左肾上腺区占位误诊荟萃分析*

目的 总结左肾上腺区占位误诊的经验教训,提高诊疗水平。方法 在中国期刊全文数据库及 万方数据库中搜集关于左肾上腺区肿物误诊的文献报道,分析其临床特征及误诊原因。结果 共收集到符合 要求的文献31 篇,总病例数47 例,包括副脾15 例、血管瘤5 例、支气管源性囊肿15 例、胃肠道间质瘤6 例、 淋巴管瘤1例、胃憩室2例、畸胎瘤2例及隔离肺1例。误诊原因包括局部解剖结构不熟悉、阅片能力不足及影像 学检查不完善等。结论 对不能确诊的左肾上腺区占位的患者,应加强对相关疾病的认识,完善三维立体CT及 MRI等检查,请有经验的影像科医生会诊,提高诊疗水平。     

抗HLA和抗MICA抗体的表达对移植肾功能和急性排斥反应的预示作用

Objective To investigate the prediction of anti-human leukocyte antigen antibodies (HLA) and anti-major histocompatibility complex class I-related chain A antibodies (MICA) to the development of acute rejection (AR) and kidney allograft function. Methods Forty-one kidney transplant patients were prospectively tested for anti-HLA and anti-MICA. Thirty-seven patients were screened using Luminex/single-antigen beads to determine the HLA and MICA-specific antibody levels at 0,30,90, 180,360,720 and 1080 days post-transplantation. The patients and donors of HLA and MICA allele typing were determined by PCR-SSOP, and donor specific antibody (DSA) and non-donor specific antibody (NDSA) were identified.Simultaneously,their serum creatinine (SCr) levels and clinical data were analyzed. Results Nine patients (21.95 % ,9/41 ) had pre-existing anti-HLA and(or) anti-MICA, including 6 cases of anti-MICA,2 cases of anti-HLA, and one case of anti-MICA and anti-HLA. Nine patients had pre-existing DSA and NDSA. In the 37 patients, 6 patients (16.2% ) developed de novo anti-HLA, and 3 (8.1%) developed de novo antiMICA. In patients positive for de novo anti-HLA, the titer of antibody was gradually increased during the follow-up of three years. Four patients out of 9 patients with pre-existing antibodies were suffered from AR (44.4%); In 6 patients positive for de novo anti-HLA,three cases (50.0%) were suffered from AR; In three patients positive for de novo anti-MICA,no AR occurred (P＜0.05). In two patients positive for DSA of HLAⅡ antibody detected at the third and seventh day after transplantation, the renal grafts were renovecd due to rejection. The Scr levels in patients positive for pre-existing MICA with AR were higher than in those positive for pre-existing MICA without AR at each scheduled time point during the follow-up period (P＜0.05). The Scr levels in patients negative for antibodies pre-transplantation and having AR were higher than in those having no AR at each scheduled time point during the follow-up period (P＜0. 01 ). The Scr levels in patients positive for de novo HLA and MICA and having AR one month following transplantation were higher than in those negative for antibodies and having no AR (P＜0.01 ). Conclusion Pre-existing and de novo anti-HLA were the irnportant factors for the development of AR, but the mismatch of HLA and MICA alleles in donors and patients was primary causes for generation of de novo antibodies.     

术前白蛋白碱性磷酸酶比值对前列腺癌根治术后生化复发时间的影响

目的 探讨术前白蛋白碱性磷酸酶比值（AAPR）与前列腺癌（PCa）根治术后生化复发（BCR）的关系。方法 收集苏州大学附属第一医院2012年5月至2015年10月收治的137例PCa患者的临床资料,根据患者有无发生BCR分为发生BCR组及未发生BCR组,比较两组间年龄、体质指数（BMI）、前列腺特异性抗原（PSA）、AAPR、高血压、糖尿病、Gleason评分、病理分期、辅助内分泌治疗（AHT）、BCR及随访时间的差异,并对有统计学差异的因素进行分层分析。取AAPR的三分位点0.5、0.64分为低AAPR组、中AAPR组及高AAPR组。根据Gleason评分分为低分组（6分）,中分组（7分）及高分组（8~10分）,参照TNM分期分为低分期组（Ⅱ期）,中分期组（Ⅲ期）,高分期组（Ⅳ期）。通过多元Logistic分析筛选出发生BCR的独立危险因素。采用Kaplan-Meier法绘制生存曲线,比较低AAPR组、中AAPR组及高AAPR组间BCR的差异。结果 本研究随访时间8~93个月,中位时间55个月,137例患者中有45例发生BCR。发生BCR组与未发生BCR组间AAPR、Gleason评分、病理分期、AHT差异有统计学意义（P<0.05）,且低AAPR组BCR发生率高于中AAPR组及高AAPR组（P<0.05）,高分组BCR发生率高于中分组及低分组（P<0.05）,高分期组BCR发生率高于中分期组及低分期组（P<0.05）。多因素Logistics回归分析结果显示,AAPR为BCR的独立危险因素（P<0.05）。AAPR与Gleason评分及病理分期无关（P>0.05）。生存曲线结果表明,高、中、低AAPR组患者PCa根治术后未发生BCR生存时间具有反向关系,即AAPR水平越高,BCR越延迟发生（P<0.05）。结论 AAPR与PCa根治术后BCR的发生有关,且与未发生BCR生存时间相关,随着AAPR的升高,BCR发生率下降,无BCR生存时间延长。     

