前列腺电汽化切除术中麻醉监测的临床意义

目的观察前列腺电汽化切除术中病人血流动力学及血糖、电解质、红细胞压积等指标的变化并分析其临床意义,指导临床预防前列腺电切综合征的发生。方法选择40例ASAⅠ～Ⅲ级,择期前列腺电汽化切除术手术患者。均采用连续硬膜外阻滞,选择L_(2～3)穿刺、头向置管3．5cm。术中输液用复方氯化钠液、聚明胶肽,补液速度控制在8～15ml·kg~(-1)·h~(-1)。分别于手术前、手术开始后30、50mmin和术毕时,抽取中心静脉血4ml检查血糖、电解质(Na~+、K~+、Cl~-)、血红蛋白、红细胞压积等。记录这四个时间点的血流动力学指标(MAP、HR、CVP)。结果手术开始后,CVP有逐渐上升趋势,术毕有明显升高(P＜0．05)。术中、术后的MAP、HR与术前比较无明显差异(P＞0．05)。与术前比较,血糖于术中50min和术毕时明显高于术前水平(P＜0．01);血清Na~+、Cl~-;血红蛋白、红细胞压积于术毕显著降低(P＜0．01;P＜0．05)。术中6例病人出现寒战反应;2例出现低钠、高血糖(Na~+＜125mmol/L,Glu＞10．0mmol/L),发生时间均在120min以上。40例病人麻醉效果满意,出血不多。结论前裂腺电汽化切除术术中CVP、血糖和电解质的监测对指导临床预防前列腺电切综合征的发生有重要作用。麻醉中病人的体温保护和冲洗液出入量的监测应引起重视。     

高龄患者经尿道前列腺电切术的麻醉体会

目的对100例高龄病人行经尿道前列腺电切术的麻醉处理进行总结和探讨。方法均采用硬膜外麻醉。低浓度、少量多次给药，仔细控制阻滞平面，加强术中监护。结果麻醉效果满意。但BP，HR及ST段等仍有不少人出现较大的变化，有些病人还出现术中并发症，经及时对症处理后均恢复正常。结论经尿道前列腺电切术采用硬膜外麻醉效果确切，安全性高，但术中应严整监护。     

高龄前列腺钬激光剜除术的麻醉

前列腺增生症是老年男性的常见疾病，随着年龄的增长各组织器官的生理功能逐渐减退，尤其是70岁以上的高龄老年人。因此本文对2000例高龄老年人行前列腺钬激光剜除术麻醉的安全性进行了总结，现报道如下。     

经尿道汽化切割和电切术治疗高龄高危前列腺增生症

目的　探讨经尿道汽化切割结合电切术治疗高危高龄前列腺增生症 ()BPH)的疗效 .方法　回顾性分析了 82例高危高龄BPH患者经尿道汽化切割结合电切术治疗的临床资料 .结果　 82例术后痊愈 ,2例术后出现电切综合征 ,12例术后发生并发症 (14 .6 % ) ,均经处理而恢复 .结论　BPH合并肺、心、肝、肾疾病或高血压、脑血管意外、糖尿病时 ,开放手术危险性大 ,经尿道汽化切割结合电切术 ,充分利用各自优点 ,减少其并发症 ,是治疗高危BPH理想的选择     

100例高龄经尿道前列腺汽化电切术患者的术后护理体会

前列腺增生(BPH)是老年男性常见病、多发病,为病人带来极大的痛苦。经尿道前列腺电切术(TURP)是目前公认的治疗良性前列腺增生的金标准。TURP具有适应证广,切除彻底,术后恢复快,疗效持久的优点[1]。我院自2001年至2005年12月共治疗高龄、高危BPH患者100例。现将术后护理体会报道如下。1资料与方法1.1临床资料本组100例,年龄70~89岁,平均79岁。经B超、国际前列腺症状评分、直肠指检、尿动力学检查诊断为前列腺增生。其中伴发高血压56例、冠心病18例、糖尿病20例、肾功能不全10例、肺部感染28例、肾功能异常5例,均先治疗伴发病,待病情稳…     

经尿道汽化切割和电切术治疗高龄高危前列腺增生症

目的探讨经尿道汽化切割结合电切术治疗高危高龄前列腺增生症()BPH)的疗效.方法回顾性分析了82例高危高龄BPH患者经尿道汽化切割结合电切术治疗的临床资料.结果 82例术后痊愈,2例术后出现电切综合征,12例术后发生并发症(14.6%),均经处理而恢复.结论 BPH合并肺、心、肝、肾疾病或高血压、脑血管意外、糖尿病时,开放手术危险性大,经尿道汽化切割结合电切术,充分利用各自优点,减少其并发症,是治疗高危BPH理想的选择.     

