离体尿道流率对兔尿道狭窄程度的评价意义

目的探讨离体尿道流率对兔尿道狭窄严重程度的评价意义。方法15只成年雄性新西兰大白兔，内镜直视下尿道粘膜电凝法制作尿道狭窄模型。30d后，逆行尿道造影、尿道镜检观察尿道狭窄形态。设计制作简易装置测定离体尿道流率。分析离体尿道流率与球部狭窄段尿道直径的相关性。结果15只动物死亡2只，余动物顺利完成实验。狭窄处直径（4．08±0．84）mm，狭窄段长（7．73±1．07）mm，尿道管腔缩窄（78．45±7．59）％；离体尿道流率（11．45±4．83）mL／s。离体尿道流率与狭窄段尿道直径具有显著相关性（Spearman相关分析，r=0．680，p=0．011）。结论本实验自行设计装置进行兔离体尿道流率测定，可从流体力学角度准确反映尿道狭窄所致的排尿阻力增加情况，结合尿道造影和尿道镜检，可全面、准确评价模型尿道狭窄的严重程度。     

MMP-1和MMP-2在肝纤维化组织中的表达和意义

目的:探讨MMP-1和MMP-2在肝纤维化组织中的作用及其机制。方法:应用免疫组化法并用图像分析技术定量检测28例手术切除的肝纤维化组织标本中MMP-1和MMP-2的表达。结果:正常肝组织与肝纤维化组织MMP-1表达无显著性差异(P>0.05),而MMP-2的表达在肝纤维化组织中明显高于正常肝组织(P<0.01)。结论:MMP-1和MMP-2可能在肝纤维化的发生和发展中有重要作用。     

兔动脉壁剪切力改变对MMP-2表达及动脉瘤形成的影响

目的: 观察局部动脉壁剪切力改变对基质金属蛋白酶2（MMP-2）表达的影响及其与动脉瘤形成的关系。方法:新西兰大白兔48只，实验组和对照组各24只。实验组行同种异体腹主动脉补片腹主动脉成瘤术，于术后1，7，14，28d取标本，并在取标本时测量动脉管径。免疫组化观察MMP-2的动态表达。结果:腹主动脉成瘤术后7d，瘤体、流入道、流出道外径均增大（均P<0.05）；管壁炎性细胞浸润，中层弹力纤维病变；MMP-2表达于术后1d达高峰（P<0.01），并持续性高表达（P<0.01）。结论:动脉壁剪切力的改变可使局部血管直径增加，管壁MMP-2表达上调。瘤体直径的增大与MMP-2的持续高表达有关；MMP-2可能在动脉壁剪切力改变与动脉瘤形成之间起到一定作用。     

下肢曲张静脉MMP-2 与TIMP-2 的表达及其意义

目的:探讨基质金属蛋白酶2(MMP-2)与基质金属蛋白酶抑制物2(TIMP-2)在下肢曲张静脉组织中的表达及其与发病机制的关系.方法:选取26例下肢静脉曲张患者大隐静脉为观察组,11例正常大隐静脉为对照组,采用免疫组织化学法检测大隐静脉组织中MMP-2和TIMP-2的表达与差异性.结果:MMP-2在下肢静脉曲张患者大隐静脉中的表达显著高于正常对照组(P＜0.05),而TIMP-2在两组中的表达差别无统计学意义(P＞0.05).结论:下肢曲张静脉中MMP-2的高表达使其与TIMP-2比例失调,在下肢静脉曲张的发生及发展中可能起重要作用.     

