糖尿病对大鼠尿道外括约肌功能的损害

目的利用大鼠模型研究糖尿病（DM）对尿道外括约肌功能的影响。方法以雌性SD大鼠制成DM模型,6-8周后测定DM大鼠和正常对照（NC）大鼠膀胱等容收缩状态下的膀胱内压、尿道充盈压和括约肌肌电图（EUS-EMG）。结果与NC大鼠对比,DM大鼠体重明显降低,血糖明显升高,膀胱容量明显增大;膀胱排尿收缩时尿道压力病理性增高;EUS-EMG表现为排尿过程中应有的尿道外括约肌高频舒张收缩减弱或消失,引发的尿道压力曲线上的高频振动波振幅降低或消失。结论DM在损伤大鼠膀胱功能的同时,还损伤排尿时尿道外括约肌正常的高频收缩舒张功能。     

直视下尿道内切开术治疗尿道狭窄20年经验总结

目的 总结直视下尿道内切开术(direct vision internal urethrotomy,DVIU)治疗尿道狭窄的经验.方法 回顾性分析1990年6月至2010年6月20年间DVIU治疗尿道狭窄或闭锁患者361的临床资料.年龄16～72岁,平均38岁.病程3～78个月,平均16个月.狭窄或闭锁长度0.2～2.0 cm,平均1.1 cm.狭窄长度≤1.0 cm 238例,其中≤0.5 cm 63例(组1),0.6～1.0 cm 175例(组2),瘢痕厚度≤1.0 cm 148例,＞1.0 cm 90例;狭窄长度1.1～2.0 cm 123例,其中1.1～1.5cm 85例(组3),1.6～2.0 cm 38例(组4),瘢痕厚度≤1.0 cm 44例,＞1.0 cm 79例.结果 361例中手术失败3例.320例获随访,随访时间12～120个月,平均42个月.因狭窄复发而接受开放手术174例(54.4%),4组中转开放手术率分别为3.3%、49.7%、83.3%和97.1%.狭窄长度≤1.0cm者获随访207例,其中瘢痕厚度≤1.0 cm转开放手术27.2%(37/136),瘢痕厚度＞1.0 cm转开放手术60.6%(43/71).狭窄长度＞1.0 cm者获随访113例,其中瘢痕厚度≤1.0 cm转开放手术78.6%(33/42),瘢痕厚度＞1.0 cm转开放手术84.5%(60/71).结论 当尿道狭窄长度≤0.5 cm时,DVIU术后转开放手术的比例明显减少;狭窄长度≤1.0 cm,瘢痕厚度≤1.0 cm者,DVIU也可获较好疗效.

Abstract：

Objective To summarize the experience and evaluate the efficacy of treatment of urethral stricture using direct visual internal urethrotomy (DVIU).Methods The clinical data of 361 patients (age range 16 -72 years, mean age 38 years) with urethral stricture who underwent urethrotomy from 1990 to 2010 was retrospectively analyzed.The disease course ranged from three months to 78 months with a mean of 16 months.The stricture length ranged from 0.2 to 2.0 cm (mean 1.1 cm).Stricture length was split into four main groups:stricture length≤0.5 cm in 63 (group 1 ), stricture length ranging between 0.6 and 1.0 cm in 175 ( group 2), stricture length ranging between 1.0 and 1.5 cm in 85 ( group 3 ) , and stricture length ranging between 1.6 and 2.0 cm in 38 ( Group 4).Of the 238 patients with length less than 1.0 cm there were 148 who's scar thickness were less than 1.0 cm, and 90 who's scar thickness were greater than 1.0 cm.Of the 123 patients with length less than 2.0 cm there were 69 who's scar thickness was less than 1.0 cm, and 54 who's scar thickness was greater than 1.0 cm.Results Three patients with DVIU failed because of long occlusion and false passage.Three hundred and twenty patients were followed-up from 12 to 120 months (mean:42).Re-openiag procedures were performed on 174 patients (54.4%) due to recurrence.The re-openiag procedure rate was 3.3%, 49.7%, 83.3% and 97.1% in Group1, Group2,Group3 and Group4, respectively.On the basis of scar thickness, of the 207 patients with stricture length less than 1.0 cm, 38 of 136 patients (27.9%) with scar thickness less than 1.0 cm underwent opening operation, and 43 of 71 patients (60.6%) with scar thickness more than 1.0 cm underwent opening operation.One hundred and thirteen patients with stricture length more than 1.0 cm, 33 of 42 patients (78.6%) with scar thickness less than 1.0 cm underwent opening operation, and 60 of 71 patients (84.5%) with scar thickness more than 1.0 cm underwent opening operation.Conclusions Good efficacy can be achieved in patients whose urethral stricture length is less than 0.5cm or whose stricture length and scar thickness is less than 1.0 cm using DVIU.     

