不同管径电切镜在经尿道前列腺电切术中的应用效果比较分析

目的：分析不同管径电切镜对前列腺增生（BPH）患者行经尿道前列腺电切术（Transurethral Re-section of the Prostate,TURP）的术中安全性及术后并发症情况。方法将495例前列腺增生患者分为三组,分别采用不同管径进行手术。A组用F24管径持续灌流式;B组用F24管径间断灌流式或附加膀胱穿刺造瘘;C组用F26.5管径持续灌流式行经尿道前列腺电切术。比较三组的手术时间、术中出血、TUR综合征、术后再手术止血、术后输血、尿道狭窄、尿失禁情况。结果平均手术时间、术中大出血、TUR综合征、再次手术止血、术后输血等指标A组与B组比较差异显著（P＜0.05）,A组好于B组;尿道狭窄、尿道外口切开情况A、B组与C组比较差异显著（P＜0.05）,A、B组优于C组。结论采用F24管径持续灌流式电切镜施行TURP术治疗前列腺增生,术中安全性优于间断灌流式及附加膀胱造瘘术式;术后尿道狭窄等并发症少于大口径电切镜,且术中一般无需做尿道外口切开,适宜国人TURP术中选用。     

创伤性后尿道断裂术后尿动力学分析

目的利用尿动力学检查方法,探讨创伤性后尿道断裂术后排尿困难和尿失禁的病因及发生机制。方法41例后尿道断裂根据病情不同而采用不同治疗方法,行Ⅰ期、Ⅱ期尿道吻合术18例,后尿道会师术23例,术后拔除尿管1周(近期)及3个月(远期),分别行尿动力学测定。以最大尿流率(Qmax)>12ml/s为正常组(A组),Qmax≤12ml/s为异常组(B组)。结果近期出现排尿困难5例,Qmax为(9.45±2.62)ml/s,其中尿道狭窄2例、前列腺增生2例、膀胱逼尿肌收缩无力1例;远期因尿道瘢痕挛缩继发排尿困难6例,Qmax为(6.28±3.26)ml/s,与正常组尿动力学参数比较,差异均有统计学意义(P<0.01)。尿失禁8例,最大尿道关闭压均低于40cmH2O〔(30.31±7.88)cmH2O〕,其中急迫性尿失禁3例,储尿期最大逼尿肌压力>15cmH2O〔(25.34±4.89)cmH2O〕;压力性尿失禁4例,漏尿点压力测定<60cmH2O〔(43.61±7.89)cmH2O〕;尿道“人工假道”性尿失禁1例。结论创伤性后尿道断裂术后尿动力学检查可以分析排尿困难和尿失禁的病因所在,有效指导临床治疗。     

两种术式治疗良性前列腺增生的临床观察

目的 对比良性前列腺增生患者应用经尿道双极等离子前列腺剜除术与经尿道双极等离子前列腺电切术治疗的临床效果.方法 采集2019年1月-2020年12月行经尿道双极等离子前列腺剜除术治疗的42例前列腺增生患者临床资料,将其纳入A组;另采集医院同期行经尿道双极等离子前列腺电切术治疗的42例前列腺增生患者临床资料,将其纳入B组.对比两组手术指标、前列腺症状评分(IPSS)以及术后并发症发生情况.结果 与B组相比,A组手术时间、膀胱冲洗时间更短,切除前列腺质量重,差异有统计学意义(P＜0.05);与术前相比,两组术后6个月IPSS评分均降低,且A组降低幅度比B组显著,差异有统计学意义(P＜0.05);与B组相比,A组并发症总发生率低,差异有统计学意义(P＜0.05).结论 经尿道双极等离子前列腺剜除术、经尿道双极等离子前列腺电切术均可将良性前列腺增生患者病变腺体有效切除,但与经尿道双极等离子前列腺电切术相比,经尿道双极等离子前列腺剜除术手术时间及膀胱冲洗时间更短,且术后并发症较少,安全性更高.     

