钬激光治疗浅表膀胱肿瘤42例

目的：评估钬激光治疗膀胱肿瘤的有效性、安全性、可行性。方法：术前42例经病理检查证实为移行细胞癌，在硬膜外阻滞或局部尿道麻醉下，应用钬激光经尿道切除，切除范围内包括距肿瘤2cm的膀胱黏膜，深度达浅肌层，术后羟喜树碱20mg加生理氯化钠40mL-50mL常规膀胱灌注，每3个月复查膀胱镜1次。结果： 门诊手术5例，住院手术37例，42例中32例应用硬膜外阻滞，10例局部尿道麻醉。每枚肿瘤切除时间1分钟－12分钟，无明显活动性出血，无输尿管口损伤或膀胱穿孔并发症。术后随访，6例复发，1年内5例，1年后1例，复发病例中2例行膀胱全切除，4例再次行钬激光治疗，半年内未见复发。结论：经尿道钬激光治疗浅表膀胱肿瘤手术时间短，并发症少，疗效可靠，部分病人可门诊治疗。     

经尿道钬激光切除术联合卡介菌多糖核酸膀胱灌注治疗浅表性膀胱肿瘤

目的探讨经尿道钬激光切除术联合卡介菌多糖核酸治疗浅表性膀胱肿瘤疗效及安全性。方法本组患者167例,术前在膀胱镜下取活检证实为T2以下肿瘤,采用连续硬膜外或骶麻,行经尿道钬激光切除,术后1周开始灌注卡介菌多糖核酸,每周1次,共8次,第1年每3个月行膀胱镜复查1次,以后每半年复查1次。结果随访3个月至7年,8例复发,复发率为4.0%。膀胱镜检肿瘤在原位5例,经再次手术后效果满意。结论钬激光膀胱肿瘤切除术联合卡介菌多糖核酸膀胱灌注,对于治疗浅表性膀胱肿瘤的效果满意,值得在临床上进一步推广应用。     

钬激光腔内切除巨大膀胱肿瘤

[目的]探讨钬激光腔内治疗巨大膀胱肿瘤的可行性及疗效.[方法]对22例巨大膀胱肿瘤患者施行经尿道或耻骨上膀胱造瘘道钬激光切除术,其中2例合并膀胱结石同期行钬激光碎石.[结果]18例一次手术切除成功,平均手术时间72 min.3例多发肿瘤2例再次手术,另1例术中出血失控转开放膀胱部分切除手术.术后均获至少12个月随访.9例复发再次或多次行腔内钬激光手术.[结论]钬激光腔内切除巨大膀胱肿瘤具有微创、并发症少等优点.患者耐受好恢复快,保留了膀胱及正常排尿功能,尤为适合有蒂腔内生长的巨大膀胱肿瘤.     

动脉栓塞化疗联合钬激光切除治疗多发性膀胱肿瘤疗效观察

目的:观察动脉栓塞化疗联合钬激光切除治疗多发性膀胱肿瘤的疗效。方法:36例多发性膀胱肿瘤患者先行髂内动脉灌注栓塞化疗,4~6 d后经尿道膀胱肿瘤钬激光切除术,术后常规吡柔比星膀胱内灌注,观察疗效。结果:患者均一次切除肿瘤,手术时间20~110 min,平均45 min,无并发症发生。术后随访1~3 a,复发15例,死亡3例,其中1例因肿瘤转移死亡,2例死于心、脑血管疾病。结论:动脉栓塞化疗联合钬激光切除治疗多发性膀胱肿瘤安全、简便,疗效满意,可提高患者生活质量。     

动脉栓塞化疗联合钬激光切除治疗多发性膀胱肿瘤疗效观察

目的:观察动脉栓塞化疗联合钬激光切除治疗多发性膀胱肿瘤的疗效.方法:36例多发性膀胱肿瘤患者先行髂内动脉灌注检塞化疗,4～6 d后经尿道膀胱肿瘤钬激光切除术,术后常规吡柔比星膀胱内灌注,观察疗效.结果:患者均一次切除肿瘤,手术时间20～110 min,平均45 min,无并发症发生.术后随访1～3 a,复发15例,死亡3例,其中1例因肿瘤转移死亡,2例死于心、脑血管疾病.结论:动脉栓塞化疗联合钬激光切除治疗多发性膀胱肿瘤安全、简便,疗效满意.可提高患者生活质量.     