经尿道前列腺电汽化术治疗前列腺增生症240例

目的 评价经尿道前列腺电汽化术（TVP）治疗前列腺增生症（BPH）临床效果。方法 经尿道前列腺电汽化术治疗前列腺增生症240例。结果 术后随访2～18个月，患者在尿流率、国际前列腺症状（IPSS）评分，剩余尿（RU）等方面均有显著改善。结论 TVP具有疗效显著，并发症少，技术简单易掌握，价格较低和住院时间短等优点。有推广应用前帚。     

经尿道前列腺汽化电切术治疗前列腺增生症78例

2002年9月～2005年5月,笔者采用经尿道前列腺汽化电切术（TUVP）治疗前列腺增生症（BPH）78例,效果满意.     

汽化电切术治疗合并糖尿病的前列腺增生症

目的：评价经尿道汽化电切术（TVP）治疗合并糖尿病的前列腺增生症（BPH）的临床效果。方法：采用TVP治疗合并糖尿病的前列腺增生症24例。结果：本组23例治疗满意;1例术后尿潴留者,经腹直肌转位术治疗后,能自行排尿。24例术后3个月复查,残余尿量明显减少,最大尿流率（Qmax）由手术前（6.7±1.8）mL/s到术后（17.9±2.6）mL/s。无电切综合征（TURS）及死亡病例。结论：TVP是治疗BPH合并糖尿病的可行方法。     

经尿道前列腺汽化电切术与等离子电切术疗效分析

近年来经尿道前列腺汽化电切术与经尿道等离子前列腺切除术在全国各大医院广泛开展，两种方法治疗前列腺增生疗效确切。2000年10月至2007年8月我院共完成经尿道前列腺汽化电切术（TVP）和经尿道等离子前列腺切除术（TUPKVP）1012例，现报告如下。     

The pattern of CD10 expression in selected pathologic entities of the prostate gland

There is increasing evidence that neuropeptides, including bombesin, may influence growth, angiogenesis, invasiveness, and metastasis in prostate cancer. One of the molecules tightly involved in the regulation of neuropeptide activity is the integral membrane glycoprotein CD10, or neutral endopeptidase 24.11. The pattern of CD10 expression in hyperplastic and neoplastic conditions of the prostate gland has not been previously described. Immunohistochemical staining for CD10 and high-molecular-weight cytokeratin was performed on 92 cases of paraffin-embedded tissue from needle-core biopsy specimens and prostatectomy specimens. Normal and hyperplastic acini showed strong and distinct membrane (apical and intercellular) and cytoplasmic CD10 expression in basal and secretory cells. In contrast, no intercellular membrane or cytoplasmic staining of secretory cells was seen in any cases of adenocarcinoma with Gleason patterns 2 or 3. A subset of high-Gleason grade adenocarcinoma (patterns 4 and 5) displayed CD10 expression in the secretory cells; those cases shared a distinct morphological pattern. Prostatic intraepithelial neoplasia (PIN) showed consistent absence of intercellular membrane and cytoplasmic CD10 expression in the secretory cells, with preserved expression in basal cells. Interestingly, the basal cells in basal cell hyperplasia lacked CD10 expression, and no expression was noted in the secretory cells in all cases examined. Atrophic acini and those associated with acute and chronic inflammation retained CD10 expression. In conclusion, a consistent differential pattern of CD10 expression was seen in basal cell hyperplasia, PIN, and adenocarcinoma, suggesting a role for CD10 in the pathobiology of the prostate gland.     

Ratio of prostate specific antigen to the outer gland volume of prostrate as a predictor for prostate cancer

Objective: As a definite diagnosis of prostate cancer, puncture biopsy of the prostate is invasive method. The aim of this study was to evaluate the value of OPSAD (the ratio of PSA to the outer gland volume of prostate) as a non-invasive screening and diagnosis method for prostate cancer in a select population. Methods: The diagnosis data of 490 subjects undergoing ultrasound-guided biopsy of the prostate were retrospectively analyzed. This included 133 patients with prostate cancer, and 357 patients with benign prostate hyperplasia (BPH). Results: The OPSAD was significantly greater in patients with prostate cancer (1.87 ± 1.26 ng/ml²) than those with BPH (0.44 ± 0.21 ng/ml²) (P < 0.05). Receiver operating characteristic (ROC) curve analysis revealed that the performance of OPSAD as a diagnostic tool is superior to PSA and PSAD for the diagnosis of prostate cancer. In the different groups divided according to the Gleason score of prostate cancer, OPSAD is elevated with the rise of the Gleason score. Conclusion: OPSAD may be used as a new indicator for the diagnosis and prognosis of prostate cancer, and it can reduce the use of unnecessary puncture biopsy of the prostate.     

