索利那新防治经尿道前列腺电切术后膀胱痉挛的疗效观察

目的 评估经尿道前列腺电切（TURP）围手术期使用索利那新对术后膀胱痉挛的防治疗效.方法 BPH患者150例.随机分为3组,每组50例.索利那新组（A组）：术前1 d起口服索利那新1次/d,5 mg/次,至拔除导尿管后3 d;托特罗定组（B组）：术前1 d起口服托特罗定2次/d,2 mg/次,至拔除导尿管后3 d;吲哚美辛组（C组）：疼痛时予肛纳吲哚美辛栓25 mg.观察比较3组患者经尿道前列腺电切术后膀胱痉挛发生次数、持续时间以及膀胱冲洗、冲洗液转清、留置导尿管时间等.结果 A组术后24、24~48、48~72 h膀胱痉挛次数（0.86±0.08,1.80±0.14,1.06±0.13）均少于B组（1.02±0.08,2.02±0.12,1.24±0.12）和C组（1.88±0.12,2.68±0.18,2.24±0.19）,且与C组相比,差异有统计学意义（P＜0.05）.A 组术后24、24~48、48~72 h膀胱痉挛平均持续时间[（0.74±0.25）、（0.17±0.03）、（0.18±0.04）h]均少于B组[（0.61±0.25）、（0.16±0.34）、（0.17±0.32）h]和C组[（0.43±0.22）、（0.13±0.04）、（0.14±0.04）h],且与C组相比,差异有统计学意义（P＜0.05）.术后A组膀胱冲洗时间、冲洗液转清时间、留置导尿管时间[（2.2±0.6）、（1.6±0.6）、（5.0±0.7）d]也均早于B组[（2.3±0.6）、（1.8±0.5）、（5.2±0.8）d]和C组[（2.6±0.7）、（2.1±0.7）、（5.4±0.6）d],且与C组相比,差异有统计学意义（P＜0.05）.A组总的不良反应率和口干的发生率（10.0%,6.0%）均较B组（26.0%,20.0%）低,且差异有统计学意义（P＜0.05）.结论 TURP患者围手术期应用索利那新可有效防治膀胱痉挛,临床效果满意、安全.     

Xp11.2易位/TFE3基因融合相关性肾癌与肾透明细胞癌的螺旋CT诊断鉴别

目的评价螺旋CT扫描在Xp11.2易位/TFE3基因融合相关性肾癌和肾透明细胞癌的诊断和鉴别诊断中的应用价值。方法回顾性分析经手术病理证实为Xp11.2易位/TFE3基因融合相关性肾癌和肾透明细胞癌的24例患者的螺旋CT资料。其中Xp11.2易位/TFE3基因融合相关性肾癌和肾透明细胞癌各12例。结果 Xp11.2易位/TFE3基因融合相关性肾癌组和肾透明细胞癌组的平均CT值增强量（即增强扫描动脉相肿瘤最大横截面平均CT值-平扫相上肿瘤最大横截面平均CT值）分别为（31.75±14.73）Hu和（88.30±31.91）Hu,Xp11.2易位/TFE3基因融合性肾癌的CT增强幅度明显小于肾透明细胞癌（P〈0.01）。结论观察病灶的CT值,可以帮助医师初步确定术前肿瘤的病理亚型。     

后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

宫内节育器膀胱及尿道异位五例报告

宫内节育器(IUD)异位至膀胱及尿道报道极少。2003年6月至2004年5月，我们先后收治IUD膀胱异位4例，尿道异位1例。现报告如下。     

中国人肠道产甲酸草酸杆菌甲酰辅酶A转移酶基因的分离、克隆和鉴定

目的 克隆产甲酸草酸杆菌甲酰辅酶A转移酶基因（frc），检测其在真核细胞中的表达。方法 用聚合酶链式反应技术从产甲酸草酸杆菌基因组DNA中扩增frc基因片段并插入真核表达载体获取重组质粒pEGFP-frc，通过限制性内切酶酶切电泳和测序鉴定重组质粒。重组质粒转染人胚。肾293细胞，检测frc基因在mRNA和蛋白水平上的表达。被转染细胞在含草酸培养液中培养，检测0～72h培养液中草酸浓度的变化。结果 frc基因的真核表达载体构建成功。转染293细胞后24～72h，可观察到明亮的绿色荧光，在mRNA和蛋白水平上可检测到frc基因在真核细胞中的表达。转染pEGFP-frc细胞12～72h培养液中草酸浓度明显低于转染空载体的细胞（P〈0．05）。结论 中国人肠道产甲酸草酸杆菌中可分离出frc基因；frc基因可在真核细胞293细胞中表达并使293细胞获得代谢草酸的能力。     

