两种止血材料在颈椎单开门椎管扩大成形术中的止血效果观察

目的:比较可吸收止血流体明胶(HFG)和可吸收明胶海绵(GS)在颈椎后路单开门椎管扩大成形术中的止血效果。方法:回顾性分析2014年2月至2016年5月接受颈椎后路单开门椎管扩大成形术治疗的患者83例,根据患者术中使用不同止血材料分两组:HFG组41例,男30例,女11例;年龄29~81岁,平均(55.6±11.6)岁;其中14例为单纯颈椎管狭窄症,9例合并后纵韧带骨化,18例合并多节段颈椎间盘突出。GS组42例,男32例,女10例;年龄36~78岁,平均(55.4±11.1)岁;其中12例为单纯颈椎管狭窄症,10例合并后纵韧带骨化,20例合并多节段颈椎间盘突出。两组患者性别、年龄及病变类型等一般资料比较,差异均无统计学意义(P0.05)。比较两组手术时间、术中出血量、术后引流量、术后不良事件及术后并发症。结果:HFG组和GS组患者手术时间分别为(137.2±30.0)、(154.8±33.5)min(P0.05);术中出血量分别为(156.1±74.6)、(242.9±120.7)ml(P0.001);术后引流量分别为(212.1±67.6)、(303.3±115.5)ml(P0.001)。HFG组手术时间、术中出血量及术后引流量均少于GS组。两组患者均未发生术后切口急性血肿及其他止血相关并发症。结论:颈椎后路单开门椎管扩大成形术中,HFG操作简单,可以减少手术时间、术中出血量和术后引流量,是一种安全并且效果优于传统止血方式的止血材料。     

Postoperative radiographic appearance of intracranial hemostatic gelatin sponge

Hemostatic gelatin sponges were placed in hemispheric defects created in four dogs which were then periodically scanned by computed tomography to determine the post-operative appearance of the sponges. The hemostatic sponges appeared as low attenuation regions for 7–10 days. The attenuation value of these Gelfoam cavities was intermediate between fat and air. Subsequently, clinical cases were selected in which the location of gelatin sponges were known to demonstrate the appearance of the material in patients. In addition to enhancing the accuracy of computed tomographic interpretation, we have found that the gelatin sponge can be useful as a transient computed tomography marker for localization of surgical activity.     

可吸收止血流体明胶预防术后脑脊液漏

目的:探索可吸收止血流体明胶预防术后脑脊液漏的有效性。方法:对2013年3月至9月有硬脊膜撕裂脑脊液漏的脊柱损伤17例患者进行回顾性分析,男16例,女1例;年龄16～67岁,平均(39.6±15.4)岁;颈椎1例,胸椎9例,胸腰段4例,腰椎3例;爆裂骨折4例,骨折脱位13例。神经损伤ASIA分级:A级12例,B级2例,D级2例,E级1例。车祸伤2例,高处坠落伤10例,重物砸伤4例,地震时从楼梯滚落1例。术中应用可吸收止血流体明胶封堵以预防术后脑脊液漏。记录术后每日的引流量。结果:17例患者有15例术后无脑脊液漏出现。2例术后出现脑脊液漏者引流管保留至术后第6～7天。术后未出现头痛、头晕、发热、颈项抵抗、皮疹、切口不愈合、切口感染、血肿、神经症状加重等并发症。随访9个月均未见到切口周围有异常现象。结论:术中应用可吸收止血流体明胶封堵硬脊膜撕裂预防术后脑脊液漏是有效的方法。     