丝裂霉素联合卡介苗交替膀胱灌注治疗浅表膀胱肿瘤疗效分析

目的 比较浅表膀胱肿瘤经尿道膀胱肿瘤钬激光切除术后不同灌注药物的疗效.方法 56例浅表性膀胱癌钬激光切除术后患者随机分为2组,卡介苗(单药组)组27例,术后用卡介苗膀胱灌注治疗;卡介苗联合丝裂霉素组(联合组)28例,术后用丝裂霉素与卡介苗交替膀胱灌注治疗.结果 随访24个月,卡介苗组和丝裂霉素联合卡介苗组2年复发率分别为29.6%和21.4%.丝裂霉素联合卡介苗组复发率明显低于卡介苗组,差异有显著性.结论 经尿道钬激光切除膀胱肿瘤后丝裂霉素联合卡介苗膀胱灌注降低术后复发率,效果优于单用卡介苗.     

膀胱嗜铬细胞瘤的诊断和治疗

目的：探讨有关膀胱嗜铬细胞瘤的诊断、治疗方法。方法：回顾4例膀胱嗜铬细胞瘤患者的资料，复习有关文献。结果：l例患者术前行膀胱镜活检时引起高血压危象、大出血，经紧急治疗后择期手术切除肿瘤。其他3例经对症治疗后顺利切除肿瘤。术后病理证实为膀胱嗜铬细胞瘤。随访2—14年，l例死亡，3例正常生存。结论：膀胱嗜铬细胞瘤的典型症状是排尿时或排尿后高血压发作。B超或彩超、CT及膀胱镜检查是确诊肿瘤的依据，对于怀疑膀胱嗜铬细胞瘤的病例不应做活检。尿肾上腺素、去甲肾上腺素、儿茶酚胺对诊断有帮助。手术是最有效的治疗方法，术后应坚持长期随访。     

钬激光在膀胱肿瘤中的临床应用

目的探讨钬激光腔内治疗膀胱肿瘤的可行性与疗效。方法对150例膀胱肿瘤患者,其中58例广泛多发性原位膀胱肿瘤及16例（T2期13例,T3期3例）要求保留膀胱的膀胱癌患者施行经尿道钬激光肿瘤切除术。对随访发现复发者,再次或多次行钬激光腔内治疗。结果150例患者成功实施钬激光切除肿瘤183台次。术后并发症有膀胱出血（12例）、创面延迟愈合（8例）。术后随访2～3a,1a内复发18例,死亡3例,2a生存率为96％。患者心理状态良好,生活基本自理,具备正常社会活动能力,生活质量自我评价良好。结论钬激光手术治疗膀胱肿瘤微创安全,效果良好,保留膀胱钬激光腔内治疗膀胱癌对患者术后生活质量影响甚微,符合循证医学原则,须严格把握肿瘤性质及分期分级等手术适应证。     

经尿道膀胱镜处理输尿管壁内部结石

目的:探讨经尿道膀胱镜处理输尿管壁内部结石的临床治疗效果。方法：报告11例单侧输尿管壁内部结石患者，于门诊行经尿道在膀胱镜下取出结石的临床资料。结果：10例成功取出，取得良好效果，1例失败后行输尿管镜下钬激光碎石术。结论：输尿管壁内部结石诊断明确后，可以经尿道膀胱镜进行处理，此乃一种简便、经济、有效的方法。     

经尿道膀胱肿瘤电切术联合吡柔比星膀胱内灌注治疗浅表性膀胱肿瘤的疗效观察

目的：探讨经尿道膀胱肿瘤电切术及术后使用吡柔比星膀胱内灌注治疗浅表性膀胱肿瘤的临床疗效。方法：75例浅表性膀胱肿瘤均采用经尿道膀胱肿瘤电切术（TURBT）,术后使用吡柔比星膀胱内灌注治疗。结果：所有病例均一次完整切除。随访2年,58例未再次复发,12例1年内再次复发,5例2年内再次复发。结论：TURBT联合吡柔比星即刻膀胱灌注治疗浅表性膀胱肿瘤手术简单,疗效好,患者痛苦小,恢复快,值得临床推广。     

Bladder cancer. What's new in diagnosis and treatment?

Advances in diagnosis and treatment have improved survival rates, bladder preservation, and quality of life in patients with bladder cancer. Flow cytometry and flexible endoscopy have enhanced early diagnosis, and intravesical use of BCG vaccine has decreased the rate of recurrence and progression of superficial bladder cancer. Systemic chemotherapy is effective in patients with invasive and metastatic bladder cancer. Although these advances are encouraging, continued investigation is required to further improve bladder preservation and survival rates, and clinical application of laser therapy and phototherapy needs to be fully developed.     

