原发性精囊癌(1例报告并文献复习)

目的探讨原发性精囊癌的临床特点。方法总结收治的原发性精囊癌1例,结合文献复习。结果行膀胱、精囊、前列腺切除直肠代膀胱术,已随访2年无复发。结论原发性精囊癌临床罕见,术前诊断较为困难,最好的治疗方法是早期手术,术中做冰冻切片检查,一经证实,则应行根治性切除术。术后定期随访,注意复发。     

应用Da Vinci机器人治疗精囊原发性恶性肿瘤的临床效果观察

目的:探讨应用Da Vinci机器人治疗精囊原发性恶性肿瘤的临床效果。方法:回顾性分析2013年1月~2016年8月解放军总医院应用Da Vinci机器人实施的4例精囊原发性恶性肿瘤手术患者的临床资料。结果:4例患者中,2例实施精囊肿瘤切除术,2例实施膀胱、前列腺、精囊切除术,其中1例术前发现盆腔淋巴结转移患者同时实施了盆腔淋巴结清扫术。4例手术均获成功,术中无直肠、大血管损伤等严重并发症。手术时间50~180min,术中失血量50~300ml。精囊肿瘤切除患者术后5天出院,膀胱、前列腺、精囊切除患者分别于术后7天和11天出院。术后病理回报,2例精囊腺癌,1例精囊未分化癌,1例精囊肉瘤。随访6个月~2年,2例精囊腺癌均无瘤存活。1例精囊未分化癌于术后1年发现局部复发,1例精囊肉瘤在术后6个月因肿瘤多发转移死亡。结论:精囊原发性恶性肿瘤恶性度高,手术操作难度较大。Da Vinci机器人操作精巧灵活,便于术野和肿瘤显露,应用于精囊原发性恶性肿瘤的手术效果良好。     

原发性精囊平滑肌肉瘤1例报告及文献复习

目的探讨原发性精囊恶性肿瘤的诊断、治疗方法。方法回顾性分析本院收治的原发性精囊恶性肿瘤i例并查阅复习文献资料,总结其病因、病理、临床表现、诊断及治疗特点。结果1例原发性精囊恶性肿瘤经手术切除及去势术,术后7月复发转移死亡。结论原发性精囊恶性肿瘤早期常无症状,且症状不典型。早期诊断困难易误诊,手术是本病的主要治疗措施,根据肿瘤的范围、周围器官受累情况选择手术切除范围。预后较差。目前尚无统一治疗方案。     

原发性精囊癌1例报道并文献复习

目的 探讨原发性精囊癌的诊治方法.方法 分析收治的原发性精囊癌1例,结合文献进行复习.结果 经CT、MRI及经直肠超声(transrectal ultrasound,TRUS)引导下穿刺活检确诊为精囊腺癌,行左侧精囊肿物切除、右侧精囊切除、膀胱与前列腺部分切除及左输尿管膀胱再吻合术,术后恢复良好.现已随访23个月,未见复发转移.结论 原发性精囊癌临床罕见,术前诊断较为困难,TRUS引导下穿刺活检可明确诊断,应根据患者个体情况选择不同的根治性切除术.术后定期随访,注意是否复发转移.     

原发性精囊透明性细胞癌1例报告并文献复习

目的:探讨原发性精囊透明细胞癌的临床表现、病理特征及诊断治疗。方法:对我院收治的1例原发性精囊透明细胞癌患者的临床资料进行回顾分析,并复习相关文献。结果:本例患者因反复血精2年入院,术前经影像学及精囊镜活检证实为右侧精囊原发透明细胞癌,免疫组织化学检查示PSA-,CK7-,CD125-,CD20-,RCC+,CD10+,EMA+,行开放性膀胱前列腺精囊切除术、盆腔淋巴结清扫术及回肠膀胱术。术后随访1年,未见肿瘤复发及肾脏占位病变。结论:原发性精囊癌病理分型为透明细胞癌类型极为罕见,手术为其主要治疗方法,需达到肿瘤切缘阴性,术后是否行抗雄激素治疗或放化疗等辅助治疗尚存在争议。     