经会阴前列腺穿刺与经直肠前列腺穿刺活检在前列腺癌诊断的初探

目的 对比经会阴与经直肠前列腺穿刺活检在前列腺癌诊断中的阳性率及并发症。方法 回顾分析2017年1月到2019年12月行前列腺穿刺活检的病例,经直肠组187例,经会阴组68例。结果 经直肠组阳性穿刺率为34.7%,经会阴组阳性穿刺率为29.4%,两组无统计学差异（P>0.05）。穿刺后经直肠组和经会阴组的血尿发生率分别为40.1%、42.6%,尿潴留发生率分别为6.9%、7.3%,直肠出血发生率分别为1.1%、0%,差别无统计学意义（P>0.05）。穿刺后经直肠组和经会阴组的会阴肿胀的发生率分别为2.6%、13.2%,两组有统计学差异（P<0.05）。结论 超声引导下经直肠、经会阴前列腺穿刺活检均为前列腺癌诊断的有效方法。两者穿刺阳性率无明显差异,但并发症各有特点。     

可吸收止血流体明胶在颈前路椎体次全切除减压融合术中的应用

目的:探究可吸收止血流体明胶在单节段颈前路椎体次全切除减压融合术(anterior discectomy fusion,ACCF)中的止血效果。方法:自2014年8月至2018年2月选取行单节段颈前路椎体次全切除减压融合术患者44例,分为两组:试验组22例,男10例,女12例,年龄(55.6±9.7)岁,术中用可吸收止血流体明胶止血;对照组22例,男11例,女11例,年龄(54.4±11.1)岁,术中采用传统止血方法止血。比较两组手术时间、椎管减压所需时间、术中出血量、术后负压引流量、术后神经功能改善率、术后骨融合时间、术后钛网沉降率、术后血肿发生以及其他术后不良事件并发症。结果:试验组手术时间(83.1±19.2)min,明显少于对照组的(89.5±17.0)min(P<0.05);两组椎管减压时间分别为(52.4±13.7)、(56.1±14.6)min,差异有统计学意义(P=0.001);两组术中出血量分别为(49.9±12.4)、(90.6±36.7)ml,差异有统计学意义(P<0.05);两组术后负压引流球内引流总量分别为(42.5±18.3)、(60.0±22.8)ml,差异有统计学意义(P<0.05);两组术后1周神经功能改善率差异无统计学意义,术后3、6个月试验组比对照组有更好神经功能改善率。两组术后6个月均获得骨性融合,术后3个月均未发现明显钛网沉降,均无出现急性血肿、脑脊液漏及其他术后并发症。结论:可吸收止血流体明胶在ACCF手术中止血效果显著,可保持良好的手术术野,可减少椎管减压时间,减少术中出血量术后引流量,是一种较传统止血方法更有效且安全的止血材料。     

16G和18G穿刺针在超声引导下经直肠前列腺活检对前列腺癌的诊断效果及并发症比较

目的:增加穿刺针的直径可能通过获取更多组织而提高前列腺癌的检出率。本研究旨在比较16G和18G穿刺针在超声引导下经直肠前列腺活检诊断前列腺癌的效果及并发症。方法:本研究为前瞻性随机对照研究。2015年7月至2018年7月在超声引导下经直肠前列腺活检的142例患者作为研究对象,采用随机数表法将142例患者分为16G组和18G组,每组各71例。穿刺后比较两组血尿、出血和感染事件的发生率。采用Clavien-Dindo评分对并发症进行分级。结果:18G组前列腺癌检出率明显低于16G组(12.68%vs 36.62%),差异有统计学意义(χ^2=10.958,P=0.001)。当f/tPSA≤0.15时,18G组前列腺癌检出率仍明显低于16G组(8.51%vs 44.44%),差异有统计学意义(χ^2=12.617,P=0.001)。当f/tPSA>0.15时,两组间PCa穿刺检出率的差异无统计学意义(P<0.05)。两组活检后直肠出血(21.13%vs 15.49%)和尿道出血(18.31%vs 16.90%)的发生率比较无统计学差异(χ^2=0.753,P=0.385;χ^2=0.049,P=0.826),两组均未见感染并发症的发生。根据Clavien-Dindo分级:18G组Ⅰ级26例,16G组20例;两组均无Ⅱ级;18G组Ⅲa级2例,16G组3例,两组Clavien-Dindo分级的比较无统计学差异(Z=-0.698,P=0.458)。结论:活检针16G前列腺癌的检出率比18G高,且不增加并发症的发生率。     