儿童膀胱横纹肌肉瘤的超声诊断

目的总结儿童膀胱横纹肌肉瘤超声声像图特点。 方法对2006年1月至2017年12月首都医科大学附属北京儿童医院收治并经手术病理检查证实为膀胱横纹肌肉瘤40例患儿的超声声像图特征进行总结。 结果40例患儿（男性27例,女性13例）术前超声均显示膀胱腔内肿物,肿物位于膀胱三角区36例（占90%）,非三角区4例（占10%）,最小肿物2.6 cm×1.7 cm×2.2 cm,最大肿物6.2 cm×4.4 cm×5.5 cm;36例肿物呈葡萄状或分叶状低回声或等回声包块。与术后病理诊断结果对照,术前超声正确诊断膀胱肿物35例（87.5%）且与病理诊断相符合,其余5例（4例误判为膀胱炎症,1例仅提示膀胱占位性病变）与病理诊断不符合。 结论因排尿困难就诊的男性患儿,超声检查发现膀胱三角区肿物,应首先考虑膀胱横纹肌肉瘤。儿童膀胱横纹肌肉瘤超声表现有特异性,是本病首选的检查方法。     

经尿道膀胱颈电切术治疗女性膀胱颈梗阻

目的：提高女性膀胱颈梗阻的诊断和治疗水平。方法：对21例女性膀胱颈梗阻患者进行尿流动力学和膀胱镜检查，全部患者均行经尿道膀胱颈电切术。结果：所有患者术后随访1～24个月，疗效满意，其最大尿流率（Qmax），残余尿量均有显著改善（P〈0．01），无尿失禁及尿瘘发生。结论：尿流动力学和膀胱镜检查是诊断该病的可靠方法，经尿道膀胱颈电切术是治疗女性膀胱颈梗阻的最佳治疗方法。     

Sonographic evaluation of anatomic results after the pubovaginal sling procedure for stress urinary incontinence.

OBJECTIVE: To investigate the anatomic changes after the pubovaginal sling procedure in women with stress urinary incontinence by transrectal sonography METHODS: This study enrolled 56 women with varying types of stress urinary incontinence who were treated with the pubovaginal sling procedure using self-fashioned polypropylene mesh. The suburethral sling was fixed without tension and was placed at the position between the bladder neck and the proximal urethra. The patients were investigated preoperatively and postoperatively by transrectal sonography of the bladder and urethra. RESULTS: At a median follow-up of 24 months (range, 6-39 months), 48 patients (85.7%) were cured, 6 (10.7%) had improved, and 2 (3.6%) had treatment failures. Transrectal sonography revealed a well-suspended bladder neck and proximal urethra in all patients who were cured. As measured by changes of the axis of the pubovesical ligament, the position of the bladder neck was elevated by a mean of 29.6 +/- 21.5 degrees in the resting condition and 47.4 +/- 27.7 degrees in the straining condition. An incompetent bladder neck and proximal urethra were noted in 8 patients who had stress urinary incontinence after surgery. The incidence of opening of the bladder neck was 84.6% in 13 patients with de novo urgency or urge incontinence, whereas only 2 (4.7%) of 43 patients who did not have postoperative urgency had opening of the neck (P = .000). CONCLUSION: Transrectal sonography provides useful information about anatomic changes after the pubovaginal sling procedure. Bladder neck incompetence after surgery was closely related to postoperative urgency or urge incontinence.     

胃肠镜下光电治疗息肉的临床分析--附2205颗息肉治疗报告

目的;探讨内镜下高频电、激光、微波、热极四种光电疗法治疗胃肠道四种类型息肉的临床应用和正确选择。方法：经内镜采用四种光电疗法治疗胃肠道息肉２２０５颗,并进行临床分析。结果：选用适当的光电方法和操作技巧,有利于胃肠镜下便捷治疗和获得良效。结论：治疗胃肠道息肉,结论：治疗胃肠道息肉、应根据其部位,类型和大小适宜地选择高频电套摘术,激光气化术,微波凝固术和热极灼除术治疗,以争取优良的临床效果和获得较为可     

Discrimination of bladder disorders in female lower urinary tract symptoms on ultrasonographic cystourethrography.