MMP-2和TIMP-2在大肠癌组织中的表达及其意义

目的探讨基质金属蛋白酶-2(MMP-2)和组织基质金属蛋白抑制剂-2(TIMP-2)在大肠癌组织中的表达及其意义。方法应用免疫组织化学SP法对60例大肠癌组织MMP-2和TIMP-2表达情况进行检测。结果MMP-2和TIMP-2在大肠癌组织中表达的阳性率分别为64.3%和30.3%。MMP-2的表达与大肠癌的病理分期和淋巴转移呈正相关(P<0.05),而TIMP-2的表达与其呈负相关,MMP-2和TIMP-2的表达呈负相关(P<0.05)。结论MMP-2和TIMP-2的表达与大肠癌的病理分期和淋巴转移密切相关,可作为判断大肠癌生物学行为的参考指标。     

犬尿道瘢痕组织中TGF—β1和MMP-1表达的研究

目的探讨犬尿道瘢痕组织中转化生长困子β1（TGF-β）和基质金属蛋白酶-1（MMP1）的表达及其意义。方法选取12只健康雄性成年犬,采用小儿电切镜制作犬尿道狭窄动物模型,应用免疫组织化学方法检测犬尿道狭窄段瘢痕组织中TGF-β1和MMP-1的表达,以实验组犬尿道狭窄远端2cm处正常尿道组织作为对照组。结果TGF-β1在实验组犬尿道瘢痕组织与对照组的阳性表达率分别为100．00％与18．18％,两者差异具有统计学意义（P〈0．05）;MMP-1在实验组犬尿道瘢痕组织与对照组的阳性表达率分别为63．64％与9．09％,两者差异具有统计学意义（P〈0．05）。结论TGF-β1和MMP-1与犬尿道瘢痕形成关系密切。     

银杏叶提取物对犬体外循环时肺组织MMP-2和MMP-9水平的影响

目的 评价银杏叶提取物对犬体外循环时肺组织基质金属蛋白酶-2(MMP-2)和基质金属蛋白酶-9(MMP-9)水平的影响.方法 健康杂种犬14只,雌雄不拘,体重14～20 kg,随机分为2组(n=7):对照组(C组)和银杏叶提取物组(Egb组).Egb组于开胸前于中心静脉经30 min输注银杏叶提取物8 mg/kg(溶于100 ml生理盐水中),C组用生理盐水替代.于开放升主动脉120 min时,颈内静脉采血后处死犬,收集支气管肺泡冲灌液,计算肺通透性指数;取肺组织,计算湿/干重比,测定MMP-2和MMP-9的含量.结果 与C组比较,Egb组肺组织湿/干重比、肺通透性指数和MMP-2、MMP-9的含量均降低(P＜0.05或0.01).结论 银杏叶提取物可通过降低肺组织MMP-2和MMP-9的活性减轻体外循环诱发犬肺损伤.     

乌司他丁对兔髓核细胞中诱导型一氧化氮合酶和基质金属蛋白酶表达的影响

目的 探讨乌司他丁对白介素-1β(interleukin-1β,IL-1β)诱导的兔椎间盘髓核细胞中诱导型一氧化氮合酶(inducible nitric oxide synthase,iNOS)、基质金属蛋白酶2(matrix metalloproteinase 2,MMP-2)和MMP-3表达的影响.方法 用酶消化法...     

罗格列酮联用维甲酸在体内对直肠癌HCT-15细胞COX-2、MMP-7、IMP-1表达的影响

目的:研究罗格列酮(ROS)联用全反式维甲酸(ATRA)对直肠癌裸鼠移植瘤HCT-15细胞COX-2、MMP-7、TIMP-1表达的影响,并初步探讨其抗肿瘤的机制.方法:建立直肠癌裸鼠移植瘤模型,荷瘤裸鼠随机分为未用药组、ROS组(ROS 25 mg·kg-1·2d-1),ATRA组(ATRA 11 mg·kg-1·2d-1)、ATRA联用ROS组f(ROS 25 mg+ATRA 11 mg),mg·kg-1·2d-1.灌胃40d后,观察各组裸鼠移植瘤体积变化;利用免疫组化SP法观察移植瘤细胞中COX-2、MMP-7、TIMP-1的表达.结果:1)用药3组瘤体体积与未用药组比较均缩小,差别有统计学意义(P< 0.05),ATRA联用ROS组的荷瘤体积缩小更明显(P<0.05);ROS组与ATRA组瘤体体积相当(P>0.05);2)用药3组移植瘤细胞内COX-2、MMP-7、TIMP-1的表达与未用药组比较均降低(P<0.05),且ROS组与ATRA组移植瘤细胞内COX-2、MMP-7、TIMP-1下降更明显(P<0.01),ROS组与ATRA组移植瘤细胞内三者的表达相当(P>0.05),结论:ROS与ATRA均有一定的抑瘤作用,ROS与ATRA联用可发挥协同抗肿瘤的作用,可能是通过抑制移植瘤细胞内COX-2、MMP-7、TIMP-1的表达而实现.     