原发性输尿管肿瘤诊治22例

目的 提高原发性输尿管肿瘤的诊断与治疗水平。方法 回顾分析自1992年以来收治的22例原发性输尿管肿瘤的诊断方法，包括尿脱落细胞学检查、B超、TVU检查、膀胱镜、RCP检查及CT扫描得到确诊。结果 临床检查显示，原发性输尿管肿瘤的最常见症状为血尿。14例行肾、输尿管全段及输尿管周围的部分膀胱壁切除术，8例行输尿管部分切除术。术后发生膀胱癌2例，行经尿道膀胱肿瘤电切术治疗。结论 对原因不明的血尿患应考虑到输尿管肿瘤的可能。掌握适应证，对原发性输尿管癌患及时进行根治性手术治疗，尤为重要。     

膀胱非上皮性良性肿瘤19例手术疗效

目的总结膀胱非上皮性良性肿瘤的临床治疗体会。方法对19例行手术治疗的膀胱非上皮性良性肿瘤患者的临床资料进行回顾性分析。男9例,女10例;年龄29～62(45.26±10.15)岁;无临床症状12例,尿频、尿急2例,排尿晕厥2例,下腹疼痛不适3例。B超、CT及MRI检查发现19例膀胱占位,均行膀胱镜检查。结果本组19例均行手术治疗:7例行经尿道膀胱肿瘤电切术,8例行开放性膀胱部分切除术,其余4例行腹腔镜膀胱部分切除术(其中3例膀胱镜联合腹腔镜行膀胱部分切除术)。术后病理异位前列腺4例、平滑肌瘤7例、副神经节瘤6例、子宫内膜异位症2例。术后随访5～60(31.15±13.94)月,均未见复发。结论膀胱非上皮性良性肿瘤临床少见,手术为主要治疗方法,根据膀胱肿瘤生长位置、大小、生长方式来选择合适的手术方式,对于腹腔镜下外凸不明显的肿瘤推荐行腹腔镜膀胱镜双镜联合行膀胱部分切除术,尤其膀胱嗜铬细胞瘤的治疗,可完整切除肿瘤,术中、术后并发症低,复发少见。     

原发性输尿管恶性肿瘤（附34例报告）

为探讨原发性输尿管肿瘤的诊断方法和治疗效果，报道原发性输尿管恶性肿瘤３４例，其中移行细胞癌３１例，鳞癌２例，平滑肌肉瘤１例。男性２３例，女性１１例；年龄２５～８４岁，平均５４．５岁。１７例行患侧肾及输尿管全切及膀胱袖状切除术，３例行患侧肾及输尿管部分切除术，４例行输尿管节段切除术，１例行患侧肾输尿管及膀胱全切术。２６例获随访，死亡８例。认为尿路造影、膀胱镜检查是最重要的诊断手段，患侧肾输尿管全切及膀胱袖状切除术是首选术式，本组５例存活５年以上者均为采取此术式患者。     

男性盆腔囊性疾病17例诊治分析

目的:探讨男性盆腔囊性疾病的诊断与治疗。方法:回顾性分析我院泌尿外科2003年5月~2013年5月收治的17例男性盆腔囊性疾病患者的临床资料,探讨各疾病发生机制及辅助检查的应用。结果:17例患者中,前列腺囊肿5例(直径3.0cm)、前列腺囊腺瘤2例、精囊囊肿6例、精囊脓肿2例、精囊腺癌1例、前列腺癌(PCa)伴血肿1例;8例行腹腔镜下囊肿切除术,5例行经尿道囊肿去顶术,2例行经腹囊肿切除术,2例行根治性前列腺切除术;术后随访6个月~10年,未见下尿路症状复发。结论:超声是诊断盆腔囊性疾病的重要方法,根据超声结果,适当选取CT、MRI及膀胱镜检查,可以提高诊断的正确率。当囊肿靠近前列腺尿道时,经尿道囊肿切开术疗效确切;对于靠近膀胱颈及位于精囊的囊性肿物,腹腔镜囊肿切除术为首选;当腹腔镜切除盆腔囊性肿物困难时,可行开腹手术。     

