联合应用TIL和IL－2治疗肾癌

联合应用ＴＩＬ和ＩＬ－２治疗肾细胞癌１７例，检测了治疗前后外周血淋巴细胞（ＰＢＬ）对ｋ５６２、Ｒａｊｉ细胞的杀伤活性及ＣＤ_３、ＣＤ_４、ＣＤ_８水平，结果治疗前对Ｋ５６２、Ｒａｊｉ细胞杀伤活性分别为２８．２３±１４．１８％及２２．３９±８．８４％，而治疗后的杀伤活性分别为３６．１８±１３．０８％及２６．４７±５．２７％，治疗前后比较，ＰＢＬ对Ｋ５６２及Ｒａｊｉ细胞的杀伤活性均有显著提高（Ｐ＜０．０５）。治疗前后ＰＢＬ中的ＣＤ_３分别为５６．５８±４．０３％及５８．４３±３．４９％，ＣＤ_４分别为３９．８８±１．５１％及４１．１９±１．９９％，ＣＤ_８分别为３０．２０±１．５２％及３３．５４±３．３３％，治疗前后有显著性差异（Ｐ＜０．０５）。随访３～１５个月，平均９．７个月，１３例无转移者均无瘤存活，有转移的４例中完全缓解１例，部分缓解１例，死亡２例。提示联合应用ＴＩＬ和ＩＬ－２可以提高病人免疫力，在质和量两方面提高ＰＢＬ中的ＣＤ_３、ＣＤ_４和ＣＤ_８水平，近期疗效较好。     

高血压患者红细胞镁含量、Mg2+/Na+交换速率的研究

目的探讨原发性高血压（ＥＨ）、肾实质性高血压（ＲＨ）和肾血管性高血压（ＲＶＨ）患者红细胞镁含量（ＥＭＣ）、Ｍｇ２＋／Ｎａ＋交换速率（ＶＮＤｍａｘ）及其与血压的关系。方法原子吸收光谱火焰法。结果（１）ＥＨ组的ＥＭＣ［（２．０３±０．０６）ｍｍｏｌ／Ｌ］显著较正常对照组（２．１６±０．０４）、ＲＨ（２．１７±０．０５）和ＲＶＨ（２．１５±０．０４）组低,而ＶＮＤｍａｘ［（１５５．３±１５．２）μｍｏｌ·Ｌ－１·ｈ－１］显著较另外三组高（分别为９６．８±１３．２、９４．３±１４．２和９７．３±１２．５）。（２）ＥＨ组ＶＮＤｍａｘ与舒张压显著相关（ｒ＝０４８７２,Ｐ＜００５）。结论（１）ＥＨ患者ＶＮＤｍａｘ明显升高,是造成ＥＭＣ低下的原因,可能在疾病的发生发展中起一定作用。（２）ＲＨ、ＲＶＨ患者细胞镁代谢状况无异常。     

大肠癌组织酶标志物研究

目的：探讨大肠癌的发病机理及早期诊断的酶标志物。方法：采用酶学方法测定大肠癌及近心端和远心端癌旁组织中鸟氨酸脱羧酶（ＯＤＣ）、γ－谷氨酰转肽酶（γ－ＧＴ）、乳酸脱氢酶（ＬＤＨ）活性及ＬＤＨ同工酶谱。结果：（１）大肠癌组织中ＯＤＣ、γ－ＧＴ及ＬＤＨ活性均显著高于癌旁正常组织；（２）大肠癌组织中ＬＤＨ５同工酶及ＬＤＨ４＋ＬＤＨ５／ＬＤＨ１＋ＬＤＨ２的比值也显著升高，ＬＤＨ同工酶谱向Ｍ型转移。结论：肠组织中ＯＤＣ、γ－ＧＴ、ＬＤＨ活性升高，ＬＤＨ同工酶谱向Ｍ型转移与大肠癌的形成有关，提示ＯＤＣ、γ－ＧＴ及ＬＤＨ可能是大肠癌的组织酶标志物     

