同种异体脱细胞真皮基质在前尿道狭窄手术中的应用

目的 评价同种异体脱细胞真皮基质（ADMA）在前尿道狭窄手术中的应用价值。方法 对9例前尿道狭窄患者进行狭窄段尿道切除后以ADMA替代尿道，长度4～9cm，并观察效果。结果 9例前尿道狭窄患者，手术4周后拔除尿管，7例患者排尿通畅，2例间断进行尿道扩张2个月。术后3个月所有患者均排尿通畅。结论 采用ADMA替代自体组织，手术效果确切，时间短，创伤小。     

会阴阴囊岛状双皮管重建尿道治疗全程尿道狭窄

目的：探讨利用会阴阴囊岛状双皮管重建尿道治疗全程尿道狭窄的应用价值及疗效。方法：本院1999～2010年采用会阴阴囊岛状双皮管一期尿道成形治疗16例全程尿道狭窄。术前先进行尿路无菌化及会阴阴囊毛发处理,术后第2天拔除橡皮引流片,并用抗生素行膀胱冲洗1次/d,术后2周拔除导尿管和膀胱造瘘管排尿。术后随访分别用逆行尿道造影、尿道镜和尿流率检查。结果：16例全程尿道狭窄患者均一期手术成功,术后随访6～36个月,平均16.3个月,1例术后3个月并发尿道外口狭窄,2例术后并发尿瘘,经再次手术矫正后均排尿通畅。1例术后尿线稍细,经定期尿扩后排尿顺畅。3例术后会阴部切口皮肤裂开并轻度感染,经换药后自行愈合。16例患者均无阳萎、尿失禁等并发症发生。尿道镜检查显示重建尿道内无毛干生长,无结石、囊袋及憩室形成。结论：会阴阴囊岛状双皮管治疗长全程尿道狭窄,是一种可行而有效的方法;该方法手术操作简单,取材方便,术中不需用特殊器械和设备,具有临床推广价值。     

磁力引导尿道扩张组件在尿道会师术的应用效果

目的观察磁力引导尿道扩张组件在尿道会师术的应用效果。方法后尿道断裂合并骨盆骨折患者56例分为两组,分别采用改良磁力引导尿道扩张组件(A组,23例)和传统尿道扩张器(B组,33例)治疗。比较两组手术时间和住院天数。术后1年随访两组疗效和术后并发症。结果A组手术时间短于B组[(58.82±3.69)min vs.(73.50±4.66)min](P<0.05),而住院天数与B组相仿(P>0.05)。A组治疗总有效率高于B组(95.65%vs.72.73%)(P<0.05)。A组术后并发症发生率低于B组(21.74%vs.48.48%)(P<0.05)。结论磁力引导尿道扩张组件在尿道会师术中可缩短手术时间,提高治疗有效率,降低术后并发症发生率。     

双镜联合尿道会师术治疗尿道伤的临床应用

目的探讨双镜联合腔镜下尿道会师术的技术要点,总结腔镜下尿道会师手术的优势。方法采用经皮肾镜与输尿管镜联合使用的方法,行腔镜下尿道会师术。结果 20例尿道伤无一例改开放手术,一期尿道会师成功率高达100%。结论双镜联合尿道会师手术时间短、创伤小、恢复快和并发症低,可作为治疗尿道损伤的最佳选择。     

男性后尿道狭窄数字化三维重建的初步研究

目的探讨基于CT扫描图像建立的精确后尿道狭窄数字化模型,在临床诊断及治疗中的应用。方法选择1例后尿道狭窄病例,进行尿道CT连续断层扫描,扫描结果导入Mimics软件中进行三维重建,利用三维重建模型指导临床。结果建立后尿道狭窄及周围结构的三维立体模型,可以方便地从任意角度和方向观察后尿道狭窄情况,测量有关的数据;还可以在数字化模型上进行手术设计。结论后尿道狭窄的数字化三维模型能够更直观、准确地反映病变部位的三维立体结构。对男性后尿道狭窄的诊断、手术规划等有较大帮助。     

脱细胞异体真皮基质治疗肛瘘临床研究

目的:评价脱细胞异体真皮基质治疗肛瘘的临床疗效。方法:回顾性分析2015年1月～2017年2月医院肛肠科收治的高位肛瘘手术患者,采用脱细胞异体真皮基质填充治疗患者44例纳入观察组,另根据年龄(±2岁)、性别、病程(±4个月)、瘘道数量,一对一选择同期传统切开挂线引流治疗患者44例纳入对照组,对比两组近远期疗效。结果:观察组随访(12±4)个月,对照组(11±5)个月,观察组、对照组各出现3例、5例复发;观察组并发症发生率、卧床时间、疼痛持续时间、创面愈合时间、恢复正常工作与学习时间、肛门失禁评分低于对照组,差异具有统计学意义(P<0.05)。结论:脱细胞异体真皮基质治疗肛瘘疗效肯定,在1年内并不会增加复发风险。     

Long-term urethral catheter drainage

Long-term catheter management is best conducted by specially trained community staff, provided there is close liaison with the urologist. Patients, hospital staff, and the primary health care team all benefit. The scheme is cost-effective, more convenient for patients and relatives, and reduces the need for emergency calls to the general practitioner and hospitals. We advocate development of similar schemes in other districts.     

