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。     

血液滤过开始时间对脓毒症预后的影响

目的:探讨连续性血液净化(CBP)开始时间对脓毒血症患者预后的影响.方法对2009.5-2010.12于本院ICU住院的50例脓毒症患者,根据诊断脓毒症后进行血液滤过的时间分为早期血液滤过组(诊断脓毒症48小时内),和晚期血液滤过组(诊断脓毒症后大于48小时).进行不同时段的CBP治疗,观察及统计其对血流动力学、氧合功能、生化指标、住ICU时问及预后的影响.结果:A,B组在治疗前APACHE-Ⅱ评分、SOFA评分、死亡危险性R(%)无显著统计学意义,但从CBP开始治疗10天后APACHE-Ⅱ评分、SOFA评分、死亡危险性R(%)均有明显下降,且A组下降更多,与B组比较存在显著差异(P<0.05);在出ICU时,虽然APACHE-Ⅱ评分无统计学意义,但SOFA评分、死亡危险性R(%)A组比B组均有明显下降(P<0.05);A组较B组人住ICU时间短,亦有显著差异(P<0.05).随着治疗时间的延长,两组患者血白细胞、血肌酐、尿素氮、血浆肿瘤坏死因子(TNF)、白细胞介素-1(IL-1)、IL-6和内毒素(LPS)浓度均有降低,但A组降低更明显(P<0.05).CBP对脓毒血症有明显的治疗作用,且早期(48小时内)介入,可以提高脓毒血症患者的救治率,改善预后.     

逼尿肌活动低下在下尿路症状中的临床特征及诊疗策略分析

目的:探讨逼尿肌活动低下(DU)在下尿路症状(LUTS)患者中的流行病学现状、临床特征及诊疗策略。方法:回顾性分析了我院1 019例排除神经源性膀胱及解剖结构异常的LUTS患者的尿流动力学检查结果及随访资料,探讨DU在LUTS中的流行病学及临床诊治特点,并对106例DU患者治疗前后行尿流动力学检查,结合文献进行临床分析。结果:在就诊患者中,储尿期症状最为多见,在男性患者中,排尿期症状稍多于储尿期症状,而女性患者储尿期症状明显多于排尿期症状。男性患者中膀胱出口梗阻(BOO)的患者为57.9%,而女性患者中压力性尿失禁(SUI)患者达到了43.3%。27.4%男性及23.2%女性诊断为DU,男性及女性患病率差异无统计学意义。DU患者与非DU患者的临床表现无明显差异,均以LUTS为主要表现。DU可能合并有逼尿肌过度活动或BOO。DU随着年龄的增加,患病率逐渐增加。106例DU患者经治疗后行尿动力学检查发现逼尿肌收缩力有一定提高,治疗前后逼尿肌肌力差异有统计学意义。结论:DU是LUTS患者的常见病因,并有可能同时合并有逼尿肌过度活动或BOO。目前针对DU患者的治疗有一定效果。     

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.     

去势抵抗性前列腺癌冷冻消融联合多西紫杉醇治疗临床观察

目的：评价氩氦刀冷冻消融联合多西紫杉醇化疗治疗去势抵抗性前列腺癌的安全性、有效性及临床价值。方法：2007-06-01-2011-12-30南京大学医学院附属鼓楼医院采用冷冻消融联合多西紫杉醇＋泼尼松3周标准方案化疗治疗去势抵抗性前列腺癌17例。以PSA缓解,前列腺MR及ECT骨扫描作为评定指标,疗效评价包括完全缓解（CR）、部分缓解（PR）、病情稳定（SD）和病情恶化（PD）。不良反应选择髓抑制、肝功能损害及呕吐作为评估。结果：17例患者经过18～66个月随访,平均随访时间31个月。冷冻手术时间（102±43）min,均未输血及术中并发症。其中29.4%（5/17）CR,47.1%（8/17）PR,17.6%（3/17）SD,5.9%（1/17）PD。CR＋PR患者的PSA进展时间为18～112周,中位进展时间为54.2周。中位生存期〉14个月。PSA无进展生存率为94.1%。合并骨痛患者11例,经治疗后72.7%（8/11）骨痛缓解,27.3%（3/11）骨痛稳定。骨髓抑制、肝功能损害和胃肠道反应等不良反应可耐受。结论：冷冻消融联合标准多西紫杉醇＋泼尼松标准方案化疗治疗CRPC安全可行,近期疗效明显,远期疗效有待进一步观察。     

