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1.
目的尝试单孔腹腔镜下经膀胱根治性切除猪前列腺,探讨其可行性,总结操作难点,为后续临床应用奠定基础。方法采用雄性未阉割香猪,全麻下进行膀胱外翻皮肤造口;将TriPort单孔多通道系统经造口处置入膀胱并固定;建立气膀胱后,用传统腹腔镜器械模拟人经膀胱前列腺根治性切除术;经膀胱完成膀胱内口与尿道吻合,经皮肤造口取出前列腺标本后关闭膀胱和腹腔。结果共完成了6例动物实验,前3例失败,原因为膀胱操作空间无法保证、吻合操作失败等;后3例均顺利完成,手术时间分别是190、160、110min,前列腺完整切除,间断吻合6针恢复尿道连续性。结论单孔腹腔镜下经膀胱猪前列腺根治性切除技术可行,但操作难度较大,鉴于猪解剖结构与人存在较大差异,需进一步在尸体模型上进行类似尝试,目前尚不适合向临床阶段过渡。  相似文献
2.
腹腔镜前列腺癌根治术围手术期并发症的处理及预防   总被引:6,自引:0,他引:6  
目的 探讨腹腔镜前列腺癌根治术围手术期并发证的处理及预防方法。方法 对26例TNM分期T1b-T2期的前列腺癌患者行腹腔镜下经腹途径前列腺癌根治术。统计围手术期出现的并发症,总结预防和治疗腹腔镜前列腺癌根治术并发症的有效方法。结果 26例手术均获成功。平均手术时间335(220-660)min;平均出血量430(200-1100)ml。开展此术式早期耻骨后静脉丛损伤导致大出血3例;术中分离损伤膀胱5例、直肠损伤3例;未发生输尿管损伤。前15例中有7例术中出现尿外渗,后11例仅有1例出现尿外渗。所有患者未出现下肢静脉血栓和心血管并发症.术后3周拔除尿管排尿通畅。术后1年有2例活动时仍有尿液经尿道流出,须使用尿垫,但每天尿垫使用量不超过1块。2例术后出现尿道膀胱吻合口狭窄,经定期尿扩后治愈。术后复查PSA值小于0.3ng/ml。结论 通过精心的术前准备、改进手术操作技术及使用适当的设备,术后保持导尿管引流通畅,能有效地防止和减少手术并发症的发生。  相似文献
3.
Laparoscopic radical prostatectomy   总被引:3,自引:0,他引:3       下载免费PDF全文
During the last 3 years, new laparoscopic radical prostatectomy (LRP) techniques have been used with satisfactory results similar to those of retropubic open surgery. In this article we describe our initial experiences with 19 consecutive LRPs performed between October 2000 and February 2003.  相似文献
4.
Background Incidence of prostate cancer has been increasing in recent decades. In the year 2005, prostate cancer became the second most common cancer in males in Macau. The purpose of this report was to review and summarize the clinical features and prognosis of the 54 patients undergoing radical prostatectomy in Macau Special Administrative Region (SAR), China.
Methods From November 2000 to November 2006, retropubic radical prostatectomy were performed in 54 cases for the treatment of prostate cancer. The mean age of patients was 69.8 years (range from 54 to 79). The preoperative prostate specific antigen (PSA) level, postoperative pathologic stage and Gleason's score, operation duration, intraoperative bleeding and intraoperative and postoperative complications were reported. The follow-up duration was 3 months to 6.25 years with a mean of 2.1 years. Postoperative parameters including PSA alteration, biochemical recurrence, local recurrence, distant metastasis and mortality were observed.
Results Most of the patients in our study were diagnosed as localized prostate cancer. The patients' preoperative serum PSA was 0-4.0 ng/ml (16.7%), 4.0-10.0 ng/ml (51.8%), 10.1-20.0 ng/ml (24.1%) and above 20.0 ng/ml (7.4%). The TNM stage T1a + T1b comprised 7.6% of patients, stage T2a + T2b comprised 20.3%, stage T2c 38.9%, stage T3a 20.3% and over T3a only 12.9%. There were 9.5% cases with Gleason scores of 2-4, 41.5% with scores of 5-6, 30.2% with scores of 7 and 18.8% with scores of 8-10. The average operative duration was 216 minutes and the average intraoperative bleeding was 760 ml. Intraoperative complications included one massive hemorrhage (1.9%), one rectal injury (1.9%) and one obturator nerve injury (1.9%). Early postoperative complications consisted of urinary incontinence (14 cases, 25.9%), bladder neck stricture (5 cases, 9.3%), acute urinary retention (4 cases, 7.4%), pelvic effusion (2 cases, 3.8%), lymphocele (1 case, 1.9%) and vesicorect  相似文献
5.
目的总结单切口腹腔镜前列腺癌根治术治疗早期局灶性前列腺癌的手术经验。方法2009年6月至8月,我科对5例早期局灶性前列腺癌患者实施单切口腹腔镜前列腺癌根治术。手术采用经腹膜外入路,取脐下约3cm长切口,使用自制Port,插入1枚10mm TROCAR及2枚5mm TROCAR,游离并切除前列腺,吻合膀胱尿道。结果5例腹腔镜前列腺癌根治术均获成功,无一例中转开放手术或传统腹腔镜手术。手术时间135~210min,平均(167±31.5)min;其中前列腺切除用时90~150min,平均(115±26)min,尿道膀胱吻合用时45~60min,平均(52±5.7)min。术中出血量50~200ml,平均(90±62)ml;标本切缘阳性1例。术后1周拔除导尿管,出现短暂尿失禁2例。术后随访4~12周,前列腺特异抗原(PSA)均<0.2μg/L。结论单切口前列腺癌根治术是安全可行的,熟练的腔镜手术技巧和特殊的Port及可弯曲器械是手术成功的关键。  相似文献
6.