Optimization of prostate cancer diagnosis by increasing the number of core biopsies based on gland volume

In this prospective, non-randomized phase-I clinical trial, we comparatively studied the performance of six laterally-directed biopsies or the modified fan-shaped biopsies (MFSB), midline sextant biopsies (MB), and transition zone biopsies (TZB) and examine their prostate cancer (PCa) detection rates. A total of 114 patients received combinations of MFSB, MB, and TZB based on prostate gland volume: those ≤15cc received 8 biopsies; those >15cc but ≤ 50cc received 14 biopsies; and those >50cc received 20 biopsies. The mean prostate-specific antigen (PSA) level, Gleason score, and prostate volume were 8.0 ng/ml, 6.4, and 47 cc, respectively. PCa detection rate of the MB was 25% while the MFSB was 22%. The overall PCa detection rate was 33.3% with all biopsies. PCa and high-grade prostatic intraepithelial neoplasia (HG-PIN) detection rates decrease as the size of the prostate increases. PCa detection rates were 50.0% for volumes ≤19.9cc and volumes of >50cc had a detection rate of 25.8%. PSA levels of <3.0 had PCa detection rates of 15% which increased to 58% with PSA levels >9.0. In a multivariate analysis, only TZB was significant for PCa diagnosed by PSA (β=7.4, p<0.01). Our study showed that it is important to perform both the lateral MFSB and the MB to improve overall PCa detections rates. Thus, we recommend performing MB, MFSB, and TZB based on prostate volume, as follows: 8 biopsies for ≤15 cc; 14 for those >15 cc but ≤50 cc, and 14-20 for those >50 cc.     

电视胸腔镜手术的麻醉处理

目的 :探讨胸腔镜手术的麻醉处理要点、并发症的防治。方法 :分析 172例胸腔镜手术的麻醉过程 ,全组均采用快诱导双腔支气管插管静吸复合全麻。结果 :全组麻醉效果满意 ,发生 5例与麻醉有关的并发症 ,无手术及围麻醉期死亡病例。结论 :胸腔镜手术的麻醉处理关键是双腔管插管位置准确 ,加强呼吸管理 ,避免低氧血症     

The value of second-opinion pathology diagnoses on prostate biopsies from patients referred for management of prostate cancer

Gleason score (GS) (sum of primary plus secondary grades) is used to predict patients' clinical outcome and to customize treatment strategies for prostate cancer (PC). However, due in part to pathologist misreading, there is significant discrepancy of GS between needle-core biopsies (NCB) and radical prostatectomy specimens. We assessed the requirement for re-evaluating NCB diagnosed by outside pathologists in patients referred to our institution for management of PC. In 100 patients, we reviewed both their original "outside" and second-opinion ("in-house") diagnoses of the same NCB specimens, and compared them with the diagnoses of the whole-mount radical prostatectomy (WMRP) specimens (gold standard for analysis). We found that both outside and in-house biopsy GS vary significantly from the WMRP diagnoses, with GS undergrading substantially predominating above overgrading. Statistical analysis demonstrated that the main diagnostic discrepancy was in the differentiation between primary and secondary Gleason grades (mainly 3 and 4) and that outside NCB GS was significantly less accurate with respect to the WMRP specimens than the in-house NCB GS. In addition, in a different cohort of 65 NCB cases, we found that in 5 out of 11 patients, outside pathologists failed to report the presence of extraprostatic extension, an important feature for diagnosis of a higher pathology stage (pT3a). Since histopathological evaluation is a critical factor for appropriate treatment selection, we recommend that a re-evaluation by in-house urologic pathologists should be performed in all outside NCB specimens before patients are admitted for treatment in any given institution.     

