前列腺特异抗原和酸性磷酸酶测定用于鉴别前列腺癌和前列腺肥大

本文报告了１８０名正常人，１１８例前列腺癌和９５３例前列腺肥大病人的ＰＳＡ和ＰＡＰ测定结果。正常人、前列腺肥大和前列腺癌病人血清ＰＳＡ水平的中位数依次为１．３、３．０和１５２μｇ／ｌ、血清ＰＡＰ的中位数为０．６、１．２和１３．５μｇ／ｌ。如分别以４．２μｇ／ｌ和２．８μｇ／ｌ为正常上限，则前列腺肥大的阳性检出率为３８．９％和１８．７％。推荐血清ＰＳＡ以２０μｇ／ｌ、ＰＡＰ以１０μｇ／ｌ为鉴别前列腺癌和前列腺肥大的有效水平，此时ＰＣａ的阳性检出率分别为９７．２％和５９．２％，但ＢＰＨ的交叉率下降到５．４％和３．１％。     

经会阴射频多极针消融术治疗前列腺增生症

目的建立使用射频多极针经会阴径路行前列腺组织消融治疗前列腺增生症的方法,验证临床效果.方法对28例前列腺增生症病人在CT或直肠B超的引导下,采用射频多极针经会阴路径行前列腺组织消融术。并对术前术后国际前列腺症状评分(IPSS)、生活质量评分(QoL)、最大尿流率(MFR)、前列腺容积(VP)、残余尿(RU)以及血清前列腺特异抗原(PSA)进行比较.结果23例定期随访,5例电话随访.随访时间分别为术后2、3和6个月.术后2个月,IPSS评分从术前26.58±5降至9.11±6.08(p<0.001);QoL从4.11±1.21降至2.40±0.91(p<0.001);MFR从5.91±3.56ml/s提高至12.8±4.12ml/s(p<0.001);RU从148±66.9ml降至17.9±9.90ml(p<0.001);VP从49.4±24.9ml缩减至42.8±12.7ml(p<0.05);PSA也有不同程度的下降.术后6个月,疗效更明显.绪论 经会阴射频多极针前列腺组织消融术是一种新的安全有效的治疗前列腺增生症的方法.     

鼻内镜下射频消融治疗青年人腺样体肥大

目的探讨在鼻内镜下青年人腺样体肥大的射频治疗。方法7例青年病人，年龄为16～27岁，其中男性4例，女性3例。在鼻内镜下应用射频消融进行治疗，观察疗效。结果在鼻内镜下应用射频治疗后，6例一次性治愈，仅1例术后1个月复查有肥大的腺样体残留并仍导致鼻塞，再次射频治疗后治愈，术后6～12个月复查未见有复发的患者。结论对长期鼻腔通气困难而无显著鼻腔疾病影响鼻通气的青年患者，应用鼻内镜和／或影像学检查以确定有无腺样体肥大。应用鼻内镜在直视下射频治疗青年人腺样体肥大，可以收到良好的治疗效果。     

经会阴射频多极针消融术治疗前列腺增生症

目的建立使用射频多极针经会阴径路行前列腺组织消融治疗前列腺增生症的方法,验证临床效果.方法对28例前列腺增生症病人在CT或直肠B超的引导下,采用射频多极针经会阴路径行前列腺组织消融术,并对术前术后国际前列腺症状评分(IPSS)、生活质量评分(QoL)、最大尿流率(MFR)、前列腺容积(VP)、残余尿(RU)以及血清前列腺特异抗原(PSA)进行比较.结果 23例定期随访,5例电话随访.随访时间分别为术后2、3和6个月.术后2个月,IPSS评分从术前26.58±5降至9.11±6.08(p<0.001);QoL从4.11±1.21降至 2.40±0.91(p<0.001);MFR从5.91±3.56ml/s提高至12.8±4.12ml/s(p<0.001);RU 从148±66.9ml降至17.9±9.90ml(p<0.001);VP从49.4±24.9ml 缩减至42.8±12.7ml(p<0.05);PSA也有不同程度的下降.术后6个月,疗效更明显.结论经会阴射频多极针前列腺组织消融术是一种新的安全有效的治疗前列腺增生症的方法.     