心内直视手术中血清LPO,LDH同工酶的变化

观察心内直视手术中血清ＬＰＯ、ＬＤＨ同工酶的变化。４９例心内直视手术患者，按阻断主动脉时间不同分组，４５分钟以内为１组，４５￣９０分钟为２组，大于９０分钟为３组。在主动脉开放前１分钟，开放后１０分钟、１、２４小时采血测ＬＰＯ、ＬＤＨ同工酶。结果发现，ＬＰＯ、ＬＤＨ同工酶值在主动脉开放后１０分钟、１、２４小时与主动脉开放前１分钟时比较有不同程度升高，其中主动脉开放后１、２４小时升高显著，有显著或非常     

PLD与APLD治疗腰椎间盘突出症比较

现对我院１９９３年～１９９５年间采用ＰＬＤ与ＡＰＬＤ切割治疗腰椎间盘突出症患者９６例进行分析、比较。临床资料ＰＬＤ组：５１例中男３７例，女１４例；年龄２０～５８岁；病程１月～１２年，其中３年以内４２例，３年以上９例；病变节段１节椎间盘突出者４５例，２节突出者５例，３节突出者１例；Ｌ_（３～４）椎间盘３节，Ｌ_（３～４）；椎间盘４３节，Ｌ_５～Ｓ_１椎间盘１３节（共５９节椎间盘）。ＡＰＬＤ组：４５例中男３１例，女１４例；年龄２３～６１岁；病程２周～８年，其中３年以内４１例，３年以上３例；病变节段１节椎…     

血清LDH和同功酶在小儿胆道梗阻和感染中的诊断意义与预后关系

本研究分为两部分：１．实验研究：测定胆道梗阻和感染的家兔，模型（实验组）的血清ＬＤＨ与同功酶，并取肝组织活检进行研究。结果表明实验组ＬＤＨ与ＬＤＨ４均较正常对照组增高（Ｐ＜０．００５、Ｐ＜０．０２）。肝组织学检查示肝细胞损害。２．临床研究：将３７例患儿分为３组，血清ＬＤＨ与同功酶的测定结果表明：①胆道感染与梗阻组的ＬＤＨ高于胆道疾病未合并感染或梗阻组（Ｐ＜０．００１）及对照组（ｐ＜０．００１）；②胆道感染与梗阻组ＬＤＨ５亦高于正常。以上结果表明血清ＬＤＨ与ＬＤＨ４或ＬＤＨ５的升高有助于小儿胆道感染与梗阻的诊断与预后判断。     

肾移植病人抗排斥反应治疗方案中应用雷公藤多甙的疗效观察

将雷公藤多甙（Ｔ_Ⅱ）用于５０例肾移植病人的术后抗排斥治疗．结果如下：Ⅰ组（试验组）：１６例（用药方案ＣｓＡ＋Ｐ＋Ｔ_Ⅱ），１年人、肾存活率均为１００％；Ⅱ组（对照组）：２１例（用药方案：ＣｓＡ＋Ｐ＋Ａｚａ），１年人、肾存活率则皆为８７．５％；试验组术后肾功能恢复正常时间为９．１９±１．５２天，比对照组（１６．８５±２．４８天）明显要快；Ⅲ组：１０例接受ＣｓＡ＋Ｐ＋Ａｚａ治疗的病人白细胞异常下降，以Ｔ_Ⅱ替代Ａｚａ后，白细胞在３～２１天恢复正常，并持续稳定，Ⅳ组及Ⅴ组病人均在接受ＣｓＡ＋Ｐ＋Ａｚａ治疗后出现急性或慢性排斥时加服Ｔ_Ⅱ，使急性排斥发生频率由５．２次／例降至２．３次／例，对慢性排斥也有一定的疗效，显效率达１８．８％。     

