).UGT1A7基因多态性与膀胱癌病理分级和临床分期均无相关性(均P>0.05).结论 UGT1A7基因多态性与膀胱癌易感性有关,该基因多态性与吸烟行为在膀胱癌的发生中存在交互作用.     

Value of SCT in staging and subtyping of renal cell carcinoma

<正>Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009,28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients’ data were reviewed and analyzed. Results There