可吸收明胶海绵负载大鼠神经干细胞的体外混合培养

目的 探讨明胶海绵作为中枢神经组织下程载体材料的可能性,为其作为神经干细胞的有效载体进行中枢神经移植奠定基础. 方法 体外培养胚胎14 d SD大鼠端脑神经干细胞,将其分为可吸收明胶海绵组和对照组,观察两组神经干细胞的形态及其增殖情况;诱导分化后,利用免疫荧光技术观察两组神经干细胞分化情况. 结果 移植组和对照组形态和增殖未见明显异常,细胞存活率分别为91.6％与92.8％;神经干细胞可黏附于可吸收明胶海绵表面,诱导分化后的细胞呈现部分神经元细胞及神经胶质细胞的典型形态,并交织成网状结构,用细胞免疫荧光方法检测特异性异性烯醇酶( NSE)和神经胶质纤维酸性蛋白(GFAP)表达阳性. 结论 神经干细胞能够与可吸收明胶海绵良好混合培养,神经干细胞形态、增殖、分化未见明显异常,为进一步可吸收明胶海绵作为中枢神经系统组织工程的载体的研究奠定了理论基础.     

A life-threatening hematochesia after transrectal ultrasound-guided prostate needle biopsy in a prostate cancer case presenting with lymphedema

A 62-year-old male presenting withlymphedema at the left lower extremity wasdiagnosed as prostatic carcinoma by anultrasound-guided needle biopsy. Six days afterthe biopsy procedure, he developed severehematochesia. Colonoscopy revealed an oozingvisible vessel at the anterior rectal wall, afew centimeters from the anus. Endoscopichemostasis with %1 athexysclerol was applicatedwith success. Rebleeding with same severity asthe first one occurred 48 hours after the firstbleeding and endoscopic hemostasis wassuccessful again. Follow-up was uneventful.     

Bacteriology profile of febrile infectious complications after transrectal ultrasound-guided prostate biopsy

ObjectiveInfection and fever are a major issue of transrectal ultrasound (TRUS)-guided prostate biopsy related complications. The aim of the present study is to evaluate the incidence and bacteriology profile of infectious complications and fever after prostate biopsies.Materials and MethodsA total of 5027 patients underwent prostate biopsy from July 2005 to December 2010 at our center. Three different prophylactic antibiotic protocols were administered 20 minutes before biopsy. The choice of protocols was according to the attending physician's preference. Patient data were reviewed for prostate pathology, medical comorbidities, risk factors for urosepsis, use of prophylactic antibiotics, causative organisms, and antibiotic sensitivity patterns in both blood and urine cultures.ResultsSeventy patients (1.39%) developed fever after biopsy. The average age was 71 years, the average calculated weight of the prostate was 50.5 ± 22 g, and the median prebiopsy prostate-specific antigen (PSA) level was 8.48 ng/mL. Among 21 urine-positive patients, seven (33.3%) urine cultures yielded Escherichia coli (E. coli) and 10 (47.6%) yielded Gram-negative bacilli. None of the patient factors or coexisting comorbidities, prebiopsy pyuria, or prostate cancer, was significantly associated with the development of fever after biopsy. There was no significant difference between each group of prophylactic antibiotic protocols.ConclusionOur study demonstrated an overall postbiopsy febrile complicating infection rate of 1.39%. E. coli was the most common pathogen. Fluoroquinolones or second generation cephalosporins are suggested as the initial choice in patients with postbiopsy fever.     