膀胱副神经节瘤6例临床病理分析

目的探讨膀胱副神经节瘤（PUB）的临床病理特征及诊断治疗方法。 方法回顾性分析2007年11月至2018年7月我院收治的6例膀胱副神经节瘤患者临床资料,总结分析膀胱副神经节瘤的临床病理特点和诊治要点。 结果6例患者中男性1例,女性5例,平均年龄42（23～55）岁,所有患者均为无功能性肿瘤,1例临床表现为尿痛,5例为体检发现膀胱占位。CT增强扫描明显强化。肿瘤均为单发,平均直径1.6（0.8～2.2）cm。1例行腹腔镜膀胱部分切除术,1例行膀胱部分切除术,4例行经尿道膀胱肿瘤电切术。平均手术时间72（35～130）min,平均估计出血量22（10～50） ml。术后病理6例均有阳性表达神经内分泌标志物CgA、CD56和Syn,而上皮性标志物如CK、CEA等为阴性。术后随访8个月至11年,1例于经尿道膀胱肿瘤电切术（TURBT）术后5年复发,其余5例均无肿瘤复发或转移。 结论膀胱副神经节瘤临床罕见,可无明显症状,CT增强扫描结合免疫组化检测可明确诊断,经尿道膀胱肿瘤电切术安全、有效,术后需长期随访。     

腹腔镜原发精囊良性肿瘤切除术的临床应用

目的:探讨腹腔镜原发精囊良性肿瘤切除术的临床经验及手术疗效。方法:回顾分析2005年6月至2010年8月4例原发精囊良性肿瘤患者的临床资料。患者平均(56.5±9.3)岁,囊肿直径平均(6.5±1.5)cm。4例患者均行腹腔镜下精囊肿瘤切除术,3例患侧肿瘤、输精管与精囊一并切除,1例术中将肿瘤完整切除的同时完整保留双侧输精管与精囊。结果:手术均顺利完成,无一例中转开放,围手术期无并发症发生。手术时间平均(81.3±13.1)min,术中出血量<50 ml,术后平均住院(5.8±1.7)d,术后平均随访(47±26.8)个月,患者不适症状消失,勃起及射精功能正常且无局部复发。结论:腹腔镜手术处理盆腔深部的精囊肿瘤视野暴露好、创伤小、患者术后康复快,是治疗原发精囊良性肿瘤安全、可行、有效的微创术式。     

原发性直肠恶性淋巴瘤诊治分析

目的探讨原发性直肠恶性淋巴瘤的诊断和治疗方法。方法回顾性分析1994～2011年我院收治的7例原发性直肠恶性淋巴瘤诊断、治疗的临床资料。结果ⅡE期1例因患有肾功能衰竭放弃治疗并于1个月后死于急性肾衰外。ⅠE期2例经肛门手术,ⅡE期2例行根治手术,其无病生存期均达5年以上。ⅡE期1例仅做化疗,生存43个月。ⅣE期1例行姑息性手术加化疗,生存20个月。结论原发性直肠恶性淋巴瘤误诊率高、早期诊断对改善预后十分重要,手术切除加规范放、化疗,可明显延长生存期。     