多功能泌尿检查床在影像尿动力学中的应用

目的总结多功能泌尿检查床在影像尿动力学中的应用经验。方法运用多功能泌尿检查床配合单纯尿动力仪行600例(女性压力性尿失禁47例、前列腺增生312例、前列腺电切术后31例、神经源性膀胱106例、其他功能性异常104例)影像尿动力学检查。除同单纯尿动力学检查:调零、记录膀胱压力(Pves)、直肠压力(Pabd)、逼尿肌压力(Pdet)、尿流率(Q)和肌电图、膀胱感觉、膀胱容量及顺应性等参数外分别在膀胱储尿前期、膀胱储尿初期、膀胱储尿晚期及排尿期的点拍记录透视影像。结果发现膀胱输尿管反流32例、膀胱结石37例、膀胱憩室49例、逼尿肌膀胱颈协同失调17例、逼尿肌尿道外括约肌协同失调41例、膀胱后壁膨出12例。结论 多功能泌尿检查床在影像尿动力学中发挥着重要的作用,能很好地将单纯尿动力学检查与影像学检查结合在一起,为膀胱尿道功能障碍性下尿路疾病的诊断、治疗等方面提供重要的信息。     

经尿道前列腺汽化电切治疗前列腺增生（附150例疗效分析）

目的：探讨经尿道前列腺汽化电切治疗前列腺增生的疗效。方法：采用回顾性分析我院收治的前列腺增生患者的临床资料,依据治疗方式分为观察组和对照组。结果：观察组手术时间长于对照组,术中出血量低于对照组,观察组术后IPSS评分、尿流率、膀胱压力、残余尿明显优于对照组,观察组电切综合征、尿失禁的发生率明显低于对照组,P〈0.05,差异均有统计学意义。结论：经尿道前列腺汽化电切治疗前列腺增生临床疗效良好。     

经阴道尿道无张力吊带术治疗女性压力性尿失禁(附40例报告)

目的　回顾性分析新的治疗压力性尿失禁的微创方法———经阴道尿道无张力吊带 (TVT)术的有效性与安全性。方法　对40例患者于阴道前壁距尿道外口 1 0cm处将阴道黏膜纵形切开 1 5cm后置入吊带。结果　 34例完全治愈 ,无尿潴留、无尿失禁 ;2例术后 2周内、1例术后 3个月后出现轻度尿潴留 ,经尿道扩张后均消失 ;2例术后尿失禁显著减轻 ;4例术中出现膀胱穿孔 ;1例术后出现大片阴道黏膜脱落 ,后自愈 ;1例术后 5天出现急性大面积心肌梗死死亡。结论　TVT术作为治疗女性压力性尿失禁的新的微创手段具有创伤小、痛苦少、效果好、并发症轻微、安全性高的优点 ,值得推广应用。     

前列腺癌根治术后、复发的TRus表现及其诊断价值

临床上,对非浸润性前列腺癌行前列腺根治术后监测术后局部复发的常规检查方法包括:对膀胱尿道吻合部及前列腺隐窝部位的直肠指诊检查(Digital rectal examlnation,简称DRE)、对患者血清前列腺特异抗原(Serum Prostate-specific Antigen简称血清PSA)水平的测量、尿前列腺特异抗原(urinary prostate specific Antigen简称尿PSA)水平的测量,对膀胱尿道吻合部及前列腺隐窝部位的经直肠超声检查(Transrectal US简称TRUS)以及行 骨盆     

经尿道前列腺电切术后暂时性尿失禁临床分析

目的分析经尿道前列腺电切术（TURP）治疗后暂时性尿失禁的原因及防治方法。方法选取经尿道前列腺电切术治疗的患者共60例,依照手术顺序随机平均分为观察组和对照组,对照组予以常规术后辅助治疗,观察组予以磁疗按摩、托特罗定口服及适当训练预防尿失禁。结果 TURP术后若不予以磁疗、适当训练和适当药物预防,患者拔管后发生尿失禁的概率更大。观察组拔管后尿失禁发生率低于对照组,尿失禁平均持续时间短于对照组（P〈0.01）。结论系统训练和适当用药、磁疗是防治TURP术后尿失禁、缩短尿失禁时间的有效措施。     

前列腺电切患者选择不同时机拔除留置尿管的护理观察

目的探讨经尿道前列腺汽化电切术后患者拔除尿管的最佳时机。方法86例经尿道前列腺汽化电切术后留置导尿管的患者随机分为观察组和对照组各43例。观察组选择在患者膀胱充盈时拔除尿管,随即排尿。对照组选择在患者膀胱空虚时拔除尿管,待下次再度充盈时排尿。比较两组患者在拔除尿管后的自行排尿情况。结果选择膀胱充盈时拔除尿管的观察组患者,拔除导尿管后,自行排尿率明显高于对照组,而诱导排尿率和排尿失败率明显低于对照组,两组间有显著性的统计学差异（P〈0．05）。结论选择膀胱充盈时拔除尿管,能提高经尿道前列腺汽化电切术后患者的自行排尿成功率。     

经尿道钬激光或铥激光膀胱袖状切除术在上尿路尿路上皮癌治疗中的应用(附14例报告)