经直肠前列腺穿刺活检中应用不同针径活检针的对比研究

目的:比较不同针径活检针在超声引导下经直肠前列腺穿刺活检中的应用价值。方法:选取2015年1月～2016年10月在我院泌尿外科行超声引导下经直肠前列腺穿刺活检患者100例,采用随机数表法将患者分为观察组与对照组,每组50例,观察组采用16G活检针,对照组采用常规18G活检针,两组均进行相同的系统12针+靶向穿刺方案,由同一名专职医师完成穿刺操作。比较两组间穿刺阳性率以及术后并发症发生率。结果:两组12针系统穿刺阳性率比较差异无统计学意义(36%vs.24%,P=0.190),而靶向穿刺阳性率比较观察组优于对照组(37.5%vs.15.0%,P=0.022)。观察组穿刺阳性率与血清总PSA水平、PSA密度有相关性。两组术后疼痛评分(P=0.629)、术后并发症发生率(P=0.648)比较差异无统计学意义。结论:16G活检针能显著提高前列腺靶向活检阳性率,且术后相关并发症风险并未增加。     

Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsy

BACKGROUND: We analyzed the outcome of repeated transrectal ultrasound (TRUS)-guided systematic prostate biopsy in Japanese men whose clinical findings were suspected of prostate cancer after previous negative biopsies. METHODS: Between January 1993 and March 2002, 1045 patients underwent TRUS-guided prostate biopsy. Among them, 104 patients underwent repeat biopsy due to indications of persistent elevated serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) or TRUS, increased PSA velocity, and/or previous suspicious biopsy findings. Several clinicopathological factors were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy. RESULTS: Prostate cancer was detected in 22 of 104 patients (21.2%) who underwent repeat biopsies. PSA concentration and PSA density at both the initial and repeat biopsies, and PSA velocity in men with positive repeat biopsy were significantly greater than those in men with negative repeat biopsy. The incidence of abnormal findings in DRE and TRUS at initial biopsy in men with positive repeat biopsy was also significantly higher than that in men with negative repeat biopsy. However, neither the presence of prostatic intraepithelial neoplasia nor number of biopsy cores at initial biopsy had a significant association with the results of the repeat biopsy. Furthermore, multivariate analysis revealed that PSA and PSA density at both the initial and repeat biopsies, PSA velocity, and DRE and TRUS findings at initial biopsy were independent predictors of malignant disease on repeat biopsy. CONCLUSION: Despite an initial negative biopsy, repeat TRUS-guided biopsy should be carried out to exclude prostate cancer in cases of suspicious clinical findings, such as elevated PSA or PSA-related parameters, or abnormal findings of DRE or TRUS.     

Pelvic hematoma following transrectal ultrasound-guided prostate needle biopsy: A case report and literature review

Transrectal ultrasound-guided prostate (TRUS-P) needle biopsy is a common procedure for detection of prostate cancer. Complications associated with TRUS-P biopsy are almost always minor and do not require hospitalization. Pelvic hematoma following TRUS-P biopsy is an extremely rare complication. Only a few cases have been reported in the past. Here we report the case of a 67-year-old man diagnosed with pelvic hematoma following TRUS-P biopsy who presented with tenderness in the lower abdomen and ecchymosis in the paraumbilical region, lower abdomen, and scrotum. To our knowledge, no other case has been reported in Taiwan. Therefore, we discuss this case report and review the literature associated with complication of TRUS-P biopsies.     

Circumferential bone grafting around an absorbable gelatin sponge core reduced the amount of grafted bone in the induced membrane technique for critical-size defects of long bones

ObjectivesThe objectives of the study were to introduce a circumferential bone graft around an absorbable gelatin sponge core using an induced membrane technique, to assess its ability to reduce the required amount of graft and to maintain the bone graft, and to evaluate the clinical outcomes in the management of critical-size bone defects.Patients and methodsCircumferential bone grafting using a staged induced membrane technique for managing critical-size bone defects was performed in 21 patients. Postoperative computed tomography scans were performed 7 days after Hemovac drain removal and 3 months after bone grafting. Volumetric measurements of the defect size, gelatin sponge proportion, and amount of grafted bone were performed by two independent observers using three-dimensional (3D) software.ResultsThe critical-size defects were located at the metadiaphyseal area of 11 tibias, eight femurs, and two humeri. The average defect size was 8.9 cm in length and 65.2 cm³ in volume. The absorbable gelatin sponge core replaced 21.4% (average) of the defect volume. There was no significant deterioration in the shape of the grafted bone among the serial 3D models. Eighteen patients (86%) were healed radiographically at 9.1 months (average).ConclusionOur study suggests that circumferential bone grafting in association with the induced membrane technique could reduce the required amount of bone graft and adequately maintain graft position and shape, with favourable clinical outcomes.     

