经直肠超声引导13点前列腺系统穿刺活检术的并发症及防治

目的探讨经直肠超声引导13点前列腺系统穿刺活检术的并发症及防治措施.方法回顾性分析本组1998年8月至2004年12月336例接受经直肠超声引导13点前列腺穿刺活检术患者的临床资料.结果336例患者中出现的并发症有:血尿218例;血便67例,血精10例,感染10例,明显疼痛(VAS评分大于5分)85例,血管迷走神经反应10例等.结论经直肠超声引导13点前列腺系统穿刺活检术用于诊断前列腺癌常可见小的并发症,大的并发症则很少见.该术式用于诊断前列腺是安全的.     

以改良TRAP法检测人膀胱肿瘤组织中端粒酶活性表达的临床意义

目的：探讨膀胱肿瘤及癌旁组织端粒酶活性表达及临床意义。方法：以改良TRAP法测定91例膀胱癌组织标本端粒酶活性表达。结果：83例膀胱移行细胞癌组织中78例检出端粒酶活性。阳性率为94％，其对应的癌旁组织也有14％的检出率，8例膀胱乳头状瘤组织中4例检出端粒酶活性，阳性率为50％，其对应的癌旁组织检出率为12％，端粒酶活性在不同临床病理类型的膀胱肿瘤及癌旁组织中表达无显差异（P＞0．05），结论：应用非放射性的银染方法对端粒酶的活性进行检测，图像清晰，简便，安全，易于临床推广。     

应用输尿管镜放置双J管早期治疗输尿管阴道瘘

Objective To evaluate the clinical effect of placing double J stent using a ureteroscope in early managing ureterovaginal fistula.Methods Twenty-eight patients cases with ureterovaginal fistula from 2002 to 2008 were treated early with placing double J stent using a ureteroscope and the clinical data were reviewed.Results Twenty-two of 28 cases were treated and double J stent was placed in them by a uretero-scope and 75% (21/28)of cases were cured.Four of 21 cases were treated twice by a ureteroscope and were cured finally.7 cases with failure ureterovaginal treatment underwent ureterocystostomy and were cured.The follow-up from 6 months to 33 months (average 10.1±6.4 months)showed that all of the 28 cases had been cured and had no urinary fistula.Conclusion Placing double J stent using a ureteroscope is the first choice of operative procedure for the early treatment of ureterovaginal fistula.     

应用输尿管镜放置双J管早期治疗输尿管阴道瘘

Objective To evaluate the clinical effect of placing double J stent using a ureteroscope in early managing ureterovaginal fistula.Methods Twenty-eight patients cases with ureterovaginal fistula from 2002 to 2008 were treated early with placing double J stent using a ureteroscope and the clinical data were reviewed.Results Twenty-two of 28 cases were treated and double J stent was placed in them by a uretero-scope and 75% (21/28)of cases were cured.Four of 21 cases were treated twice by a ureteroscope and were cured finally.7 cases with failure ureterovaginal treatment underwent ureterocystostomy and were cured.The follow-up from 6 months to 33 months (average 10.1±6.4 months)showed that all of the 28 cases had been cured and had no urinary fistula.Conclusion Placing double J stent using a ureteroscope is the first choice of operative procedure for the early treatment of ureterovaginal fistula.     

应用输尿管镜放置双J管早期治疗输尿管阴道瘘

Objective To evaluate the clinical effect of placing double J stent using a ureteroscope in early managing ureterovaginal fistula.Methods Twenty-eight patients cases with ureterovaginal fistula from 2002 to 2008 were treated early with placing double J stent using a ureteroscope and the clinical data were reviewed.Results Twenty-two of 28 cases were treated and double J stent was placed in them by a uretero-scope and 75% (21/28)of cases were cured.Four of 21 cases were treated twice by a ureteroscope and were cured finally.7 cases with failure ureterovaginal treatment underwent ureterocystostomy and were cured.The follow-up from 6 months to 33 months (average 10.1±6.4 months)showed that all of the 28 cases had been cured and had no urinary fistula.Conclusion Placing double J stent using a ureteroscope is the first choice of operative procedure for the early treatment of ureterovaginal fistula.     