耻骨上前列腺摘除术手术方法的探讨

1991年3月～1992年11月,我们对12例前列腺肥大症患者行耻骨上前列腺摘除术,在术中无选择地对常规手术方法做了改进,达到了满意的止血效果,介绍如下。     

对耻骨上前列腺摘除术手术方法的改进

1991年2月～1992年11月我们对12例前列腺肥大症患者,行耻骨上前列腺摘除术,在术中无选择地对常规的手术方法做了改进,达到了满意的止血效果,现介绍如下。 一般资料 本组12例,年龄60～75岁,平均年龄68岁。有高血压4例,肺气肿3例。术中常规输血300ml者7例,其余5例术中均未输血,术后无1例输血。术后血尿:均呈淡红色,24小时之内颜色变清亮者5例,16小时之内颜色完全变清者2例,     

结扎膀胱下动脉前列腺摘除术的外科解剖和临床应用

在32侧成人标本上解剖观察了前列腺的动脉和神经的起源和分布。供应前列腺的动脉主要为膀胱下动脉的分支,平均每侧有5.6支(2～6)。其分出点于膀胱前列腺间沟的4(8)及3(9)点钟之上24±10mm((?)±SD),各支可经膀胱前列腺间沟的任何一处进入前列腺实质或其包膜。至海绵体组织的植物性神经主要集中于膀胱前列腺间沟及前列腺表面的4点和8点钟外。作者认为,于膀胱前列腺连接部的侧面盲目缝扎包膜,试图结扎其中的动脉而达止血的目的,未必奏效。我们在7例良性前列腺增生的手术摘除术中,采用直视下膀胱下动脉结扎的方法,结扎动脉干可靠,术中术后出血量显著减少。因不会误扎神经,可避免术后病人性功障碍。     

经膀胱前列腺切除术治疗良性前列腺增生的体会

良性前列腺增生症(BPH),是老年男性常见疾病之一,其治疗方法很多,在基层医院经膀胱前列腺摘除术仍然是最有效的方法。我科1996年10月～2000年10月用此术式治疗BPH 59例,疗效满意,报告如下。 一、临床资料 本组病例59例,年龄62～78岁,平均68岁,病史3年以上,均有进行性排尿困难,不同程度尿频、排尿等待、尿流变细等。残余尿量80～330ml,平均150ml,42例有1次或多次急性     

射频热毁损治疗肝脏恶性肿瘤

射频热毁损 (radiofrequency therm al ablation,RFA)是国内外近几年来开展的一项治疗肝脏恶性肿瘤的新技术 ,具有快速毁损肝脏肿瘤而且安全性高、并发症少、患者易接受、可重复治疗等诸多优点 ,具有良好的应用前景 〔1～ 4〕。1　射频治疗仪和射频热毁损原理射频 (RF)是一种频率在 30 HHz- 30 0 MHz的高频电磁波 ,电流高度集中 ,随高频发生离子振荡而产生 90～ 12 0℃的高温。射频治疗仪主要由射频发射器、针式治疗电极、弥散电极板及 B超监视系统等部分组成〔1 ,2〕。目前使用的主流机型为 RF2 0 0 0 TM型治疗仪 ,其发射器频率为 46…     

前列腺癌治疗后的组织学效应及其临床意义

目的 探讨前列腺癌放疗和内分泌治疗后的组织学效应及其临床意义。方法 22例前列腺癌治疗后4～36月作1～2次穿刺活检复查。将治疗前后组织学形态和免疫组化改变作对比分析。对残余癌的治疗效应进行分级并作随访。结果 治疗后残余癌检出率59％，13例有残余癌病例中，5例重度、5例中度、2例轻度治疗效应。有3例治疗后活检发现无明显治疗效应的癌灶，4例单纯内分泌治疗病例疗效明显比合并放疗者差。残余癌PCNA表达下降与治疗效应增强有相关性。同时，良性前列腺组织也产生一系列治疗诱导的形态改变。结论 为防止误诊和不适当的组织学分级，病理医师应熟悉前列腺癌治疗后的形态改变，对有残余癌的病例应作效应评级。检查是否存在无明显治疗效应的癌灶，以区分阳性活检中的治疗成功者和失败者，从而为临床进一步治疗和判断预后提供依据。     

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.     