超长段尿道狭窄术后勃起功能的评估

目的 探讨自体组织替代治疗超长段尿道狭窄对勃起功能的影响.方法 回顾性分析2007年1月至2009年1月采用不同自体组织补片(阴囊纵隔、包皮内板、口腔黏膜)Onlay术式替代治疗超长段男性尿道狭窄患者的临床资料,并随访患者ⅡEF-5评分、QOL评分及最大尿流率,并与术前相应情况进行分析.结果 根据研究标准收集23份有效数据.患者术前及术后3、6、12个月QOL评分分别为5.22±0.75、1.22±1.40、1.82±1.17、2.07±0.46,最大尿流率分别为(3.93±3.62)、(22.46±4.65)、(23.81±6.22)、(21.52±7.44)ml/s,术后不同时期均较术前明显改善(P＜0.01).术前及术后3、6、12个月ⅡEF-5评分分别为14.47±9.55、14.70±5.32、14.26±3.29和14.58±3.62,组间比较差异无统计学意义(P＞0.05).9例狭窄部位累及至后尿道者术后3、6、12个月ⅡEF-5评分分别为11.67±2.59、12.35±1.83、13.19±1.67,14例单纯前尿道狭窄者分别为17.79±6.42、16.57±4.78、16.01±3.85,2组间比较差异均有统计学意义(P＜0.05).狭窄累及后尿道患者多元线性回归分析中,年龄、受伤时间及尿道狭窄段长度与替代术后ⅡEF-5评分呈多元线性相关.结论 自体组织替代治疗男性超长段尿道狭窄对勃起功能影响不明显;狭窄段累及后尿道时可能对患者勃起功能产生一定影响.患者年龄和受伤时间对勃起功能有协同影响作用.

Abstract：

Objective To investigate the effect of substitutive reconstruction of long urethral stricture on male erectile function. Methods From January 2007 to January 2009, 23 patients with anterior or posterior long urethral stricture were accepted for a variety of onlay substitutive procedures, including lingual mucosa, perputial skin, and mid-scrotal skin. During the follow-up, data from the International Index of Erectile Function-5 (ⅡEF-5) questionnaire and the Quality of Life (QOL) questionnaire as well as maximal flow rate were recorded. All data were compared with those obtained before surgery. Results Significant improvement in QOL (1.22 ± 1.40, 1.82 ± 1. 17,2.07± 0.46) and maximal flow rate (22.46± 4.65, 23.81 ± 6.22, 21.52 ±7.44 ) could be observed 3, 6 and 12 months after surgery compared with those before surgery (5. 22 ± 0. 75, 3. 93 ± 3. 62)(P＜0.01). No significant differences in the responses to the ⅡEF-5 questionnaire were observed among all patients during the follow-up (P＞0. 05). At the 3, 6 and 12 months after procedure,scores of ⅡEF-5 in patients with anterior urethral stricture ( 17.79 ± 6.42, 16. 57 ± 4. 78, 16.01 ±3.85) were significantly higher than those with posterior urethral stricture (11.67 ± 2.59, 12.35 ±1.83,13. 19±1.67, P＜0.05). In patients with posterior urethral stricture, the multiple linear regression showed that age, time interval of injury and length of stricture were related to the ⅡEF-5score (P＜0.05). Conclusions Substitutive reconstruction for treating the long urethral stricture has little effect on male erectile function. But the location of stricture, especially extended to posterior urethra, may have impact on the erectile function.     