OBJECTIVE: To evaluate morphologic features of bladder disorders in female lower urinary tract symptoms using ultrasonographic cystourethrography and to elucidate the anatomic association of these morphologic characteristics. METHODS: Ultrasonographic cystourethrography was performed in 1049 women with lower urinary tract symptoms and 1 single urodynamic diagnosis, including 764 patients with genuine stress incontinence, 190 with detrusor instability, and 95 with a hypersensitive bladder. Thirty-six women with no lower urinary tract symptoms served as control subjects. Ultrasonographic assessment included measurement of the bladder neck position at rest and during stress and observation of the development of bladder neck funneling and cystocele during the Valsalva maneuver. RESULTS: Hypersensitive bladder and control groups had a significantly higher bladder neck position at rest and during stress, a lesser rotational angle of the bladder neck, a lower prevalence of bladder neck funneling and cystocele formation, and lesser mean bladder wall thickness than the other diagnostic groups. In the study groups, age, parity, and menopause may have effects on the cystourethrographic parameters except rotational angle and funneling of the bladder neck. With control of the confounding factors, bladder wall thickness at the trigone and dome was negatively correlated with the resting bladder neck angle (P = .006 and 0.019, respectively). Bladder wall thickness at the dome was positively associated with the rotational angle of the bladder neck (P = .022). Funneling of the bladder neck and development of cystocele during stress were positively associated with the resting and straining bladder neck angles as well as the rotational angle of the bladder neck. CONCLUSIONS: Ultrasonographic manifestation of a hypersensitive bladder is significantly different from that of genuine stress incontinence and detrusor instability.     

Power Doppler ultrasound imaging for quantification of urinary bladder neck blood flow changes

This study was designed to evaluate power Doppler imaging for assessment of urinary bladder neck blood flow in comparison with laser Doppler flowmetry (LDF) in an animal model. Transrectal power Doppler ultrasound (US) and LDF of the urinary bladder neck were performed in three anesthetized pigs during comparative cystometry. Normal saline (NaCl) was used for the first run, followed by a second run with 0.2 mol/L potassium chloride (KCl). Standardized sonographic equipment settings (Acuson Sequoia 512); MountainView, CA) were used for power Doppler imaging. Computer-assisted calculation of color pixel density (CPD) of power Doppler images was performed using Scion Image) software image analysis. Tissue perfusion units (TPU) were measured using a BLF21 laser Doppler flowmeter (Transonic Systems Inc., Ithaca, NY, USA). The power Doppler results were compared with the findings obtained by LDF. NaCl filling resulted in a mean CPD increase at the bladder neck from 18.65 (+/- 1.78) at empty bladder to 37.8 (+/- 1.84) at 100 mL and to 88.32 (+/- 1.35) at full bladder capacity (C(max)) of 270 mL, respectively. With KCl filling, a mean CPD increase from 18.65 (+/- 1.78) to 59.63 (+/- 0.5) at 100 mL and 110.82 (+/- 2.98) at full bladder capacity (270 mL) was observed. The CPD increase was significantly higher for KCl than with NaCl (p < 0.001). With NaCl filling, bladder neck blood flow increased from 22 TPU (empty) to 46 TPU (100 mL) and 62.5 TPU at C(max), compared to 22 TPU, 50 TPU and 102.5 TPU with KCl. CPD and TPU measurements showed a strong correlation at p = 0.01. In conclusion, transrectal power Doppler US image quantification is a feasible and accurate method for assessing blood flow changes in the urinary bladder neck.     

改良经闭孔无张力尿道中段悬吊带术联合经尿道膀胱颈内切术治疗女性压力性尿失禁合并膀胱颈梗阻的效果

目的分析改良经闭孔无张力尿道中段悬吊带术(TVT-O)联合经尿道膀胱颈内切术治疗女性压力性尿失禁合并膀胱颈梗阻的效果。方法将我院2015年3月至2020年3月收治的70例女性压力性尿失禁合并膀胱颈梗阻患者依照随机数字表法分为对照组(35例)与研究组(35例)。对照组给予传统TVT-O联合传统膀胱颈内切开术,研究组行改良TVT-O联合经尿道膀胱颈内切术治疗。比较两组患者的治疗效果。结果研究组手术时间、尿管留置时间、住院时间均短于对照组,术中出血量少于对照组(P<0.05)。研究组的并发症总发生率低于对照组,治疗总有效率高于对照组(P<0.05)。结论压力性尿失禁合并膀胱颈梗阻患者采用改良TVT-O联合经尿道膀胱颈内切术的效果确切,值得临床推广应用。