Retrovesical mass in men: pitfalls of differential diagnosis

PURPOSE: We review the differential diagnosis and treatment of retrovesical masses in men. MATERIALS AND METHODS: During the last 8 years 21 male patients 3 to 79 years old (mean age 47.1) presented with symptoms or signs of a retrovesical mass. Clinical features and diagnostic findings were reviewed, and related to surgical and histopathological findings. RESULTS: The retrovesical masses included prostatic utricle cyst in 3 cases, prostatic abscess in 1, seminal vesicle hydrops in 6, seminal vesicle cyst in 2, seminal vesicle empyema in 3, large ectopic ureterocele in 1, myxoid liposarcoma in 1, malignant fibrous histiocytoma in 1, fibrous fossa obturatoria cyst in 1, hemangiopericytoma in 1 and leiomyosarcoma in 1. In 17 patients various symptoms were seen and in 4 the mass was incidentally detected. A mass was palpable on digital rectal examination in 16 cases and visible on sonography in 20. For a cystic mass medial location relative to the bladder neck was suggestive of prostatic abscess or utricle cyst, while lateral location was suggestive of seminal vesicle cyst/hydrops or empyema, ectopic ureter or ureterocele. In 6 patients diagnosis was established only by exploratory laparotomy and histopathological examination. CONCLUSIONS: Digital rectal examination and sonography reliably detect a retrovesical mass. Nevertheless, clinical signs and median or lateral location relative to the bladder neck on ultrasound are diagnostic only for cystic lesions. Computerized tomography and magnetic resonance imaging are useful for staging malignant tumors. However, needle or open biopsy is required in most cases to establish a histopathological diagnosis. Exploratory laparotomy and histopathological examination are the procedures of choice when other findings are equivocal.     

Cystic epithelial-stromal tumor of the seminal vesicle

A cystic tumor composed of atypical glands in a cellular stroma arose in the pelvis of a 49-year-old man. Two years later an identical tumor was again excised from the pelvis. Morphologic, immunohistochemical and ultrastructural studies indicate that this neoplasm arose in the seminal vesicle, possibly from a seminal vesicle cyst. The tumor did not involve the prostate gland, and immunohistochemical stains for prostate-specific antigen and prostatic acid phosphatase were negative. Ultrastructural study showed that both the glandular and mesenchymal components of the tumor recapitulated features of normal seminal vesicle, further establishing origin from this site. This tumor resembles the rare cystadenoma of the seminal vesicle, yet the cytologic atypia suggests low grade malignant potential. Following the second excision, the patient has had a disease-free interval of 18 months. Long term follow-up and recognition of additional cases is necessary to define the biologic potential of this unusual tumor.     

Primary adenocarcinoma of the seminal vesicles

PURPOSE: We provide an overview of seminal vesicle carcinoma, a rare entity that is difficult to diagnose and traditionally has been associated with a poor prognosis. MATERIALS AND METHODS: A literature search for seminal vesicle carcinoma was performed, and current concepts related to the diagnosis and clinical management were reviewed. Two unpublished additional cases recently treated at our institution were added to the international experience. Special attention was given to new developments in diagnostic methods. Histopathological changes and biomarker criteria are provided to allow accurate diagnosis of this condition. RESULTS: Early diagnosis of seminal vesicle carcinoma has often been difficult due to a lack of immunohistochemical markers that distinguish this entity from invasive adenocarcinoma of adjacent organs. A total of 49 documented cases of seminal vesicle carcinoma in men between 19 and 90 years old has been reported in the current literature. Two additional cases that were diagnosed and treated at our institution are incorporated into this review. Recently the tissue marker CA 125 has substantially increased the accurate diagnosis of seminal vesicle carcinoma. In addition, increased serum CA 125 in patients with this disease has been reported and serum levels correlate well with the clinical course of the disease. Radical surgery in combination with adjuvant radiotherapy or androgen deprivation has resulted in long-term palliation in some patients with advanced disease. CONCLUSIONS: Including seminal vesicle carcinoma in the differential diagnosis of lower urinary tract symptoms will improve detection. Improved imaging tools and the availability of a serum marker will undoubtedly enhance detection at the earliest stages. More defined histopathological criteria will allow diagnosis even with small biopsy specimens. Radical surgery appears to offer the best chance for cure but hormonal manipulation and radiotherapy seem to be effective as adjuvant treatment modalities.     