阿法D3防治绝经后骨质疏松症的临床研究

应用阿法Ｄ３防治绝经后骨质疏松症２４例。年龄６０．５３±６．６岁，绝经年龄４８．６±１０．９岁。阿法Ｄ３０．２５μｇＢｉｄ，钙剂（乳酸钙）日５００ｍｇ元素钙，疗程半年。结果：血ＡＬＰ、尿ＨＹＰ／Ｃｒ，尿Ｃａ／Ｃｒ，尿Ｃａ／Ｃｒ用药后明显下降。Ｌ２－４ＢＭＤ轻度增高。骨痛改善率５９．３％。以上骨癌症状消失，Ｌ２－４ＢＭＤ改善的总疗效为９０．５％。其中６例手足肌肉痉挛者５例症状消失，１例明显减轻。全组血尿常规，肝肾功能，肾脏Ｂ超于用药后均未见异常。未出现高血钙，不良反应轻微。表明阿法Ｄ３是防治绝经后骨质疏松症安全有效的药物。     

活性维生素D治疗原发性骨质疏松的疗效观察

为了评价１αＯＨＤ３对原发性骨质疏松病人治疗的有效性，作者应用１αＯＨＤ３对３２例（男１９例，女１３例）骨质疏松病人进行为期６个月的治疗。作者对病人的临床症状，Ｌ２～４ＢＭＤ和ＢＭＣ及相关生化指标进行检查，并对结果进行统计学分析。临床结果表明，服用１αＯＨＤ３６个月可以使男性和女性病人的ＢＭＤ分别增加５．０％和４．６％。但是１αＯＨＤ３对抗骨吸收的作用男女有差别，女性病人的骨转换率治疗后增高     

温血诱导心脏停搏及终末温血灌注在婴幼 儿心内直视术中的应用研究

目的探讨温血诱导心脏停搏及终末温血灌注技术在婴幼儿先天性心脏病（ＣＨＤ）手术中对心肌的保护作用。方法将４０例＜３岁ＣＨＤ患儿随机分成２组：温血诱导心脏停搏＋终末温血灌注组（温血组）;冷晶体液心脏停搏组（冷晶体组）。２组主动脉阻断时间无明显差异;体外循环前、后分别抽血测定乳酸脱氢酶（ＬＤＨ）、肌酸激酶（ＣＫ）、肌钙蛋白Ｔ（ＴｎＴ）;电子显微镜观察两组缺血后心肌超微结构。结果发现冷晶体组ＬＤＨ（１９７．９±７３．６Ｕ／Ｌ）,ＣＫ（１０７．６±５０．６Ｕ／Ｌ）,ＴｎＴ（８．９±４．０μｇ／Ｌ）升高值均高于温血组（８５．２±４７．７Ｕ／Ｌ,５５．８±３５．９Ｕ／Ｌ和３．３±２．４μｇ／Ｌ,Ｐ＜０．０５）,电子显微镜观察缺血后超微结构温血组优于冷晶体组。结论温血诱导心脏停搏及终末温血灌注技术对婴幼儿心肌保护作用有利     

Is antibiotic prophylaxis necessary in infants with obstructive hydronephrosis?

PURPOSE: We investigated the relationship between the level of obstruction of the upper urinary tract and the risk and onset of urinary tract infection in infants with severe obstructive hydronephrosis to determine the need for antibiotic prophylaxis. MATERIALS AND METHODS: A total of 105 patients were prenatally diagnosed with severe hydronephrosis (Society for Fetal Urology grade III or IV) due to upper urinary tract obstruction between 1994 and 2004. Of these patients 75 had ureteropelvic junction obstruction and 30 had lower ureteral obstruction. We retrospectively evaluated the clinical course and incidence of urinary tract infection during the first 12 months postnatally without antibiotic prophylaxis. RESULTS: The incidence of overall urinary tract infection during followup was 36.2% (38 of 105 patients), and it demonstrated a higher trend with lower ureteral obstruction than with ureteropelvic junction obstruction (50% vs 30.7%, p=0.063). Most cases of urinary tract infection (92.8%) occurred before age 6 months, with a mean age at onset of 2.6 months. Of 105 patients 77 (73.3%) underwent corrective surgery at a mean age of 3.8 months. The incidence of urinary tract infection before surgical correction was 33.8% at a mean age of 2.1 months. The incidence of urinary tract infection in surgical cases was significantly higher with lower ureteral obstruction than with ureteropelvic junction obstruction (54.2% vs 24.5%, p=0.011). CONCLUSIONS: Urinary tract infection in infants with severe obstructive hydronephrosis has a high incidence, occurs before age 6 months and is more common with lower ureteral obstruction than with ureteropelvic junction obstruction. These findings indicate that infants with severe hydronephrosis due to obstruction of the upper urinary tract should receive antibiotic prophylaxis.     

