膀胱肿瘤术前诊断方法的评价

膀胱肿瘤是泌尿系中最常见的肿瘤,发病年龄大多数为50～70岁,男性发病率显著高于女性,男女之比约为4：1。根据组织类型,膀胱肿瘤分为上皮性和非上皮性肿瘤两类,95％以上为上皮性肿瘤,非上皮性肿瘤极少见。根据分化程度,膀胱肿瘤可分为乳头状瘤、乳头状低度恶性倾向的尿路上皮肿瘤、     

航空人员乳头状膀胱上皮肿瘤1例

1临床资料 患者男性,26岁,东航安全员,总飞行时间3 000 h左右。2010-09-12突发右肾绞痛,B超提示右肾结石伴积水,右输尿管扩张,膀胱三角区实质性肿块,考虑膀胱肿瘤28 mm×15 mm×18 mm,尿常规（-）。于9月16日行膀胱镜检查,活检病理示膀胱内翻尿路上皮乳头状瘤,小区呈恶性潜能未定尿路上皮肿瘤。     

膀胱内翻性乳头状瘤的MSCT表现及与尿路上皮乳头状癌的鉴别

目的 探讨膀胱内翻性乳头状瘤(IPB)的MSCT表现特点及其与尿路上皮乳头状癌的鉴别诊断价值.方法 回顾性分析经手术病理证实的14例IPB及25例尿路上皮乳头状癌患者的MSCT表现,比较两者的发病部位、病灶形态及强化程度,并进行统计学检验.结果 14例IPB中10例位于三角区,4例位于侧壁,伴局部膀胱壁增厚者5例;13例呈乳头状,1例呈菜花状.25例尿路上皮乳头状癌中6例位于三角区,19例位于顶侧壁,伴局部膀胱壁增厚者18例;10例呈乳头状,15例呈菜花状.IPB和乳头状癌病灶向腔内突出的最长径与基底部宽径之比分别为2.164 ±0.761、0.747 ±0.196;两者强化值为:动脉期分别为(25.357±17.376) HU、(37.400±14.705) HU,静脉期分别为(34.143 ±22.055) HU、(41.680±17.264) HU,延迟期分别为(42.357±12.701) HU、(39.360±22.038) HU.两者发病部位和病灶形态比较差异具有统计学意义(P＜0.05),两者动脉期强化程度比较差异具有统计学意义(P=0.027),静脉期和延迟期强化程度比较差异无统计学意义(P＞0.05),但IPB强化程度呈逐渐升高趋势,而乳头状癌静脉期强化程度最高,延迟期减低.结论 IPB多位于三角区,呈乳头状,窄基底与膀胱壁相连;增厚膀胱壁无明显强化;病灶最长径明显大于基底部宽径;三期强化程度呈逐渐升高趋势,但相对较弱.上述影像特点有助于与尿路上皮乳头状癌相鉴别.     

肾移植术后尿路上皮肿瘤的临床特点及诊疗经验

 目的 总结肾移植术后尿路上皮肿瘤的临床特点及诊治体会。方法 回顾性分析清华大学第一附属医院和解放军总医院第三医学中心2004-07至2017-12收治的31例肾移植术后尿路上皮肿瘤患者的临床资料。结果 31例肾移植术后尿路上皮肿瘤患者中,男10例,女21例,15例为输尿管肿瘤,7例为膀胱肿瘤,3例膀胱肿瘤同时合并输尿管肿瘤,5例肾盂肿瘤,1例移植肾肾盂癌。患者均接受手术治疗,其中17例患者术后肿瘤复发而再次接受手术治疗。随访期内6例因肿瘤复发死亡,1例因肠梗阻伴脓毒症死亡。结论 肾移植受者更易发生肿瘤,应早期诊断并根据肿瘤特点尽早采取积极的手术治疗措施。     

人精氨酸/丝氨酸丰富剪接因子1在膀胱尿路上皮癌中表达及临床意义

目的探讨人精氨酸/丝氨酸丰富剪接因子1(SRSF1)在膀胱尿路上皮细胞癌的表达及其临床意义。方法应用免疫组化方法检测41例膀胱尿路上皮癌及10例正常膀胱尿路上皮中SRSF1的表达情况。结合临床资料以及分析SRSF1与病理分期,组织学分级和复发转移情况的关系。结果 SRSF1在膀胱尿路上皮细胞癌的阳性表达率为83(34/41),而对照组的阳性率为10.0%(1/10),两组间比较差异有统计学意义(P<0.01)。SRSF1的阳性表达与膀胱尿路上皮癌的初发和复发、是否转移显著相关(P<0.05);但在病理分期,组织学分级和肿瘤数量无显著差异。结论 SRSF1在膀胱尿路上皮细胞癌的表达明显上调,并且与膀胱尿路上皮癌的复发及转移密切相关,SRSF1可能通过与肿瘤基因相互作用,调控细胞周期及凋亡等多途径,参与肿瘤的发生及发展。SRSF1可用于膀胱上皮细胞癌早期诊断和复发、转移的一项重要指标。     