Epithelial stromal tumor of the seminal vesicle

Primary tumors of the seminal vesicles are rare neoplasms; there have been only 69 accepted cases. The histologic features are usually adenocarcinoma; however, there are rarely reported epithelial stromal tumors of the seminal vesicles. We report a case of a 70-year-old man with an epithelial stromal tumor of the seminal vesicle who presented without symptoms of bladder outlet obstruction. The patient underwent radical cystoprostatectomy. No signs of tumor recurrence were noted within 14 months of surgery. To our knowledge, 13 cases of epithelial stromal tumors of the seminal vesicle have been previously reported.     

精囊间质瘤1例报道

目的:探讨精囊间质瘤的临床表现、病理特点和诊治方法。方法:对1例精囊间质瘤进行回顾性分析,并结合国内外文献复习,从临床表现、病理特点、诊治方法及手术切除后疗效进行总结。结果:患者行连同肿瘤的精囊切除,病理报告符合精囊间质瘤,术后至今10个月超声、CT检查未见肿瘤复发。结论:精囊间质瘤临床少见,易漏诊、误诊。应常规行直肠指检,泌尿系超声,泌尿系CT、MRI有利于明确诊断。目前公认的治疗为切除肿瘤,预后良好。     

原发性十二指肠恶性肿瘤17例报告

探讨原发性十二指肠恶性肿瘤诊断和外科治疗的方法。方法总结1991～1996年间经手术和病理证实的原发性十二指肠恶性肿瘤17例资料。结果从出现症状到获得诊治平均8个月．8例行根治性手术或肿瘤切除术，存活6个月～6年；7例行短路手术，5例术后2～8个月死亡，2例失访；2例末手术，均于6个月内死亡。结论原发性十二指肠恶性肿瘤发病率低，易误诊，应力争早期诊断，争取手术切除。     

非腺癌前列腺恶性肿瘤19例诊治报告

目的探讨非腺癌前列腺恶性肿瘤的诊断及治疗方法。方法非腺癌前列腺恶性肿瘤19例。年龄2～64岁，平均32岁。病程5d～10年。临床症状以尿道刺激症、排尿困难及会阴部胀痛为主。直肠指诊提示前列腺部位肿瘤。12例血清前列腺特异性抗原、5例酸性磷酸酶检查正常。B超、CT、MRI检查初步诊断为前列腺恶性肿瘤。19例术前均行前列腺穿刺活检术。12例仅行姑息性尿流改道术，7例行根治术，其中6例术后予以放疗和（或）化疗。结果病理报告侵袭性血管纤维瘤病1例、鳞癌2例、平滑肌肉瘤5例、横纹肌肉瘤3例、纤维肉瘤2例、恶性外周性原始神经外胚层肿瘤2例、间叶肉瘤3例、恶性间质瘤1例。12例行姑息性尿流改道术者术后15个月内因肿瘤全身转移死亡，5例行根治术的患者生存15～26个月后死于肿瘤全身转移，1例恶性间质瘤患者根治术后辅以化疗已生存13个月，1例间叶肉瘤行根治性膀胱前列腺全切加回肠膀胱术，术后予以放疗及化疗，已生存3个月。结论非腺癌前列腺恶性肿瘤患者的临床表现、直肠指诊、B超及CT检查对诊断有重要意义，有效治疗是早期根治术为主的综合治疗。     

腹腔镜治疗精囊良性肿瘤3例报告

目的:探讨腹腔镜手术治疗精囊良性肿瘤的效果。方法:2007年4月至2008年6月我院为3例患者行腹腔镜精囊良性肿瘤切除术。术前均经B超、CT及MRI等检查明确诊断,肿物大小40mm×30mm×25mm~63mm×45mm×40mm。结果:3例手术均成功切除精囊占位。手术时间64~120min,平均84min,术中失血60~120ml,平均74ml。术后平均随访11.3个月,未见局部复发及远处转移。结论:腹腔镜手术具有创伤小、并发症少、住院时间短等优点,是治疗精囊良性肿瘤的有效方法。