Calcitonin immunoreactive cells in prostate gland and cloacal derived tissues

Summary Calcitonin- and serotonin-storing cells have been immunocharacterized in prostate gland, urethra, urinary bladder and anal canal. In addition, a few hCG and somatostatin immunoreactive cells have been detected in prostate gland. All these cells were dispersed throughout the epithelial lining. In the anal canal, calcitonin cells were exclusively confined to the anal ducts and anal transitional zone epithelium. Calcitonin and serotonin cells were seen in some examples of prostatic adenocarcinoma. Combined techniques most often showed coexistence of calcitonin and serotonin immunoreactivities in the same endocrine cell. hCG immunoreactive cells corresponded to a subpopulation of serotonin-, calcitonin-storing cells. Calcitonin and serotonin cells were present in most organs which originated from the cloaca. In this territory, this distinctive endocrine pattern could be regarded as an excellent marker of cloacal derived tissues. These tissues constitute an additional site for extrathyroid C-cells. It is likely that calcitonin cells are a component of some prostatic adenocarcinomas.     

Prostate hyperplasia in St Mary's Hospital Lacor: utility of prostate specific antigen in screening for prostate malignancy

IntroductionProstate cancer is the second commonest cancer in men worldwide. At present, every patient with lower urinary tract symptoms (LUTS) in St. Mary''s Hospital Lacor is undergoing prostate biopsy regardless of the prostate specific antigen (PSA) level. We sought to determine the association between PSA and malignant prostate histology.MethodsThis was a retrospective study. Data on age, PSA, prostate volume and prostate histology reported between Jan 2012 and Dec 2019 were retrieved from St. Mary''s Hospital Lacor archive and analyzed using STATA SE/13.0.ResultsRecords of 97 patients with LUTS was analyzed. The median (range) age of the patients was 71 (43–100) years. Median (range) of prostate volume was 91.8 (8.0–360.0) cc. Overall, PSA ranged from 0.21 to 399.2 ng/ml. Prostate histology showed 3.1% acinar adenocarcinoma, 24.7% adenocarcinoma and 72.2% benign prostatic hyperplasia. The median PSA amongst patients with malignant and non-malignant prostates were 15.8 ng/ml and 6.07 ng/ml respectively. Serum PSA level was significantly higher in patients with malignant prostate histology (Difference of mean= 9.7; p=0.001).ConclusionPatients with LUTS and PSA levels of 15ng/ml or more were more likely to have malignant prostate histology.     

Prostate specific antigen and prostate specific acid phosphatase in adenocarcinoma of Skene's paraurethral glands and ducts

An autopsy case of adenocarcinoma of Skene's paraurethral gland co-incident with renal cell carcinoma is described. The adenocarcinoma showed distinct prostate specific antigen and prostate specific acid phosphatase pointing to the equivalence between the male prostate and Skene's paraurethral glands and ducts. Skene's gland are the homologue of the prostate in females and tumours arising from them are immunohistochemically similar to male prostate carcinoma.In the title and text the authors used the official term of Nomina Anatomica paraurethral (Skene's) glands and ducts. Nevertheless recently published data on cross-antigenicity between the male prostate and Skene's glands and the newly discovered exocrine and neuroendocrine parameters of the prostate homologue in the female, comparable with the male prostate (Zaviai 1987), support the use of the same term — the prostate — for prostatic tissue in both sexes (Zaviai 1987, Zaviai et al. 1985). The designations female prostate homologue or female prostate equivalent are a compromise between terms the female prostate and Skene's paraurethral glands.     

Distribution of lipochrome pigment in the prostate gland: Biological and diagnostic implications

Lipochrome pigment is characteristically found in Wolffian duct—derived structures including seminal vesicles and ejaculatory ducts. The presence of lipochrome pigment is helpful in identifying atypical histological patterns of seminal vesicle or ejaculatory duct that mimic prostatic adenocarcinoma. The authors studied the distribution of lipochrome pigment in 28 radical prostatectomy specimens using a modified Ziehl-Neelson stain and fluorescence microscopy. In all cases secretory epithelium of the central zone contained lipochrome pigment often in significant amounts (2 to 3+). Secretory epithelium from peripheral and transition zones in each of four specimens (14.3%) contained lipochrome pigment. In addition, occasional examples of nodular hyperplasia, prostatic intraepithelial neoplasia, and prostatic adenocarcinoma contained lipochrome pigment. The preferential distribution of lipochrome pigment in central zone epithelium adds further support to the hypothesis that central zone glands are derived embryologically from Wolffian duct (mesoderm) rather than urogenital sinus (endoderm), which gives rise to transition and peripheral zone glands. Furthermore, lipochrome pigment should not be used as the sole diagnostic criterion for separating atypical histological patterns of seminal vesicle and ejaculatory duct from those of prostatic origin.