改良W形回肠代膀胱术的疗效观察(附36例报告)

目的 :探讨改良W形回肠代膀胱术的疗效。方法 :对 36例膀胱肿瘤患者行根治性膀胱切除、W形回肠代膀胱术 ,并对术式进行改进。结果 :36例手术时间平均 4 .2h。术后 31例随访 4～ 19个月 ,平均 10 .6个月 ,无严重并发症 ,均无瘤生存。患者一般于术后 3周自主可控性排尿 ,日间尿控率为 10 0 % ,术后 3、6、12个月夜间尿失禁发生率分别为 2 2 .5 %、11.1%及 6 .2 %。术后 6个月尿动力学检查膀胱容量 (36 0± 30 )ml,最大尿流率 (13.6± 2 .6 )ml/s,剩余尿量 (11.5± 5 .8)ml,充盈期膀胱压力明显低于尿道闭合压。新膀胱造影发现新膀胱呈球形 ,完全位于盆腔 ,未见输尿管反流。B超及IVU检查发现原上尿路积水 4例均明显减轻 ,其余未发现输尿管狭窄和上尿路积水征象。无高氯性酸中毒 ,肾功能正常。结论 :改良W形回肠代膀胱术手术时间短 ,操作简单 ,创伤轻 ,并发症少 ;新膀胱容量大 ,内压低 ,顺应性好 ,功能接近于正常膀胱 ,保持原位排尿 ,明显提高了患者术后生活质量 ,值得临床推广应用。     

免疫抑制剂对实验性矽肺的影响研究

目的：探讨免疫抑制剂对矽肺发病的影响。方法：动物采用随机法，分对照组，免疫抑制组。石英粉尘非暴露式吸人4周后，测定肺巨噬细胞功能，气管、支气管、肺显微镜观察。结果：免疫抑制组肺巨噬细胞吞噬功能受到明显抑制，肺内细胞结节增多，肺细支气管等管壁增厚并胶原纤维增生。结论：免疫抑制剂可加重矽肺的病程。     

细针吸取细胞学诊断阴茎转移性直肠腺癌1例并文献复习

目的:提高对阴茎转移性癌的认识及探讨阴茎肿块的诊断方法。方法:对1例阴茎硬结行细针吸取(fine-needle aspiration,FNA)操作及细胞学检查。结果:细胞学涂片见大量高柱状肿瘤细胞,部分细胞可见腺腔样排列,背景中见大量坏死,结合病史考虑阴茎转移性直肠腺癌。结论:阴茎转移性癌少见。其临床主要表现为阴茎硬结、异常勃起等。FNA检查安全、微创、高效、诊断准确,可作为诊断阴茎转移癌的首选方法。     

外周血游离DNA/NETs在脓毒症诊断和预后评估中的应用价值

目的探讨血浆游离DNA/中性粒细胞胞外诱捕网(cf-DNA/NETs)对脓毒症临床诊断和严重度评估的价值。方法收集脓毒症患者、非感染全身炎性反应综合征(nf-SIRS)患者入监护室时的血液标本,检测两组患者血液中cf-DNA/NETs的水平,并绘制受试者工作特征(ROC)曲线,与白细胞(WBC)、降钙素原(PCT)和白细胞介素-6(IL-6)比较,评价cf-DNA/NETs及其他感染指标鉴别脓毒症患者的能力。根据预后将脓毒症患者分为生存组和死亡组两个亚组,比较两组间感染指标是否有显著差异,并与序贯器官衰竭评分(SOFA评分)进行相关性分析。结果脓毒症组与nf-SIRS组比较,cf-DNA/NETs和PCT明显升高(均P0.05),而WBC和IL-6在两组患者间差异无统计学意义(均P0.05)。cf-DNA/NETs、PCT用于脓毒症诊断时的ROC曲线下面积分别为0.884和0.803,诊断脓毒症的敏感性分别为81.2%和79.2%,特异性分别为82.4%和81.0%。死亡组与生存组比较,cf-DNA/NETs和PCT水平明显升高(均P0.05)。双变量相关分析显示cf-DNA/NETs和PCT均与SOFA评分有较好的相关性,r值分别为0.573和0.518(均P0.01)。结论 cf-DNA/NETs和PCT均可以作为脓毒症早期的诊断指标。cf-DNA/NETs与PCT相比,在脓毒症诊断能力上有一定的优势,并且有助于对脓毒症严重程度的评估。     

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.