目的:探讨采用经尿道钬激光或铥激光膀胱袖状切除术处理末段输尿管在上尿路尿路上皮癌治疗中的临床应用价值。方法:2009年8月至2017年5月,肾盂、输尿管癌患者14例,行经尿道钬激光或铥激光膀胱袖套状切除术及后腹腔镜下肾输尿管全切除术。先取截石位,行尿道膀胱镜检查,经膀胱镜置入钬激光或铥激光光纤,经患侧输尿管口置入或不置入输尿管导管,距输尿管口外周约0.5 cm处环形切割膀胱壁,深度达膀胱外脂肪组织,激光配合镜体上推游离输尿管下段约3 cm,使输尿管脱离膀胱壁,留置导尿。改健侧卧位,行后腹腔镜下肾输尿管全长切除术。术后定期膀胱灌注及膀胱镜检查。结果:14例均完成经尿道钬激光或铥激光膀胱袖状切除术。经尿道激光膀胱袖状切除时间14～25 min,平均17.3min。术后住院天数7～11 d,平均8.3 d;术后无感染、出血及明显尿外渗等并发症。11例术后随诊6～48个月,1例12个月后出现局部复发伴肝转移。无膀胱内新发肿瘤。结论:在上尿路尿路上皮癌的治疗中,经尿道钬激光或铥激光膀胱袖状切除术处理末段输尿管安全、可行,损伤小、并发症少、效果确切,是上尿路尿路上皮癌根治术中处理末段输尿管较理想的方法。     

Transurethral resection of the prostate-related changes in the prostate gland: correlation of MRI and histopathology

PURPOSE: The purpose of this work was to demonstrate signal changes of the prostatic urethra after transurethral resection of the prostate (TURP) on MR images and histopathologic correlation. METHOD: Sixty-three patients with prostate cancer confirmed by either TURP (Group A, 19 patients) or transrectal biopsy (Group B, 44 patients) were evaluated by endorectal MRI before radical prostatectomies. The MR images of postcurettaged prostatic urethras were correlated with the histopathologic features. RESULTS: On the T2-weighted images, a thin zone of hypointense signal surrounding the curettaged prostatic urethra was identified in 52.6% (10/19) of Group A patients, imaged soon after (mean 21.1 days) TURP, but was indiscernible in Group B patients and the other Group A patients, imaged later after TURP (mean 49.2 days). This hypointense signal zone histopathologically correlates with a zone of inflammatory tissue reaction surrounding the widened urethra. CONCLUSION: Inflammatory tissue reaction surrounding curettaged prostatic urethra after TURP accounts for the presence of a low signal zone on T2-weighted images.     

The importance of urethra visualization for preplanned permanent prostate implants

PURPOSE: To assess the potential consequences of using a surrogate urethra on urethral dose estimates in preplanned 125I prostate implants. METHODS AND MATERIALS: For n=220 patients, the A-P and L-R extents of prostate and urethra contours were measured in transrectal ultrasound images. Treatment plans were then developed for 6 patients, of which 5 had atypical urethral positions. For each patient, three plan variations were made using the visualized and two different surrogate urethra contours. RESULTS: The urethra typically remains fixed in the L-R direction and extends slightly below midgland, but may veer off-center and can come within 0.5 cm of the posterior surface of the prostate. Use of a surrogate urethra can potentially result in up to 30% of the urethra receiving doses exceeding a planned limit of 1.5 x 145 Gy over a contiguous length of 2.0 cm. CONCLUSIONS: The urethra should be visualized for preplanning purposes, because unintended urethral doses arising from the use of a surrogate urethra can approach levels associated with late urinary morbidity. Visualization is also essential in the postimplant setting for accurate collection of dose-toxicity data.     

Shape analysis of the prostate: Establishing imaging specifications for the design of a transurethral imaging device for prostate brachytherapy guidance

PurposeTo examine specific prostate and urethra dimensions and prostate shape to facilitate the design of a transurethral ultrasonographic imaging device.Methods and MaterialsComputed tomographic (CT) data sets were retrospectively evaluated from 191 patients who underwent permanent prostate brachytherapy at our institution. The prostate, rectum, urethra, and bladder were each segmented with imaging software. Collected data and calculations included prostate volume at specific distances from the urethra and rectum, distances from seeds to urethra (SU), distances from seeds to rectum (SR), prostate length, and curvilinear prostatic urethra length.ResultsThe CT-based, postimplant mean prostate volume was 49 cm³ (range, 22–106 cm³). Mean prostate length was 4.5 cm (range, 3.1–6.0 cm). The mean curvilinear length of the prostatic urethra was 4.5 cm. The mean (standard deviation) prostatic urethra bend was 29.0° (12.2°). The mean surface distance from the prostate to the urethra was 2.9 cm and from the prostate to the rectum w as 4.6 cm (p < 0.001, paired t test). The mean SU distance was 1.6 cm, and the mean SR distance was 2.3 cm (p < 0.001). In the largest prostate, the mean SU distance was 3.9 cm and the mean SR distance was 6.0 cm.ConclusionsA urethral imaging device for prostate brachytherapy and other minimally invasive prostate therapies should ideally have a 6-cm imaging field of view to image all the prostates in this series in a single image. The mean distance from the SU in permanent prostate brachytherapy is less than 70% of the mean SR distance.     