代谢综合征与肾透明细胞癌分级和分期相关性的研究

目的：研究代谢综合征及其各组分与肾脏透明细胞癌分级和分期之间的关系。方法：筛选2018年1月—2019年12月本院收治的153例病理确诊为肾透明细胞癌患者的资料进行回顾性分析,收集年龄、性别、吸烟、饮酒、体重指数、血压、空腹血糖、血脂水平、肿瘤直径、分级及分期等信息。肿瘤分级采用1982年Fuhrman四级分类,将Ⅰ、Ⅱ级合并成高分化组,Ⅲ、Ⅳ级合并成低分化组。根据2010年TNM分期标准,将T1a、T1b期作为低分期组,T2a、T2b期作为高分期组。计量资料比较采用t检验进行统计学分析;计数资料比较使用χ2检验;使用Logistic回归分析寻找独立危险因素。结果：肾透明细胞癌的病理分级和分期与代谢综合征有关（P < 0.05）,高血压、糖尿病、高血脂与肾透明细胞癌的病理分级、分期有关（P < 0.05）。多因素Logistic回归分析结果表明,高血压、糖尿病、高血脂是肿瘤病理分级的独立危险因素（P < 0.05）,而糖尿病和高血脂是肿瘤分期的独立危险因素（P < 0.05）。结论：肾透明细胞癌合并代谢综合征患者的Fuhrman分级、TNM分期更高。     

“镜面人”行左侧肾上腺肿瘤切除1例并文献复习

“镜面人”,又称“镜子人”或“镜像人”,即全内脏反位（situs inversus viscerum,SIV）,其内脏位置与正常相反,恰好如同常人在镜子中的影像一样,是十分少见的先天性畸形,“镜面人”合并外科疾病需要行手术治疗的病例在临床上更为罕见。现将本院1例全内脏反位行腹腔镜左侧肾上腺肿瘤切除术病例结合文献复习报道如下。     

抗HLA和抗MICA抗体的表达对移植肾功能和急性排斥反应的预示作用

Objective To investigate the prediction of anti-human leukocyte antigen antibodies (HLA) and anti-major histocompatibility complex class I-related chain A antibodies (MICA) to the development of acute rejection (AR) and kidney allograft function. Methods Forty-one kidney transplant patients were prospectively tested for anti-HLA and anti-MICA. Thirty-seven patients were screened using Luminex/single-antigen beads to determine the HLA and MICA-specific antibody levels at 0,30,90, 180,360,720 and 1080 days post-transplantation. The patients and donors of HLA and MICA allele typing were determined by PCR-SSOP, and donor specific antibody (DSA) and non-donor specific antibody (NDSA) were identified.Simultaneously,their serum creatinine (SCr) levels and clinical data were analyzed. Results Nine patients (21.95 % ,9/41 ) had pre-existing anti-HLA and(or) anti-MICA, including 6 cases of anti-MICA,2 cases of anti-HLA, and one case of anti-MICA and anti-HLA. Nine patients had pre-existing DSA and NDSA. In the 37 patients, 6 patients (16.2% ) developed de novo anti-HLA, and 3 (8.1%) developed de novo antiMICA. In patients positive for de novo anti-HLA, the titer of antibody was gradually increased during the follow-up of three years. Four patients out of 9 patients with pre-existing antibodies were suffered from AR (44.4%); In 6 patients positive for de novo anti-HLA,three cases (50.0%) were suffered from AR; In three patients positive for de novo anti-MICA,no AR occurred (P＜0.05). In two patients positive for DSA of HLAⅡ antibody detected at the third and seventh day after transplantation, the renal grafts were renovecd due to rejection. The Scr levels in patients positive for pre-existing MICA with AR were higher than in those positive for pre-existing MICA without AR at each scheduled time point during the follow-up period (P＜0.05). The Scr levels in patients negative for antibodies pre-transplantation and having AR were higher than in those having no AR at each scheduled time point during the follow-up period (P＜0. 01 ). The Scr levels in patients positive for de novo HLA and MICA and having AR one month following transplantation were higher than in those negative for antibodies and having no AR (P＜0.01 ). Conclusion Pre-existing and de novo anti-HLA were the irnportant factors for the development of AR, but the mismatch of HLA and MICA alleles in donors and patients was primary causes for generation of de novo antibodies.     

