耻骨上膀胱切开前列腺摘除术

目的探讨前列腺摘除术的手术方式．方法总结１９９０～１９９９年间，２０１例前列腺增生症患者经耻骨上膀胱切开前列腺摘除术中，膀胱颈的缝合方法的改进．结果此术式止血效果好，无膀胱颈狭窄．结论此法安全可靠，少并发症，疗效满意．     

150例高龄患者耻骨上前列腺切除术后护理体会

前列腺良性增生(BPH)是老年男性常见病、多发病,主要表现为膀胱出口梗阻症状.手术治疗有经尿道电切术和开放手术,其中耻骨上前列腺切除术为开放手术中采用最多的方法.我院自2004年至2008年采用耻骨上前列腺切除术治疗高龄、高危BPH患者共150例,现将术后护理体会报告如下.     

淋病性膀胱炎及膀胱憩室结石伴双输尿管开口阻塞误诊1例

淋病性化脓性膀胱炎引起双输尿管开口炎性阻塞，同时伴双肾重度积水感染急性肾功能不全，代谢性酸中毒，在临床上十分少见。我科2003年6月收治1例双尿管下段结石伴双肾重度积水发生误诊，现报告如下。     

前列腺摘除术后膀胱痉挛性疼痛的护理

耻骨上经膀胱前列腺摘除术是治疗急性前列腺增生症常用而有效的方法,但手术后有52.3％～75％的患者发生膀胱痉挛。术后膀胱痉挛性疼痛呈阵发性发作,间隔数分钟至数小时不等,每次持续时间30s以上,多在术后2～6h开始出现,术后第一个24h t为严重,2～3d逐渐减轻或消失。痉挛发生时患者可出现阔气呻吟,膀胱冲洗液注入缓慢或不通畅,切口漏尿,继而引流液血色加深或近流,不仅患者非常痛苦,也是导致术     

耻骨上经膀胱前列腺摘除术的护理体会

前例腺增生症是老年男性的常见病,是引起老年排尿困难最常见的原因,且常伴有并发症。良好的护理是提高手术成功率的关键。我院自1995年1月至1997年12月,共行耻骨上经膀胱前列腺摘除手术68例,现将护理体会总结如下。1 临床资料本组年龄59岁以下8例,60-69岁23例,70-85岁34例,85岁以上3例,平均年龄为73.2岁,住院天数最长40天,平均住院天数20.4天。68例中合并高血压、心脏病、慢性支气管炎等混合病者25例,占36.7%。     

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。     

改良耻骨上经膀胱前列腺切除术的临床应用

目的：探讨改良耻骨上经膀胱前列腺切除术治疗前列腺增生症的临床疗效。方法：采用自行设计的耻骨上经膀胱前列腺切除术(简称改良术)，对50例前列腺增生症(BPH)患者行前列腺切除术。结果：术后拔除尿管后均排尿通畅．并发轻微尿失禁4例，膀胱痉挛6例，均自愈。结论：该术式具有操作简单，出血少，易于掌握且疗效好的优点.     

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。     

180例老年腹腔镜胆囊切除术的临床分析

目的 探讨腹腔镜胆囊切除术(LC)在治疗老年胆囊结石中的临床价值。方法 回顾分析老年组180例围手术期的处理，特别是对并存有心血管系统、呼吸系统、糖尿病、肝硬化、急性胆源性胰腺炎等疾病的诊治，以及对手术时机、适应证的选择等，与同期非老年组840例临床资料作统计学分析。结果 172例(95．7％)LC成功，8例中转开腹手术，22例术中心率失常，33例术中出现血压升高或大幅度波动，4例术后引流管短暂胆汁漏，8例术后出现肺部感染。本组病例恢复好，无死亡。结论 虽然老年组LC风险相对较非老年组大，只要重视围手术期处理和监护，把握手术时机和合适的适应证，LC对老年人同样是安全并能获得满意的疗效。     

Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center

Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3 radical prostatectomy modalities. Preoperative prostate-specific antigen density and number of positive surgical margin foci were the only independent predictors of biochemical recurrence.     

Robot-assisted laparoscopic radical prostatectomy: four cases

The role of the da Vinci robot is being defined in minimally invasive urologic surgery. Robot-assisted laparoscopic radical prostatectomy (rLRP) has emerged as a feasible treatment option for patients with organ-confined prostate cancer. We performed the first four rLRPs on four prostate cancer patients in the Republic of Korea. This is a report of its techniques and outcomes. In all four cases, the surgery was successfully completed with a mean operative time of 392.5 minutes. The mean estimated blood loss was 312.5mL, and catheterization lasted 14 to 21 days. There were no major intraoperative or postoperative complications. The mean hospital stay was 11 days. The rLRP is a safe and feasible approach. It will become one of the standard options for the management of localized prostate cancer.     