Dissolution of ureteral uric acid calculi with local litholytic irrigation

This study was designed to evaluate the efficacy of local litholytic irrigation (LII) in the treatment of ureteral uric acid calculi. Fourteen cases of ureteral uric acid calculi were diagnosed by abdominal plain radiography (KUB), retrograde urography, ultrasonography( B-mode ultrasound) spiral computerized tomography(CT) and blood biochemical examinations. A ureteral catheter was passed retrogradely across ureteral calculi by cystoscopy,LLI with tromethamine E(THAM-E) was performed via the ureteral catheter after the improvement of renal function and general situation and the control of urinary tract infection under the condition of intravenous application of antihiotics. The irrigation rate varied from 1000 to 1500 ml per day. Retrograde pyelography demonstrated complete dissolution of all the stones,13 cases within 10 days and I within I2 days. Mild hematuria was observed in the majority of the cases and temporary aggravated lumbago in 1 case, with no other side effects. It is concluded that LLI is a practical and effective method in the treatment of ureteral uric acid calculi for its advantages of shorter duration,lower cost,less physical suffering and no severe complications。     

Xp11.2易位/TFE3基因融合相关性肾癌的临床与病理分析

目的探讨Xp11.2易位/TFE3基因融合相关性肾癌的临床及病理学特点。方法回顾性分析13例Xp11.2易位/TFE3基因融合相关性肾癌的临床和组织学资料。结果 13例中,10例以无痛性肉眼血尿为首发症状,且肿瘤临床分期较高。影像学上CT增强幅度为(31.85±14.65)HU。行开放肾癌根治术7例,腹腔镜肾癌根治术5例,腹腔镜肾癌射频消融1例。组织学最具特征的表现是由透明细胞构成的乳头状结构,常伴有由嗜酸性颗粒胞浆的瘤细胞组成的巢状结构。13例肿瘤均弥漫高表达TFE3,不同程度表达CD10、CK7、P504S和Vimentin。结论 Xp11.2易位/TFE3基因融合相关性肾癌发病率较低;肿瘤CT增强幅度较普通肾透明细胞癌小;其诊断主要依靠特征性的组织病理学改变和免疫标记TFE3阳性。     

膀胱内异位前列腺初诊膀胱肿瘤1例报道并文献复习

<正>异位前列腺是指在前列腺正常部位以外发生的前列腺组织。据统计,从1894年Jores首次发现异位前列腺迄今,国内外总计约有200余例相关报道,2013年我院收治1例,现报告如下。1临床资料患者男性,48岁,因体检B超发现膀胱肿瘤5 d于2013年4月收住入院。病程中患者无腰酸、腰痛,无尿频、尿急、尿痛,无排尿困难,无肉眼血尿。直肠指检:前列腺增大,两横指半,表面光滑,质韧,无压痛,未触     

后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

靶向STAT3的decoy核酸抑制膀胱癌细胞生长的实验研究

目的观察特异性靶向STAT3的decoy寡核苷酸（0DNs）对膀胱癌细胞增殖和凋亡的影响，并探讨其作用机理。方法通过体外细胞培养技术，将STAT3 decoy ODNs转染入膀胱癌T24细胞内，台盼蓝排斥试验检测细胞活力，MTT法检测细胞增殖状态，Hoechst33258／PI荧光双染检测细胞凋亡特征，流式细胞仪检测细胞周期和早期凋亡，凝胶阻滞电泳检测STAT3的DNA结合活性，RT-P（、R检测STAT3下游靶基因Cyclin D1和Bcl—xL的mRNA表达水平。结果STAT3 decoy ODNs使膀胱癌细胞生长速度减慢，细胞增殖抑制率达75．0％；使细胞周期阻滞，S期细胞比率明显减少，由29．83％下降至1626％，而G0～G1期细胞比率明显增多，由50．82％上升至71．20％；促进膀胱癌细胞凋亡，细胞早期凋亡率高达50．75％；使STAT3的DNA结合活性下降，并使Cyclin D1、Bcl—xL的mRNA表达水平明显下降。结论STAT3 decoy ODNs可特异性靶向作用于STAT3蛋白，阻断STAT3的过度激活效应，通过下调Cyclin D1和Bel—xL的表达抑制膀胱癌细胞增殖，促进其凋亡。