罗格列酮联用维甲酸在体内对直肠癌HCT-15细胞COX-2、MMP-7、TIMP-1表达的影响

目的：研究罗格列酮（ROS）联用全反式维甲酸（ATRA）对直肠癌裸鼠移植瘤HCT-15细胞COX-2、MMP-7、TIMP-1表达的影响,并初步探讨其抗肿瘤的机制。方法：建立直肠癌裸鼠移植瘤模型,荷瘤裸鼠随机分为未用药组、ROS组（ROS 25 mg.kg-1.2d-1）、ATRA组（ATRA 11mg.kg-1.2d-1）、ATRA联用ROS组[（ROS 25 mg＋ATRA 11 mg）.kg-1.2d-1]。灌胃40 d后,观察各组裸鼠移植瘤体积变化;利用免疫组化SP法观察移植瘤细胞中COX-2、MMP-7、TIMP-1的表达。结果：1）用药3组瘤体体积与未用药组比较均缩小,差别有统计学意义（P〈0.05）,ATRA联用ROS组的荷瘤体积缩小更明显（P〈0.05）;ROS组与ATRA组瘤体体积相当（P〉0.05）;2）用药3组移植瘤细胞内COX-2、MMP-7、TIMP-1的表达与未用药组比较均降低（P〈0.05）,且ROS组与ATRA组移植瘤细胞内COX-2、MMP-7、TIMP-1下降更明显（P〈0.01）,ROS组与ATRA组移植瘤细胞内三者的表达相当（P〉0.05）。结论：ROS与ATRA均有一定的抑瘤作用,ROS与ATRA联用可发挥协同抗肿瘤的作用,可能是通过抑制移植瘤细胞内COX-2、MMP-7、TIMP-1的表达而实现。     

The distribution of neuronal and inducible nitric oxide synthase in urethral stricture formation

PURPOSE: The distribution of neuronal (n) and inducible (i) nitric oxide synthase (NOS) may have a role in the maintenance of normal urethral spongiosum and during the development of spongiofibrosis in urethral stricture disease. MATERIALS AND METHODS: Eight normal and 33 strictured human bulbar urethras were studied by histological and immunohistochemical techniques for the neuronal markers S-100, nNOS and iNOS. The smooth muscle-to-collagen ratio was calculated by morphometric analysis of Masson's trichrome sections. Immunohistochemical staining patterns of the neuronal markers in normal urethral tissue was compared to that in urethral stricture tissue with spongiofibrosis. RESULTS: The smooth muscle-to-collagen ratio was significantly lower in the strictured urethra compared to that in the control group (p = 0.001). In the strictured bulbar urethra nNOS immunoreactivity was decreased compared to that in normal urethral tissue. The severity of spongiofibrosis corresponded to the loss of nNOS immunoreactivity. iNOS immunoreactivity was found in strictured urethral epithelium and spongiosal tissue, whereas the control group was nonimmunoreactive to iNOS. CONCLUSIONS: Urethral stricture formation is a fibrotic process associated with significant changes in NOS metabolism. Abnormal collagen synthesis following urethral trauma may be stimulated by inappropriate iNOS activity. A functional nerve supply to the urethral spongiosum seems to be crucial in the maintenance of the unique ultrastructure of the urethral spongiosum.     