前列腺癌穿刺与切除标本Gleason评分比较   总被引:2,自引:0,他引:2  
Xia T  Dong J  Zhang J 《中华医学杂志》2002,82(23):1604-1605
目的 比较胶列腺穿刺活检标本与根治性切除术标本的Gleason评分。方法 对 40例前列腺穿刺活检标本的Gleason评分及对应的根治性切除术标本的Gleason评分进行配对t检验。结果 穿刺活检组 2~ 9分 ,平均 (5 6± 1 7)分 ;根治性切除术组 4~ 10分 ,平均 (6 4± 1 3)分 ;两组差异显著 (P <0 0 5 )。结论 前列腺穿刺活检标本的Gleason评分低于根治性切除术标本的Gleason评分。宜采取相应措施降低低估率。  相似文献
7.
Laparoscopic radical prostatectomy is considered the first treatment of choice for local prostate cancer due to its minimal invasion advantage. To further achieve the goal of minimal invasion, single port laparoscopic radical prostatectomy has been developed to minimize the complications associated with puncture tracks. The aim of this study was to illustrate the technique for single port laparoscopic radical prostatectomy and evaluate its efficacy and safety. We reported 8 cases of radical prostatectomy with excellent early outcome carried out in Shanghai Changzheng Hospital from June 2009 to August 2009 using a home-made multiple instrument access port and adding an additional small incision at McBurney point.
  相似文献
8.
Li K  Li H  Yang Y  Ian LH  Pun WH  Ho SF 《中华医学杂志(英文版)》2011,124(7):1001-1005
Background  Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.
Methods  From 2000 to 2009, 149 patients with prostate cancer received radical prostatectomy and were followed up. Among these patients, 111 received retropubic radical prostatectomies, 38 received laparoscopic radical prostatectomies. All patients were followed-up on in the 3rd month, 6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint, serum prostate-specific antigen (PSA), full biochemical test and uroflowmetry was acquired.
Results  The average age was (69.0±6.1) years, preoperative average serum PSA was (10.1±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%, the incidence of the most common complication, bladder outlet obstruction, was about 26.8%, and that of the second most common complication, urinary stress incontinence, was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml), average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml, 6.0±1.2 and 5.4±1.4, respectively) (P=0.004, P=0.001 and P=0.001, respectively). A univariate analysis showed that positive surgical margin had a positive statistical association with serum PSA (P=0.007), Gleason score (P <0.001), pathological T stage score (P <0.001) and biochemical recurrence (BCR) (P=0.035). The most common location of a positive surgical margin was in the apex of the prostate, which was about 63% (36/57). Sixty-four percent (23/36) of patients with positive surgical margin in apex were also involved in prostate lobe; other locations were prostate lobe (23%, 13/57), seminal vesicle (9%, 5/57). The multivariate analysis showed that positive surgical margin had a positive statistical association with Gleason score (P=0.03) and pathological T stage score (P=0.02). Neither univariate analysis or multivariate analysis showed any statistical relationship between BCR and any other risk factors covered in this study.
Conclusions  Positive surgical margin is associated with pre-operative PSA, Gleason score, pathological T stage and biochemical recurrence. Earlier diagnosis and improved techniques of dissection of prostate apex could decrease the incidence of positive surgical margins.
  相似文献
9.
Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China, it will be necessary to elaborate the diagnosis, clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy.
Data sources Positive surgical margin, prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized.
Study selection Using positive surgical margin, prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature. By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials.
Results A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained. Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%, and although most patients with positive surgical margins are stable for a considerable period, the data available now suggested that the presence of a positive surgical margin will have an impact on the patient's prognosis. The risk factors of positive surgical margin include preoperative prostate specific antigen level, Gleason's score and pelvic lymph node metastasis. The most common site with positive surgical margin is in apical areas of the prostate; therefore surgical technique is also a factor resulting in positive surgical margins. From data available now it appears that as long as the surgical technique is skilled, different surgical modes do not affect the rate of surgical margin. Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy, but combination with androgen deprivation therapy may increase the curative effect.
Conclusion The current data indicated that the presence of posit  相似文献
10.
腹腔镜前列腺癌根治术开展初期术中并发症分析   总被引:1,自引:1,他引:0       下载免费PDF全文
目的回顾腹腔镜前列腺癌根治术(LRP)开展初期阶段术中并发症的发生情况,分析原因并总结经验。方法通过视频回顾的方法统计2010年1月至2012年11月3名泌尿外科医生在独立开展前20例LRP时出现的术中并发症,并收集患者一般资料、肿瘤分期等相关因素,分析发生术中并发症的原因。结果 60例LRP中共出现并发症23例(38.3%),其中导尿管被误缝7例,术中出血而中转开放5例,前列腺组织残留5例,二次吻合4例,直肠损伤1例,标本遗失1例。所有并发症均在术中得到处理。发生并发症的原因包括解剖层次不清、解剖标记不明、助手配合不默契、手术细节考虑不周全等,其中部分病例肿瘤分期偏晚、手术难度较大。结论 LRP在开展初期应尽量选择难度较低的病例,形成相对固定的手术团队,通过观摩手术,对器械选择、手术步骤、解剖标记、操作手法形成相对完善的套路,并在实践中逐步摸索和改进。  相似文献
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