前列腺癌根治术后压力性尿失禁的发展规律

目的 探讨不同定义下的前列腺癌根治术后压力性尿失禁随时间的变化规律及其相关因素.方法 2010年3月至2013年11月,由同一术者完成腹腔镜前列腺癌根治术91例.患者年龄51～ 75岁,平均67岁.术前PSA0.1～ 50.8 μg/L,中位数为10.3μg/L;Gleason评分5～8分;TNM分期T1c～ T2c.术后10 ～ 17 d拔除尿管,分析其术后尿失禁的发生率及发展规律.控尿良好的定义分为不漏尿、有少量尿滴漏但不用尿垫以及每天使用尿垫不超过1张,共3种.结果 随访1 ～ 45个月,平均18个月.根据3种不同的定义,术后拔除尿管后控尿率分别为0％、5％和33％,术后1个月为5％、22％和63％,术后3个月为30％、63％和93％,术后6个月为54％、88％和97％,术后12个月为76％、98％和100％.结论 前列腺癌根治术后尿失禁常见,多数在术后6个月内好转.根据严格的控尿定义,近1/4患者在术后1年仍有尿失禁;但若根据宽松的控尿定义,则几乎所有患者均在1年内达到基本控尿.     

Influence of perineal prostatectomy on anal continence

OBJECTIVE:

Perineal prostatectomy has been proposed as a less invasive and safe procedure, but the risk of anal incontinence has been studied. This study aimed to evaluate the effects of perineal access on anal continence mechanisms after perineal prostatectomy.

METHODS:

From August 2008 to May 2009, twenty three patients underwent perineal prostatectomy. These patients were evaluated before surgery and eight months postoperatively using the Cleveland Clinic Anal Incontinence Score, the Fecal Incontinence Quality of Life Score, and anorectal manometry.

RESULTS:

The mean age of the subjects was 65 (range, 54-72) years, and the mean prostate weight was 34.5 (range, 24-54) grams. Gleason scores ranged from 6-7, and the mean Cleveland Clinic Anal Incontinence Score (mean±standard deviation) values were 0.9±1.9 and 0.7±1.2 (p>0.05) before and after surgery, respectively. The Fecal Incontinence Quality of Life Score did not change significantly after surgery. The mean values for anal manometric parameters before and after surgery were, respectively: Resting Pressures of 64±23 mmHg and 65±17 mmHg (p = 0.763), Maximum Squeezing Pressures of 130±41 mmHg and 117±40 mmHg (p = 0.259), High Pressure Zones of 3.0±0.9 cm and 2.7±0.8 cm (p = 0.398), Rectal Sensory Thresholds of 76±25 ml and 71±35 ml (p = 0.539), Maximum Tolerated Rectal Volumes of 157±48 ml and 156±56 ml (p = 0.836), and Sphincter Asymmetry Indexes 22.4±9% and 14.4±5% (p = 0.003).

CONCLUSION:

There was a significant decrease in the sphincter symmetry index after perineal prostatectomy. With the exception of the sphincter asymmetry index, perineal prostatectomy did not affect anal continence parameters.     

108例前列腺癌根治标本全器官取材的临床病理学观察

目的：应用前列腺癌根治术标本的全器官取材方法观察前列腺癌的临床病理学特征。方法系统性全器官取材前列腺癌根治标本108例,并复习相关临床病理资料。结果患者年龄55~80岁(平均68．1岁),术前血清PSA平均值18．3μg/ml。病理分期：pT2期59例(54．6%,59/108),其中14例为pT2a期(23．7%,14/59),5例为pT2b期(8．5%,5/59),40例为pT2c期(67．8%,40/59);pT3期49例(45．4%,49/108);pT3a期29例(59．2%,29/49),其中pT3b期20例(40．8%,20/49)。84例同时送检盆腔淋巴结,3例可见淋巴结转移(转移率3．6%)。 Gleason评分：9例≤6分(8．3%),66例为7分(61．1%),33例≥8分(占30．6%)。29例存在Gleason 5生长方式。切缘状况：28例(25．9%)呈切缘阳性,21例为pT3期(75%),15例(53．6%)存在Gleason 5生长方式。术前活检与术后病理分期比较：pT2期肿瘤术前PSA平均值14．00μg/ml,肿瘤累及针数≤2针者占68．5%,>5针者占4．3%;pT3期肿瘤术前PSA平均值23．82μg/ml,肿瘤累及针数≤2针者占19．6%,>5针者占28．3%。 pT2期与pT3期肿瘤活检累及针数差异有统计学意义(P<0．01)。术前活检指标在Gleason 6分者81．3%根治标本上升为7分或以上。结论要获得准确的病理分期、分级及切缘状况评估需全器官系统化取材前列腺癌根治标本。 PSA水平、Gleason评分、肿瘤累及针数是前列腺癌术前临床分期和危险度评估的良好指标。     

大鼠坐骨神经超微结构的老年性变化

为了研究老年大鼠坐骨神经超微结构特点,随机取3月龄(成年组)和24月(老年组)龄正常SD大鼠各10只,用电镜观察两组间坐骨神经超微结构的差异。结果显示:老年组大鼠坐骨神经内有髓纤维的百分比、轴突间胶原纤维密度以及Schwann细胞胞质中脂褐质沉积密度均多于成年组(P<0.05);但无髓纤维之百分比少于成年组(P<0.05)。上述结果提示坐骨神经内的有髓纤维与无髓纤维百分比、轴突间胶原纤维密度以及Schwann细胞胞质中脂褐质沉积密度是衡量大鼠坐骨神经老化的形态标志之一。