前尿道狭窄的病因和治疗

前尿道狭窄的发生率有增高趋势,如治疗不当,会进一步加重尿道损伤而造成复杂性前尿道狭窄,难于处理。近年来在其治疗上取得了很大进步,但多数泌尿外科医师对此病认识不足,治疗上存在差异,可能导致并发症的发生。     

Staged urethroplasty in the management of complex anterior urethral stricture disease

Staged buccal mucosa graft urethroplasty has emerged as a reliable procedure for difficult anterior urethral strictures not amenable to one-stage graft or flap reconstruction. It has primarily been used for strictures and/or fistulae occurring after previous surgery for hypospadias or those related to lichen sclerosus (LS). Success rates in these patient populations have improved when compared to earlier techniques. However, prior studies have demonstrated a number of patients requiring more than two procedures to complete the reconstruction, as well as some who have been content with their voiding pattern after the first operation and therefore elected to forego second stage tubularization. In this setting, we have reviewed the surgical technique and summarized previously published work. There may be an opportunity to complete more of these repairs in two operations using additional oral mucosa at the time of tubularization.     

Buccal mucosa graft urethroplasty for anterior urethral stricture repair: evaluation of the impact of stricture location and lichen sclerosus on surgical outcome

PURPOSE: We report our experience with buccal mucosa grafts for anterior urethral strictures. We compared outcomes in the pendulous and bulbar urethra as well as the impact of lichen sclerosus on success. MATERIALS AND METHODS: A total of 53 men underwent buccal mucosa graft urethroplasty from 1997 to 2004 for strictures of all etiologies, including lichen sclerosis in 13. Of the patients 46 underwent 1-stage repair and 7 with full-thickness circumferential disease underwent multistage repair. For 1-stage repair strictures were limited to the bulb in 33 cases and they involved the pendulous urethra in 13. A dorsal onlay was used in 24 cases and a ventral onlay was used in 22. For multistage urethroplasty 2 strictures were in the bulbar urethra and 5 were in the pendulous urethra. Success was defined as no postoperative procedures or complications. RESULTS: The success rate of all urethroplasties was 81% (43 of 53 cases) at a mean followup of 52 months. For bulbar vs pendulous urethroplasty the success rate was 86% (30 of 35 cases) vs 72% (13 of 18, p = 0.23). For 1-stage urethroplasty by graft location success was achieved in 20 of 24 cases (83%) for dorsal onlay vs 17 of 22 (77%) for ventral onlay (p = 0.61), in 18 of 21 (86%) for bulbar-dorsal onlay, in 10 of 12 (83%) for bulbar-ventral onlay, in 2 of 3 (66%) for pendulous-dorsal onlay and in 7 of 10 (70%) for pendulous-ventral onlay. For multistage urethroplasty success was achieved in 2 of 2 cases (100%) for bulbar repair vs 4 of 5 (80%) for pendulous repair. In the 13 patients with lichen sclerosus success was achieved in 4 of 8 (50%) with 1-stage repair vs 4 of 5 (80%) with multistage repair (p = 0.28). Complications developed in 10 of 53 cases (19%), including fistula in 1, urinary tract infection in 1 and stricture in 8 that required treatment, including dilation in 3, internal urethrotomy in 4 and perineal urethrostomy in 1. Five of these 8 recurrent strictures (63%) developed in patients with lichen sclerosus, including 4 in urethras in which 1-stage repair was done for lichen sclerosus. There were no donor site complications, postoperative erectile dysfunction or chordee. CONCLUSIONS: A buccal mucosa graft placed dorsally or ventrally remains an excellent graft material in the bulbar and pendulous urethra. When lichen sclerosus is present, careful consideration should be given to complete excision of the diseased urethra with multistage repair vs accepting a higher rate of stricture recurrence with 1-stage repair.     