后路小切口人工全髋关节置换术

目的 观察后路小切口人工全髋关节置换术（total hip arthroplasty，THA）的临床效果。方法 将70例患者按年龄、性别、体重指数、病种、髋关节功能配对分为两组进行前瞻性研究。35例小切口组，术前Harris评分52．21（24～76），35例标准后路手术组（简称标准组），术前Harris评分51．6（33～68）。分析手术时间、术中出血＋术后12h引流量、并发症、切口长度、疼痛评分、Harris评分等。结果 平均随访11.5个月（6～14个月）。两组手术时间相近。小切口组平均切口长9．0cm（7．0～12cm），标准组16cm（12—20cm），两组差异有统计学意义（P〈0．01）；小切口组平均出血500ml（270～700m1），29％（10／35）需输血，输血量约400ml，而标准组平均出血约950ml（600～1200m1），100％需输血，平均输血650ml，小切口组明显比标准组具有优势（P〈0．05）；小切口组疼痛评分平均为4．8分，标准组为6．8分（P〈0.01）。术后6个月，小切口组Harris评分94．0（84～100），标准组Harris评分90．5（82～94）。结论 后路小切口微创技术具有创伤小、出血少、疼痛小、恢复快的特点，可获得与常规后路手术相同的冶疗效果。     

直视下尿道内切开术后再次狭窄20例分析

目的对直视下尿道内切开术(DVIU)的术后疗效进行分析,重新认识DVIU的手术适应证,探索降低DVIU术后再次狭窄的方法。方法回顾性分析2004年1月至2009年4月78例尿道狭窄行DVIU术临床资料,对DVIU术后再次尿道狭窄病例进行分析,术前狭窄长度≤1.0㎝15例,1.1～2㎝42例2,～2.5㎝15例,≥2.5㎝6例,狭窄部位后尿道42例、前尿道36例,尿道球部2例。结果 DVIU1次成功70例,2次成功8例,术中加用电切12例,术后留置尿管时间3天～3月。术后随访1年,再次发生尿道狭窄20例,其中术后3月9例,术后半年11例。结论选择≤1㎝的尿道狭窄作为手术适应证,术中轻柔操作,合理选择留置尿管时间等,能降低DVIU术后再次尿道狭窄的复发率,应当有选择性地应用DVIU。     

Organ Movements and Dose Exposures in Teletherapy of Prostate Cancer using a Rectal Balloon

BACKGROUND AND PURPOSE: During radiotherapy of localized prostate cancer, organ movements for the dose exposure of organs at risk like rectum, urinary bladder and urethra play, inter alia, a significant role. One possibility of internal organ stabilizing is offered by the usage of a rectal balloon during radiotherapy. The influence on organ movements and dose allocation of the organs at risk is unknown. PATIENTS AND METHODS: Twelve patients (Table 1) were characterized based on planning-CT's regarding organ movements and organ doses using a rectal balloon, inflated with 0 ml and 60 ml air. For the determination of the organ doses, three-dimensional conformal radiation plans (3-field-pelvis box) with a cumulative dose of 59.4 Gy were created, and the dose-volume-histograms for the anterior rectal wall, the posterior rectal wall, the rectal mucosa, the whole rectum, as well as the urinary bladder were compared (Figures 1 and 2). RESULTS: The application of a 60 ml air-filled rectal balloon during each fraction of teletherapy led to significant organ movements of the anterior and posterior rectal wall and to a reduction of the transversal prostate diameter, as well as to a changed organ dose exposure of the organs at risk. A ventral shift of the anterior rectal wall (maximum 0.8 cm, mean 0.4 cm) was shown, as well as a dorsal shift of the posterior rectal wall (maximum 1.2 cm, mean 0.7 cm), associated with a transversal prostate diameter decrease (maximum 0.8 cm, mean 0.3 cm) (Table 2, Figure 3). The organ dose of the anterior rectal wall increased significantly (maximum 1.3 Gy, mean 0.5 Gy) during application of a rectal balloon, the one of the posterior rectal wall decreased significantly (maximum 18.6 Gy, mean 6.5 Gy). Related to the entire rectal mucosa and the rectum as a complete organ, a decrease of the maximum doses was shown (rectal mucosa: maximum 9.1 Gy, mean 3.0 Gy; rectum: maximum 9.4 Gy, mean 3.7 Gy). The organ dose of the urinary bladder did not show significant changes (Tables 3 and 4, Figures 4 to 7). CONCLUSION: The application of a rectal balloon in teletherapy of localized prostate cancer leads to significantly changed dose exposition of organs at risk. The decreased dose exposure of the posterior rectal wall and the rectal mucosa is opposed by the higher organ dose of the anterior rectal wall. It has to be shown weather documented organ dose exposure is associated with short and long-term consequences.     