The fate of the upper urinary tract in exstrophy

PURPOSE: We evaluated the impact of reconstructive bladder procedures on the upper urinary tract in bladder/cloacal exstrophy. MATERIALS AND METHODS: A total of 57 patients underwent bladder neck procedures for urinary incontinence due to bladder exstrophy between 1988 and 2001. We correlated evidence of renal injury to urinary continence and type of surgery. Renal scarring and moderate/severe hydronephrosis were considered significant upper tract changes. RESULTS: Overall 27 patients (47%) underwent bladder neck closure, 38 (67%) augmentation cystoplasty and 44 (77%) a Mitrofanoff procedure. Mean interval since last continence procedure was 4.5 years and mean patient age at last followup was 11.7 years. Hydronephrosis was noted in 18 patients (32%) at last followup (after bladder neck reconstruction in 15). Renal scarring in 14 cases on dimercapto-succinic acid scan was evenly distributed regardless of the type of bladder neck procedure or presence of augmentation. Of 6 patients with grade 3 to 4 hydronephrosis 5 had renal scarring versus only 1 in the 39 without hydronephrosis (p <0.0001). Serum creatinine remained normal in 55 patients, mild renal insufficiency developed in 1 and renal transplantation was performed in 1. Two patients with persistent incontinence are anticipating an augmentation. CONCLUSIONS: Of our 57 patients with exstrophy 14 (24%) had significant upper tract damage in the form of renal scarring and/or moderate or severe hydronephrosis. The surgical method of achieving continence was not predictive of hydronephrosis or scarring. Bladder neck closure appears to provide better urinary continence and was equally safe with respect to hydronephrosis or scarring compared to patent forms of bladder neck reconstruction.     

微创经皮肾取石术治疗幼儿上尿路结石的临床分析

目的探讨微创经皮肾取石术（MPCNL）治疗幼儿上尿路结石的安全性及临床疗效。方法2008年9月至2008年10月,采用MPCNL技术治疗幼儿上尿路结石7例,合并轻度积水1例,中度肾积水2例,重度肾积水4例。其中1例双侧结石。结果8侧肾脏均为16F单通道取石,术后仅1侧肾小盏残留小结石,其余结石完全清除。无严重并发症。结论MPCNL治疗幼儿上尿路结石合并肾积水安全、有效,同时具有创伤小、恢复快等优点。     

Studies of enzymuria and proteinuria: Report 1: N-acetyl-beta-glucosaminidase in urological diseases

N-Acetyl-beta-glucosaminidase (NAG) exists in renal tubules and seminal tract. We measured the NAG level in patients with urinary tract and seminal tract diseases and evaluated its clinical significance. The urinary NAG level was high in renal tubular function disorders such as glomerulonephritis, diabetic nephropathy and hydronephrosis. In these patients, NAG-isoenzyme studies indicated that the A-type isoenzyme decreased while the B-type isoenzyme increased. On the other hand, in the seminal tract disease patients, the urinary NAG level was high in benign prostatic hypertrophy with a catheter indwelling and in prostatitis. Urinary and seminal NAG-isoenzymes were measured in normal subjects. The isoenzyme patterns for urinary NAG and seminal NAG differed. The urinary NAG isoenzymes were measured in acute prostatitis patients, we found that the A-type isoenzyme decreased and the B type increased. In conclusion, when the A/B ratio of the NAG-isoenzyme is close to 24.9/75.0 in the urine, the presence of urological diseases in which seminal plasma could be mixed in, especially prostatic diseases, should be suspected.     