The diagnosis and management of acquired urethral stricture disease

Urethral stricture disease is a commonly presenting problem to the urologist. Any condition that damages the urethral epithelium or underlying spongy tissue has the potential to cause a stricture. Patients with a urethral stricture can present either acutely or chronically with a range of urinary symptoms. An understanding of urethral stricture disease and a systematic approach to the history and investigations will enable clinicians to manage patients appropriately. This article aims to give an overview, appropriate for surgeons in their early years of training, on the aetiology, presentation and investigation of urethral stricture disease, as well as a basic understanding of the principles of management.     

The diagnosis and management of acquired urethral stricture disease

Urethral stricture disease is a commonly presenting problem to the urologist. Any condition that damages the urethral epithelium or underlying spongy tissue has the potential to cause a stricture. Patients with a urethral stricture can present either acutely or chronically with a range of urinary symptoms. An understanding of urethral stricture disease and a systematic approach to the history and investigations will enable clinicians to manage patients appropriately. This article aims to give an overview, appropriate for surgeons in there early years of training, on the aetiology, presentation and investigation of urethral stricture disease, as well as a basic understanding of the principles of management.     

冷刀12点位尿道内切开术治疗前尿道狭窄疗效观察

目的探讨冷刀12点位尿道内切开术治疗前尿道狭窄的可行性和疗效。方法前尿道狭窄患者32例,平均年龄33岁。狭窄段长2．3～6．0 cm,平均3．7 cm。均采用冷刀12点位尿道内切开术治疗。对手术时间、术中出血量、住院天数及随访情况进行分析。结果32例手术均顺利完成。手术时间17～83 min,平均22 min。术后住院3～6 d,平均4 d。随访3～36个月,32例患者排尿均通畅,尿流率均〉15 ml／s。结论冷刀12点位尿道内切开术治疗前尿道狭窄简单易行,疗效安全可靠。     

The diagnosis and management of acquired urethral stricture disease

Urethral stricture disease is a commonly presenting problem to the urologist. Any condition that damages the urethral epithelium or underlying spongy tissue has the potential to cause a stricture. Patients with a urethral stricture can present either acutely or chronically with a range of urinary symptoms. An understanding of urethral stricture disease and a systematic approach to the history and investigations will enable clinicians to manage patients appropriately. This article aims to give an overview, appropriate for surgeons in there early years of training, on the aetiology, presentation and investigation of urethral stricture disease, as well as a basic understanding of the principles of management.     

Anastomotic urethroplasty for posttraumatic urethral stricture: previous urethral manipulation has a negative impact on the final outcome

PURPOSE: We evaluated the long-term results of anastomotic urethroplasty for posttraumatic urethral stricture and assessed the impact of previous endourethral/surgical intervention on the subsequent outcome. MATERIALS AND METHODS: From January 1988 to April 2005, 51 patients underwent anastomotic urethroplasty for posttraumatic urethral stricture following pelvic fracture (41) or perineal blunt trauma (10). Of these patients 28 (55%) underwent previous surgical procedures, including endoscopic urethrotomy with endoscopic realignment in 20 and open urethroplasty in 8. Median followup was 4.6 years. Results were evaluated. Success was characterized by a maximum urine flow of more than 15 ml per second, sterile urine, and normal urethral imaging and/or endoscopy. A satisfactory result was considered to be 1 episode of recurrence diagnosed on routine imaging/endoscopy that was successfully managed by 1 or 2 direct vision internal urethrotomies. Failure was characterized by the necessity for repeat instrumental and/or open surgery. Results were analyzed using Kaplan-Meier curves and the log rank test. RESULTS: At 1, 5 and 10 years overall success rates were 63%, 55% and 43%, while satisfactory result rates were 84%, 80% and 76%, respectively. However, the 23 patients without urethral manipulation before anastomotic urethroplasty had a satisfactory result of more than 90% vs more than 60% in patients with previous surgical treatment. These results were maintained for 100 months (p <0.05). CONCLUSIONS: Endoscopic and/or open urethral manipulation before anastomotic urethroplasty for posttraumatic urethral stricture has a significant impact on the outcome of urethral reconstruction. Cases of posttraumatic urethral stricture should preferably be referred to a center of expertise.