膀胱内翻性乳头状瘤的超声表现及与尿路上皮癌的鉴别

目的探讨膀胱内翻性乳头状瘤与尿路上皮癌的超声鉴别诊断价。方法回顾性分析病理证实的膀胱内翻性乳头状瘤12例,与尿路上皮癌超声表现进行对比分析,比较年龄、病灶最大径、纵径与最大横径比值(L/T)、病灶形态、边缘、回声强度、有无钙化及血流情况。结果膀胱内翻性乳头状瘤和尿路上皮癌患者年龄分别为(55.50±5.84)岁、(70.06±0.57)岁,病灶最大径分别为(1.25±0.47)cm、(2.25±1.13)cm,病灶纵径与最大横径比值(L/T)分别为1.32±0.39、0.71±0.17,膀胱内翻性乳头状瘤患者年龄及病灶最大径均小于尿路上皮癌,病灶纵经与最大横径比值大于膀胱尿路上皮癌,差异有统计学意义(P均0.01),二者的病灶形态及内部回声强度无明显统计学差异(P0.05),膀胱内翻性乳头状瘤病灶边缘较光滑,内部回声较均匀,乏血供,部分尿路上皮癌病灶边缘粗糙,内部及周边伴钙化,回声不均匀,血流丰富。结论膀胱内翻性乳头状瘤边缘较光滑,病灶的纵径大于最大横径,乏血供表现有助于与尿路上皮癌相鉴别。     

膀胱上皮性肿瘤的病理分析

膀胱肿瘤是泌尿系统中常见的肿瘤,以上皮来源的最为多见,来自间质成分的占少数。据资料报告90％至95％的来自膀胱移形上皮,而来自间质的仅占5％左右。我院自1985年至1995年间经活检及手术切除的标本诊断为膀胱上皮性肿瘤共28例,其中移形上皮乳头状瘤19例,移形细胞癌9例。病变发生于膀胱三角区、膀胱顶部、底部及近输尿管开口处。患者男性多于女性,40岁以上多见。通过本文的分析,以阐述膀胱移形细胞乳头状瘤的诊断及移形细胞癌的分级是必要的,二者不可相混。     

多层螺旋CT尿路成像对引起血尿的非泌尿系统肿瘤的诊断

目的 探讨多层螺旋CT尿路成像(multislice spiral CT urography,MSCTU)对引起血尿的非泌尿系统肿瘤的诊断价值.方法 复习54例经手术病理证实引起血尿的非泌尿系统肿瘤的MSCTU资料,观察病灶部位、起源及与泌尿系统的关系,分析其导致血尿的原因.结果 54例非泌尿系统肿瘤中52例发生于盆腔,占96.30%(52/54).44例依据解剖部位可正确诊断肿瘤起源器官(81.48%,44/54).非泌尿系统肿瘤产生血尿的原因是输尿管受累28例、膀胱受累20例、输尿管与膀胱同时受累6例.与泌尿系统肿瘤不同,所有非泌尿系统肿瘤的最大径线均位于尿路之外.结论 MSCTU检查可帮助鉴别引起血尿的原因,对临床诊断和治疗具有重要指导意义.     

电子膀胱镜下经尿道钬激光膀胱肿瘤剜除术18例——初步经验报道

目的:探讨电子膀胱镜下经尿道钬激光膀胱肿瘤剜除术(Ho LEBt)治疗非肌层浸润性膀胱癌(NMIBC)的安全性和可行性。方法:2014年5月至2017年4月,影像学或膀胱镜检查诊断为NMBIC的患者18例,男性12例,女性6例;平均年龄72.5岁。均为初发肿瘤,其中肿瘤平均直径0.8 cm(0.5～1.6 cm);前侧壁肿瘤8例,颈部肿瘤2例,顶壁肿瘤7例,多发肿瘤1例。7例取平卧位手术,其中4例因髋、膝关节原因无法取膀胱截石位,3例因心肺功能原因无法长时间放置膀胱截石位。实施Ho LEBt治疗,置入电子膀胱镜后,选择200μm钬激光光纤,激光功率调至60 W,在距离肿瘤蒂部约1.5 cm处以钬激光环形切开膀胱黏膜至浅肌层,在深、浅肌层之间将肿瘤完整切除,切除标本经尿道完整取出体外。结果:18例均顺利完成手术,患者耐受良好。平均手术时间21 min,术后膀胱冲洗时间18 h,平均导尿管留置时间47 h。术中无闭孔神经反射、无膀胱穿孔、无术后出血等并发症。术后病理报告证实p Ta期肿瘤8例,p T1期肿瘤6例,p T2 a期肿瘤2例,其中高级别尿路上皮癌5例,低级别尿路上皮癌8例,低度恶性潜能的尿路上皮乳头状肿瘤2例,切缘阴性,标本基底为肌层。结论:采用电子膀胱镜下经尿道钬激光膀胱肿瘤剜除术治疗非肌层浸润性膀胱肿瘤是安全、可行的。钬激光的物理特性避免了闭孔神经反射的发生。肿瘤的整块切除可得到最准确的术后病理标本,且能减少癌细胞的术中播散,有必要进行进一步的临床应用研究。     

胰腺实性假乳头状瘤(附2例报告)

胰腺实性假乳头状肿瘤(solid-pseudopapillary tumor of pancreas,SPTP)是一种少见的低度恶性的胰腺肿瘤,1959年由Frantz首先报道,曾有多种诊断名词,如实性乳头状肿瘤、乳头状囊腺瘤、实性-囊性肿瘤、实性-囊性乳头状上皮肿瘤、Frantz瘤等,1996年WHO国际肿瘤组织学分类将其统一命名为胰腺实性假乳头状瘤,分类为生物学行为未定或交界性恶性潜能的肿瘤.以往对其认识不足,术前难以正确诊断,而病理学检查又极易误诊.现将我院术前被误诊,术后经病理确诊的2例结合文献复习如下.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.