经尿道等离子体双极电切术治疗前列腺增生症(附48例报告)

目的探讨经尿道等离子体双极电切术治疗前列腺增生症的安全性和疗效。方法用等离子体双极电切术治疗前列腺增生症48例。结果本组病例，术中出血少，术野清，无水中毒发生，术后全部患者排尿通畅，无尿失禁发生。结论等离子体双极电切术治疗前列腺增生症，具有止血效果好、疗效确切、安全性高、并发症少的优点。     

Fine needle aspiration biopsy of the prostate gland

With the worldwide acceptance of mechanically assisted, ultrasound guided thin needle biopsy of the prostate gland, prostate fine needle aspiration (FNA) has fallen out of favor with both urologists and cytopathologists. Nonetheless, given today's trend to submit from 12 to 18 core biopsies per patient, prostate FNA remains less expensive, more expedient and more economical than any other sampling method so far developed. This short overview presents prostate FNA as a sensitive, specific and reliable diagnostic modality that should not be dismissed, as an anachronism, from the diagnostic armamentarium of either the urologist or the pathologist.     

Carcinosarcoma of the prostate

A unique case of carcinosarcoma of the prostate occurring in a 32 year old man is presented. This is the youngest case reported to date among nine well-documented examples. The patient underwent a total prostatectomy under the diagnosis of prostatic sarcoma. Despite adjuvant chemotherapy and full-dose radiotherapy being undertaken, the patients died from multiple lung metastases about 8 months after the operation. The surgically resected primary tumor was composed of two histologically distinct elements, these being an undifferentiated carcinoma and a sarcoma with various mesodermal components. These elements were intimately intermingled and transitional forms were often noticed. The sarcomatous portion contained myxoid areas, spindle cell sarcomas with nuclear palisading, areas of osteoid formation and small islands of chondromatous differentiation. The pathogenesis of this complex neoplasm is discussed, and it is suggested that vestigial embryologic Müllerian mesodermal tissue may be capable of diverse differentiation.     

Phyllodes tumor of the prostate

In this report, we describe a case of phyllodes tumor of the prostate with a high value of prostate-specific antigen (PSA). A 47-year-old man with symptoms of hematospermia presented with a steadily elevated serum PSA value of 60.76 ng/mL (normal range, < 4 ng/mL). A needle biopsy revealed atypical stromal cells without any evidence of malignancy. After radical prostatectomy, the tumor measured 2.9 cm in diameter and consisted of a single nodule composed of irregular, elongated epithelial ducts and atypical stromal cells with enlarged, occasionally multinucleated, pleomorphic, or hyperchromatic nuclei. Immunohistochemistry showed that the atypical stromal cells were positive for vimentin, androgen receptor, estrogen receptor, progesterone, and 5α-reductase, but negative for MIB-1, PSA, SMA, p53, desmin, CD34, c-kit, CD10, S-100, and EGFR. Excess PSA might be secreted by hyperplastic luminal cells driven by 5α-reductase-positive stromal and epithelial cells. Array-comparative genomic hybridization (array CGH) for genomic alterations revealed a gain of 11p13, which includes the WT1 gene, and a loss of 1p36.23 and 12p12.1. After surgery, the serum PSA value rapidly decreased to within the normal range; no recurrence or distant metastasis was noted after 2 years of follow up.     

Polymorphisms in the vitamin D receptor gene, ultraviolet radiation, and susceptibility to prostate cancer

Ultraviolet radiation (UVR) exposure may protect against prostate cancer development via a mechanism involving vitamin D. The vitamin D receptor (VDR) gene is therefore a candidate susceptibility factor for prostate cancer. This possibility has been previously investigated with conflicting results. We examined the association of VDR genotypes (variants at the CDX-2, Fok1, and Taq1 sites), haplotypes, and genotype combinations with risk by studying 368 prostate cancer and 243 benign prostatic hypertrophy (BPH) patients. CDX-2, Fok1, and Taq1 genotype and haplotype frequencies were not significantly different in cancer and BPH patients. As the impact of VDR polymorphisms may depend on UVR exposure, we studied associations of variants with risk in men stratified into low (below median) and high (above median) cumulative exposure/year groups. In men with UVR exposure above the median (1,100 hr/year), CDX-2 GA and AA (odds ratios [OR] = 2.11 and 2.02, respectively) and Fok1 ff (OR = 2.91) were associated with increased prostate cancer risk. No associations were observed for Taq1 genotypes. Of the genotype combinations, relative to all other CDX-2 and Taq1 and combinations, GGTT (P = 0.022, OR = 0.30), and relative to all other Fok1 and Taq1 combinations, FFTT (P = 0.026, OR = 0.35) were associated with reduced prostate cancer risk in the presence of the main effects. None of the other two- or three-genotype combinations was associated with risk. These data indicate that VDR variants influence prostate cancer risk and that this association is dependent on the extent of UVR exposure.