盆底三维超声判断压力性尿失禁患者盆底功能损伤和疗效的价值

目的 探讨盆底三维超声在压力性尿失禁患者盆底功能损伤和疗效判断中的应用价值.方法 选取40例产后压力性尿失禁患者纳入本次实验作为观察组,另选择同期产后40例正常产妇纳入本次实验作为对照组,观察组产后接受盆底康复治疗,2组均接受盆底三维超声检查,统计并比较2组盆底功能(盆底裂孔面积、膀胱尿道后角以及膀胱颈至耻骨联合下缘的...     

不同时机实施分娩镇痛对产程及分娩方式的影响

目的探讨在不同时机实施硬膜外分娩镇痛对产程的长短及分娩方式的影响。方法将愿意接受硬膜外分娩镇痛的足月初产妇180例随机分为两组：潜伏期组（A组,宫口〈3 cm）和活跃期组（B组,宫口〉3 cm）。硬膜外穿刺成功后,两组首剂给予0.125%罗哌卡因和0.5μg/ml舒芬太尼混合液10～15 ml,30 min后连接镇痛泵,背景剂量2 ml/h,追加剂量2 ml,锁定时间15 min。连续监测呼吸循环情况,采用视觉模拟疼痛评分（VAS）,并观察记录产程进展及分娩方式、产后出血量、新生儿Apgar评分、缩宫素使用情况、副作用及产妇满意度。结果两组镇痛后VAS评分均降低,与B组相比,A组潜伏期VAS评分明显降低（P〈0.05）,器械助产率升高（P〈0.05）,镇痛满意度升高,下肢麻木发生率升高（P〈0.05）。两组产程、剖宫产率、催产素使用量、产后出血量、新生儿Apgar评分无统计学差异（P〉0.05）。结论分娩早期实施椎管内麻醉镇痛不影响产程和剖宫产率,可提高孕妇对分娩镇痛的满意度,但器械助产率有所增高。     

Quantifying clinical severity of physics errors in high-dose rate prostate brachytherapy using simulations

PURPOSETo quantitatively evaluate through automated simulations the clinical significance of potential high-dose rate (HDR) prostate brachytherapy (HDRPB) physics errors selected from our internal failure-modes and effect analysis (FMEA).METHODS AND MATERIALSA list of failure modes was compiled and scored independently by 8 brachytherapy physicists on a one-to-ten scale for severity (S), occurrence (O), and detectability (D), with risk priority number (RPN) = SxOxD. Variability of RPNs across observers (standard deviation/average) was calculated. Six idealized HDRPB plans were generated, and error simulations were performed: single (N = 1722) and systematic (N = 126) catheter shifts (craniocaudal; -1cm:1 cm); single catheter digitization errors (tip and connector needle-tips displaced independently in random directions; 0.1 cm:0.5 cm; N = 44,318); and swaps (two catheters swapped during digitization or connection; N = 528). The deviations due to each error in prostate D90%, urethra D20%, and rectum D1cm³ were analyzed using two thresholds: 5–20% (possible clinical impact) and >20% (potentially reportable events).RESULTSTwenty-nine relevant failure modes were described. Overall, RPNs ranged from 6 to 108 (average ± 1 standard deviation, 46 ± 23), with responder variability ranging from 19% to 184% (average 75% ± 30%). Potentially reportable events were observed in the simulations for systematic shifts >0.4 cm for prostate and digitization errors >0.3 cm for the urethra and >0.4 cm for rectum. Possible clinical impact was observed for catheter swaps (all organs), systematic shifts >0.2 cm for prostate and >0.4 cm for rectum, and digitization errors >0.2 cm for prostate and >0.1 cm for urethra and rectum.CONCLUSIONSA high variability in RPN scores was observed. Systematic simulations can provide insight in the severity scoring of multiple failure modes, supplementing typical FMEA approaches.