过氧化物酶体增殖激活物受体与15-脂氧合酶-2在前列腺癌组织中的表达及其意义

目的 观察过氧化物酶体增殖激活物受体(PPAR-γ)及15-脂氧合酶-2(15-LOX-2)在前列腺癌中的表达,探讨其意义.方法 采用免疫组织化学方法检测28例前列腺癌组织中PPAR-γ及15-LOX-2蛋白的表达,取26例前列腺增生组织作为对照.结果 PPAR-γ在前列腺癌组表达阳性程度高于前列腺增生组(x2=4.84,P＜0.05);15-LOX-2在前列腺癌组表达阳性程度低于前列腺增生组(x2 =9.00,P＜0.05).T3期前列腺癌PPAR-γ的表达阳性程度明显高于T2期(H=4.103,P＜0.05);T2期与T3期前列腺癌细胞15-LOX-2的表达阳性程度差异无统计学意义(H =0.076,P＞0.05).Gleason评分≥7分前列腺癌PPAR-γ的表达阳性程度明显高于Gleason评分＜7分(H=5.306,P＜0.05);Gleason评分≥7分与Gleason评分＜7分前列腺癌15-LOX-2的表达阳性程度差异无统计学意义(H =0.313,P＞0.05).结论 PPAR-γ蛋白在前列腺癌组织中高表达,并且与病理分期及Gleason评分有关;15-LOX-2在前列腺癌组织中低表达.它提示PPAR-γ和15-LOX-2与前列腺癌发生与发展有关.     

非编织状聚乙醇酸膜片重建兔尿道的实验研究

目的探讨非编织状聚乙醇酸膜片重建兔全层尿道的效果。方法制备1cm×1cm的非编织状PGA膜片。建立新西兰大白兔尿道腹侧1cm全层尿道缺损动物模型,将PGA膜片植入尿道缺损区域,修补尿道缺损。术后1、2、3个月进行尿道造影、大体观察和组织学观察评价尿道重建情况。结果PGA膜片修复新西兰兔全层尿道缺损,9只动物除1只术后1个月发生尿瘘外．其余动物均排尿通畅。组织学检查发现尿道黏膜再生良好,但尿道海绵体区域主要以纤维瘢痕增生为主,未见明显尿道海绵体再生。结论PGA膜片能够修复新西兰大白兔1cm尿道黏膜的缺损,但缺乏尿道海绵体再生。     

干细胞在组织工程技术修复重建下尿路疾病中的应用

应用组织工程技术进行泌尿系统重建的研究开展已有多年,但取材不便,细胞材源不足等问题始终未得以解决,从而限制了其进一步向临床推广。干细胞由于具备的自我更新及定向分化潜能,及对供区较小创伤等优势,为今后的研究工作提供了新的可能。研究者尝试以干细胞与脱细胞基质复合构建组织工程膀胱,适当诱导环境下,骨髓间充质干细胞能够向内胚层起源尿路上皮细胞分化。干细胞在尿道组织工程的研究中尚无相关动物模型的报道,但考虑到尿道与膀胱在组织结构及体内诱导环境上的相似性,推断干细胞在体内尿道组织中可能具有与膀胱间质中相似的分化能力。尿道超声引导下尿道周黏膜下层、横纹肌括约肌内注射自体肌源性干细胞、成纤维细胞是一种治疗压力性尿失禁的有效方法。间充质干细胞在海绵体组织中具有分化潜能外,还可促使一氧化氮分泌以改善勃起功能,并在内皮型一氧化氮合酶转染情况下,可通过进一步提高一氧化氮水平达到治疗勃起功能障碍的目的。     

原发性前列腺印戒细胞癌诊疗分析

目的 提高对原发性前列腺印戒细胞癌临床特点的认识和诊治水平. 方法 原发性前列腺印戒细胞癌患者23例.年龄57～90岁,平均74岁.有排尿症状者18例,体检偶然发现PSA升高者5例.实验室检查PSA平均45.3(7.4～126.8)ng/ml.MRI多示外周带有异常区呈T1w低信号、T2W高信号,增强后明显强化,中央带见增生结节,呈混杂信号.其中行前列腺癌根治术7例,2例切缘阳性者术后辅以全雄激素阻断治疗及体外放射治疗,16例行全雄激素阻断治疗,其中11例因存在下尿路梗阻而行前列腺绿激光汽化术,3例行体外放射治疗.23例均行消化道内镜或钡餐检查排除转移性印戒细胞癌. 结果 23例均经病理证实为印戒细胞癌,其中纯印戒细胞癌6例,混有典型前列腺癌成分17例,其中典型癌成分均为Gleason评分7～10分的高级别低分化前列腺癌.免疫标记PSA、前列腺酸性磷酸酶均为阳性,AB/PAS阴性,CEA阴性21例.TNM临床分期Ⅱ期7例,Ⅲ期10例,Ⅳ期6例.20例平均随访24(6～56)个月,8例生存6～42个月后因肿瘤转移死亡,5例12～21个月后出现生化复发,失访3例. 结论 原发性前列腺印戒细胞癌侵袭性强、转移快且累及前列腺外各种脏器、复发早,早期诊断及综合治疗或能提高远期生存率.