明胶海绵-血凝酶封堵剂用于猪肺穿刺活检的作用机制

目的观察经皮肺穿刺后给予明胶海绵-血凝酶封堵剂所致病理学变化,探讨其预防术后并发症的作用机制。方法对12头巴马小型猪行CT引导下经皮肺穿刺,于肺内活检针切割区注入明胶海绵-血凝酶封堵剂泥浆,并封堵穿刺针道。分别于术后1、4、8和12天各对3头猪行胸部CT扫描,观察明胶海绵泥浆球变化;CT扫描后1天处死动物,获取包含明胶海绵的肺组织,行常规HE染色后,于光镜下观察明胶海绵和周围肺组织病理学改变。结果经皮肺穿刺术后1、4、8天,活检针切割区明胶海绵泥浆球最大径分别为(14.45±1.43)mm、(9.79±1.80)mm和(3.09±1.04)mm(P<0.01),术后12天明胶海绵基本被吸收。术后1天肺组织中的明胶海绵泥浆球呈圆形或椭圆形,间隙内可见红细胞浸润和血栓形成,周围肺组织受明胶海绵泥浆压迫,针道完全被封堵剂泥浆条封堵;术后4天明胶海绵泥浆均以血液和明胶海绵混合物形式存在,明胶海绵颗粒大部分融合,其内部空间减小;术后8天明胶海绵结构松散,间隙增大;术后12天仅见残留明胶海绵泥浆区域,无混合物,泥浆周围肺组织少量纤维化。结论CT引导下经皮猪肺活检后给予明胶海绵封堵可通过吸收血液、压迫肺组织而达到止血和预防气胸的效果;且封堵剂在体内可完全吸收,安全性好。     

Symphysitis following transrectal biopsy of the prostate

Transrectal ultrasound-guided needle biopsy of the prostate is a widely accepted technique to obtain prostatic tissue for histological examination. Severe complications are rarely seen. We report a case of symphysitis causing hospitalization and severe pain and discomfort of the patient. Possible etiologic factors are traumatic osseous lesions and transport of rectal bacteria to the periosseous region. Especially in small prostates, care should be taken to avoid this condition. Prolonged perioperative antibiotic prophylaxis is mandatory.     

Significance of lateral biopsy specimens during transrectal ultrasound-guided prostate biopsies in Japanese men

OBJECTIVES: Lateral biopsies are thought to have a better cancer detection rate compared with standard sextant biopsies. This study aimed to determine whether lateral peripheral zone biopsies in Japanese men who underwent transrectal ultrasound-guided prostate biopsies provided a significantly higher cancer detection rate than sextant biopsies. METHODS: Between 1999 and 2004, data were collected from 461 men who underwent prostate biopsy and had enough data regarding the performance of lateral biopsies for statistical analysis. There were two categories in this study: (i) patients who underwent sextant prostate biopsies; and (ii) patients who underwent sextant biopsies plus lateral biopsies. RESULTS: Prostate cancer was detected in 141 (30.6%) of 461 patients. It was detected in 24 (22.2%) of 108 patients who underwent sextant biopsies and 117 (33.1%) of 353 patients who underwent sextant plus lateral biopsies. Lateral biopsies were not associated with a statistically higher rate of positive biopsy findings; however, we found a significantly higher ratio of patients with positive findings in those with prostate specific antigen (PSA) levels 10 ng/mL (one of 71, 1.4%) among those who had positive cores only in lateral biopsy samples (P < 0.0001). CONCLUSIONS: Lateral biopsies did not show a significantly higher detection ratio of prostate cancer compared to sextant biopsies. However, lateral biopsies were more effective than sextant biopsies in patients with lower PSA levels. Our findings might be useful for the establishment of biopsy strategies to detect prostate cancer, especially in patients with lower PSA levels.