经膀胱镜输尿管双J管置入治疗小儿上尿路梗阻

目的探讨经膀胱镜留置输尿管双J管在小儿上尿路梗阻中的应用价值。方法回顾性分析2014年12月~2018年5月45例膀胱镜输尿管双J管置入治疗上尿路梗阻的资料,其中先天性肾积水20例,急性输尿管结石梗阻23例,肾盂离断成形术后积水复发2例。均经膀胱镜逆行置入F3、F4或F4.7双J管。结果2例先天性肾积水和3例急性输尿管结石梗阻未能置入输尿管双J管,其余40例留置双J管位置良好。先天性肾积水18例均于术后6个月取出双J管,8例随访3~4年积水未加重,10例因积水加重行腹腔镜肾盂离断成形术;急性输尿管结石梗阻20例于1~2周拔除输尿管双J管,二期输尿管镜钬激光碎石成功;肾盂离断成形术后积水复发2例均于术后6个月拔除输尿管双J管,1例随访1年5个月肾积水无再次加重,1例因肾积水再次加重于拔管后20天行腹腔镜肾盂离断成形术。结论输尿管双J管置入可有效缓解小儿上尿路梗阻,达到缓解肾脏压力的目的,可作为婴幼儿和儿童上尿路梗阻的一线治疗方案。     

CKD and bladder problems in children

Approximately 35% of children with CKD who require renal replacement therapy have a significant urological abnormality, including posterior urethral valves, a neuropathic bladder, prune belly syndrome, Hinman syndrome, or severe vesicoureteral reflux. In such children, abnormal bladder function can have a significant deleterious effect on the renal function. In children with bladder outlet obstruction, bladder compliance and capacity often are abnormal, and a sustained intravesical pressure of >40 cm H(2)O impedes drainage from the upper urinary tract. Consequently, in these conditions, regular evaluation with renal sonography, urodynamics, urine culture, and serum chemistry needs to be performed. Pediatric urological care needs to be coordinated with pediatric nephrologists. Many boys with posterior urethral valves have severe polyuria, resulting in chronic bladder overdistension, which is termed as valve bladder. In addition to behavioral modification during the day, such patients may benefit from overnight continuous bladder drainage, which has been shown to reduce hydronephrosis and stabilize or improve renal function in most cases. In children with a neuropathic bladder, detrusor-sphincter-dyssynergia is the most likely cause for upper tract deterioration due to secondary vesicoureteral reflux, hydronephrosis, and recurrent urinary tract infection (UTI). Pharmacologic bladder management and frequent intermittent catheterization are necessary. In some cases, augmentation cystoplasty is recommended; however, this procedure has many long-term risks, including UTI, metabolic acidosis, bladder calculi, spontaneous perforation, and malignancy. Nearly half of children with prune belly syndrome require renal replacement therapy. Hinman syndrome is a rare condition with severe detrusor-sphincter discoordination that results in urinary incontinence, encopresis, poor bladder emptying, and UTI, often resulting in renal impairment. Children undergoing evaluation for renal transplantation need a thorough evaluation of the lower urinary tract, mostly including a voiding cystourethrogram and urodynamic studies.     