一次性输尿管软镜和重复性输尿管软镜治疗肾下盏结石的疗效分析

目的 探讨重复性输尿管软镜(FURS)和一次性FURS治疗肾下盏结石的疗效。方法 回顾性分析2020年1月至2021年3月在本院治疗的206例肾下盏结石患者的临床资料,根据手术方式分为重复性FURS组（154例）及一次性FURS组（52例）。比较两组的一般情况、结石侧别、结石长径、结石数量、结石密度、肾盂肾下盏漏斗夹角（IPA）等方面的差异。结果 两组的一般情况、结石侧别、结石长径、结石数量、结石密度、IPA、术后并发症、住院时间及结石清除率比较,差异均无统计学意义（均P>0.05）。重复性FURS组的手术时间高于一次性FURS组[（42.96±16.81）min vs.(37.31±14.88)min,P=0.041],而住院费用低于一次性FURS组[（23 492.60±5 151.34）元 vs. (29 262.33±2 099.96)元, P<0.001]。结石数量、结石长径、结实密度及术后并发症与手术时间均有相关性（均P<0.05）。通过logistic回归分析结果得出,结石数量、结石长径及手术方式均为影响手术时间的独立危险因素（均P<0.05）。结论 对于肾下盏结石的治疗,一次性FURS与重复性FURS的疗效相似。对于肾下盏结石数量较多、结石长径较大的患者,在经济情况的允许下,可优先选择一次性FURS,可缩短手术时间。     

术前白蛋白与碱性磷酸酶比值对局限性阴茎癌术后复发的影响

目的 探讨术前白蛋白与碱性磷酸酶的比值(AAPR)与局限性阴茎癌(T1～3N0M0)术后复发的关系。方法 收集苏州大学附属第一医院2012年1月—2017年1月收治的93例局限性阴茎癌患者的临床资料，比较术后复发组与非复发组间年龄、体质指数(BMI)、AAPR、高血压、糖尿病、肿瘤直径、术后病理分级及分期的差异。Cox回归分析术后发生复发的独立危险因素。采用Kaplan-Meier法绘制生存曲线，比较高、低AAPR组间术后发生复发的差异。结果 复发组较非复发组有较高的WHO/国际泌尿外科病理学学会(ISUP)病理分级(P=0.018)和病理分期(P=0.012)、较低的AAPR(P=0.001)。Cox回归结果显示，AAPR为术后发生复发的独立危险因素(P=0.041)。生存曲线结果表明，高、低AAPR组患者与术后未发生复发的生存时间负相关(P=0.028)。结论 术前AAPR是局限性阴茎癌术后复发的独立危险因素，且与未发生复发时间相关。随着AAPR的升高，复发发生率下降，无进展生存时间延长。     

前列腺移行细胞癌一例报告并文献复习

前列腺恶性肿瘤95%以上是腺癌,移行细胞癌(TCC)少见.我院2008年11月收治1例经病理证实的原发性前列腺TCC,结合文献复习,报道如下.患者,男,48岁.因间断性无痛性肉眼血尿2个月就诊,直肠指诊(DRE):前列腺稍大,质韧,表面光滑,中央沟存在,没有明显硬质结节.     

mpMRI阴性患者诊断有临床意义前列腺癌的危险因素分析与风险分层

目的:探讨前列腺多参数磁共振(mpMRI)阴性患者诊断为有临床意义前列腺癌(CsPCa)的独立危险因素及风险分层方案。方法:回顾性分析2015年10月至2021年1月苏州大学附属第一医院、苏州大学附属第二医院、南京中医药大学附属昆山市中医院收治的前列腺mpMRI检查阴性且行系统穿刺的549例患者的临床资料。患者中位年龄...