端粒酶活性在人膀胱肿瘤组织中表达的临床意义

目的：探讨不同临床病理类型的膀胱肿瘤及癌旁组织端粒酶活性表达及临床意义，方法：以改良TRAP法测定91例膀胱肿瘤组织标本端粒酶活性表达。结果：83例膀胱移行细胞癌组织中78例检测到端粒酶活性，阳性率为94％，其对应的癌旁组织也有14％的检出率，8例膀胱乳头状瘤组织中4例检测到端粒酶活性，阳性率为50％，其对应的癌旁组织检出率为12％，端粒酶活性在不同临床病理类型的膀胱肿瘤及癌旁组织中表达差异无显著性意义（P＞0．05），结论：膀胱肿瘤及癌旁组织端粒酶活性的检测对肿瘤的诊断有重要意义。     

非融合型横过异位肾(附二例报告)

非融合型横过异位肾极少见,我院收治二例,报告如下。例1,女,35岁,右腹肿块、胀痛五年,无尿频、尿急、尿痛、血尿及排石史,于1975年5月3日入院。体检:血压110/70mmHg,发育正常,营养良好,腹软,平坦;右脐旁扪及-鸭蛋大实性肿块,椭圆,光滑,略可移动,轻触痛。尿常规:白细胞5～10/高倍,红细胞0～2/高倍,NPN33mg％。腹平片:第四腰椎右侧旁2×1.5cm结石致密影,肾轮廊不清。静脉尿路造影:右肾功能、形态、位置正常,其下方有一肾影,显影稍浅淡,各盏粗大,上盏有结石影,输尿管稍粗与脊柱交叉,两肾分界不清,右输尿管及膀胱影象正常。入院诊断:横过异位肾(左肾移右侧)并结石。入院后行腹膜后充气造影,第四腰椎右侧有7×5cm肾影,轮廓清晰,与方11×5cm肾影不相连。侧位片,     

体外冲击波与输尿管镜下气压弹道碎石术治疗输尿管上段结石的疗效评价

自 1991年 7月至 2 0 0 1年 9月 ,我院采用体外冲击波碎石 (ESWL)和输尿管镜下气压弹道碎石 (URSL)共治疗输尿管上段结石 14 5 6例 14 83侧 ,疗效满意。现报告如下。材料与方法　ESWL患者 ,男 6 87例 ,女 6 38例 ,年龄 17～ 76岁 ,平均 5 3.2岁。结石最大径 7～ 31mm ,平均 14mm。URSL患者 ,男 5 4例 ,女 77例 ,年龄 2 1～ 6 9岁 ,平均 5 1.4岁。结石最大径 6～ 2 5mm。 14 83侧中 ,单用ESWL12 5 7侧 ,单用URSL 134侧。 2者合用92侧 ,其中 ,ESWL→URSL 4 6侧 ,URSL→ESWL 13侧 ,ESWL→URSL→ESWL 33侧。ESWL采用湛江…     

单纯PSA增高大前列腺体积良性前列腺增生患者的诊治(附71例报告)

目的 探讨单纯前列腺特异性抗原(PSA)增高大前列腺体积良性前列腺增生(BPH)患者的诊治.方法 选取大前列腺体积(＞75 m1)伴单纯PSA增高(＞4.00 ng/ml,无其他前列腺癌迹象)的BPH患者共71例,采取B超引导下经直肠前列腺穿刺活检,分别在术后1周、1个月、3个月复查血清PSA.结果 穿刺活检发现前列腺癌8例(11.27%),BPH 63例(88.73%).所有BPH患者均行耻骨上前列腺摘除术,术后病理检查均为BPH,术后1周有31例(49.21%)PSA降至正常[平均PSA(2.89±0.71)ng/ml,P＜0.01];1个月有46例(73.02%)PSA降至正常[平均PSA(2.36±0.65)ng/ml,P＜0.01],3个月有61例(96.83%)PSA降至正常[平均PSA(2.12±0.36)ng/ml,P＜0.01],1例PSA 6.77 ng/ml,1例PSA 18.34 ng/ml.2例PSA仍高患者予重复穿刺,1例为BPH,予继续观察,1例为前列腺癌.结论 单纯PSA增高大前列腺体积BPH患者穿刺活检阳性率低,可不予行前列腺穿刺活检而直接行耻骨上前列腺摘除术,术后定期复查血清PSA可预防前列腺癌的漏诊.     

经直肠超声引导下的前列腺神经阻滞术

目的 评价经直肠超声引导下的前列腺神经阻滞术在前列腺穿刺活检术中的临床价值。方法 73例拟接受经直肠超声引导13点前列腺系统穿刺活检术的患者随机分为A、B两组。在经直肠超声引导下，于前列腺基底部，左、右两侧精囊与前列腺交接处进行注射。A组患者左、右两侧分别注射1％利多卡因5ml,B组患者注射生理盐水5ml。采用视觉模拟评分（VAS）评估患者在穿刺活检术中的疼痛程度。结果 两组患者平均疼痛评分分别为1．1分、5．9分，差异有非常显著意义（t=4．81，P〈0．01）。两组患者均未出现局麻药的不良反应。结论 前列腺神经阻滞术可明显减轻患者在前列腺穿刺活检术中的疼痛和不适，是一种安全、有效的局麻方法，值得临床推广应用。