经皮肾造瘘软膀胱镜下钬激光碎石术治疗上尿路结石

目的 探讨经皮肾造瘘软膀胱镜下应用钬激光治疗上尿路结石的有效性与安全性.方法经皮肾造瘘软膀胱镜下应用钬激光治疗肾和输尿管中上段结石26例.其中肾结石合并输尿管结石8例、肾多发结石5例、单纯肾盏结石4例、输尿管中上段结石9例.结石直径1.0～3.2 cm,平均2.2 cm.肾轻度积水4例,中度积水15例,重度积水7例,合并肾功能不全13例.均在B超引导下经肾中盏穿刺单通道取石.结果 22例一期取石成功,4例二期取石.18 F穿刺通道18例,24 F穿刺通道6例.手术时间45～140 min,平均72 min.结石取净率96.2%(25/26),术中和术后均无输血.术后高热1例,抗感染治疗2 d后体温正常,无其他明显并发症.术后22例平均随访(11±4)个月,B超复查患肾积水明显减轻,未见结石复发.结论 经皮肾造瘘软膀胱镜下钬激光碎石是治疗上尿路结石的一种有效的微创方法,尤其适用于肾盏和输尿管中上段结石.     

PCNL术中人工肾积水临床体会与技术改进

目的 探讨PCNL术中超声定位下经皮肾穿刺时人工肾积水的必要性.方法 回顾本院无人工肾积水时采用超声定位行上尿路结石PCNL术196例临床病例的治疗情况.结果 本组中重度肾积水共114例患者均未人工肾积水,直接穿刺成功;轻度肾积水患者中62例直接穿刺成功,3例经人工肾积水辅助下穿刺成功;17例无明显肾积水患者中1 1例直接穿刺成功,6例行人工肾积水后穿刺成功.结论 多数患者可以不需要行人工肾积水而直接经皮肾穿刺造瘘.     

急性单侧上尿路梗阻肾脏与肾周改变的多排螺旋CT特点及其内在联系

目的分析急性单侧上尿路梗阻患侧肾脏及肾周改变的多排螺旋CT（MDCT）表现特点,并探讨两者的内在联系。 方法收集南海医院2015年至2017年间376例因结石所致急性单侧上尿路梗阻病例,所有病例均行MDCT扫描。回顾分析其患侧肾脏及肾周改变的MDCT的表现,采用Spearman秩相关系数来衡量两变量之间相关关系的强弱。 结果肾周改变分级与肾积水程度低度相关（R_s=0.194,P<0.001）;与肾实质密度减低中度相关（R_s=0.387,P<0.001）;与肾体积增大中度相关（R_s=0.545,P<0.001）。 结论通过分析急性单侧上尿路梗阻时肾脏及肾周间隙MDCT表现特点,能了解其内在联系,肾周改变的严重程度与肾积水程度和肾肿胀程度密切相关。     

The surgical approach to urological complications in renal allotransplant recipients.

Urinary extravasation or ureteral obstruction occurred in 22 patients who received 30 transplants in a series of 290 renal transplants. This incidence represent 10.3 per cent of the entire transplant experience at The Johns Hopkins Hospital and Baltimore City Hospitals from 1968 to the present time. Ureteroneocystostomy was used as the primary form of urinary tract reconstruction in all but 1 patient who had urinary complications. These 22 patients received 30 renal transplants: 6 from living related donors and 24 from cadaver sources. There were 15 instances of urinary extravasation and 14 instances of obstruction. All but 2 fistulas were diagnosed within 30 days of the original transplant. Obstruction occurred later, with 4 cases of ureterovesical obstruction being diagnosed 3 to 5 years after the transplant procedure. The ureterovesical junction or bladder was the site of complication in 17 of the 29 instances. Surgical management in these cases was highly individualized, with successful outcomes more commonly attained in those cases characterized by obstruction. Ureteral stents were used in all but 1 secondary procedure involving the ureter and these stents were not associated with an increased incidence of urinary tract infection. Death directly related to the urological complications occurred in 2 cases, 5 patients underwent transplant nephrectomy and 2 patients died of rejection and infection more than 6 months after the urinary fistulas were successfully managed. From the original series, there are 15 of the 22 patients who have stable renal function after secondary or tertiary urological procedures on the transplanted kidney. Four patients underwent surgical correction of hydronephrosis associated with infection or diminishing renal function more than 3 years after the transplantation and 3 of these had good results.