Acellular pertussis vaccine safety and efficacy in children, adolescents and adults

This review offers a perspective on the acellular pertussis vaccine efficiency trials concluded in the 1990s and presents the main conclusions of a meta-analysis of 52 studies that assessed the safety and efficacy of the diphtheria-tetanus (DT)-whole cell pertussis (DTwP) and DT-acellular pertussis (DTaP) vaccines administered to children. A clear serological correlate of immunity to pertussis following DTaP vaccination was not identified despite an intensive analysis. It can be speculated that this may be because various combinations of antibody to agglutinogens (pertussis toxin, filamentous haemagglutinin, pertactin and fimbriae) provide protection, or because serum antibody levels and responses do not uniformly reflect mucosal IgA antibody levels.Long-term efficacy following DTaP vaccination is becoming characterised and cell-mediated immunity (T-cell memory) may have importance. DTaP vaccination appears to establish herd immunity after sufficient uptake within communities and countries. As experience with DTaP vaccine safety has accumulated, a 1-2% occurrence of large, local injection reactions with all products has been defined for booster doses. The pathophysiological mechanisms for the reactions are not established but a majority appear likely to be IgE-mediated reactive oedema and a minority to be IgG-mediated reactive Arthus-type reactions. DTwP and DTaP combinations with other vaccines have been studied and licensed; the most controversial combination products are the DTaP/Haemophilus influenzae type B polysaccharide conjugate vaccines.Pertussis epidemiology is changing with a clear increase in occurrence in adolescents and adults. This development has spurred studies and licensure of safer DTaP vaccines for this older population. The economic impact of pertussis and transmission from adults to vulnerable infants provides a cost-benefit justification for widespread use of DTaP vaccines in all age groups with routine boosting every 10 years.     

无细胞百日咳疫苗抗体活性持久性监管研究

目的：比较不同类型无细胞百日咳疫苗免疫小鼠后诱导的抗体应答及其持久性。方法：将来自于3家企业,采用2种不同工艺生产的无细胞百日咳疫苗（组分苗和共纯化苗）按一定比例稀释后分别给3组小鼠皮下接种,0.5 mL/只,于第4周加强免疫,剂量与初免疫相同。于免疫后第4周、第5周、第8周、第12周、第17周、第30周、第40周、第50周和第65周取血,分离血清,检测小鼠血清中抗百日咳抗体IgG水平（抗-PT和抗-FHA）和PT的中和抗体水平,并对其结果进行分析比较。结果：两类疫苗组检测结果比较,在免疫后第30周之前,两组之间抗-PT和抗-FHA水平无显著性差异;但在30周之后,两组之间抗-PT和抗-FHA水平有显著性差异（P < 0.05）,组分苗组抗体水平高于共纯化苗组。中和抗体方面,组分苗组中和抗体水平高于共纯化苗组,两组比较有显著性差异（P < 0.05）。结论：两种类型的百日咳疫苗免疫小鼠后均能诱导产生体液免疫应答,组分苗组的抗体持久性（包括百日咳抗体IgG和百日咳PT中和抗体）强于共纯化苗组;且百日咳IgG抗体与中和抗体之间具有一定的相关性。     

Acellular pertussis vaccines for use among infants and young children

Pertussis is still one of the most common vaccine-preventable childhood diseases in developed countries. Infants, particularly those < 6 months, are the most susceptible and those who suffer the greatest disease burden and mortality. In the 1970s, concerns about the reactogenicity of whole-cell vaccines led to a decrease in vaccine coverage and later the re-emergence of the disease in many countries. The advent of acellular vaccines in recent years has constituted an important advance in the acceptance of this immunisation and consequently the control of the disease. The efficacy of acellular pertussis vaccines is approximately 59 - 93%, similar to whole-cell vaccines, but all available data confirm the substantial improvement in safety of the new vaccines. With the licensure of acellular pertussis vaccines and combined vaccines containing them, pertussis immunisation has become significantly developed. Furthermore, the possibility of continuing to vaccinate adolescents and adults with new diphtheria, tetanus, and pertussis (dTap) vaccines is an important step in achieving control and elimination of the disease.     

经尿道输尿管镜下置导尿管治疗前尿道损伤临床分析

目的探讨微创方法治疗前尿道损伤的治疗效果。方法回顾性分析近年9例采用输尿管镜下经尿道置尿管治疗前尿道损伤的临床疗效。结果本组9例患者,均经试导尿证实为前尿道断裂,全部采用输尿管镜下置导尿管术。术后随访1-12个月,效果满意并发症少。结论采用输尿管镜下置尿管治疗前尿道损伤方法,是较理想有效的治疗方法。     

拔除留置双腔气囊导尿管引起尿道刺激症状原因分析

目的 探讨不同拔除导尿管的方法对减少尿道黏膜刺激的影响.方法 将入选的428例患者随机分为对照组和观察组.对照组在膀胱空虚时直接拔管,观察组在膀胱充盈时缓慢抽净气囊内液体,再注入0.5 ml的生理盐水后顺时针旋转拔管.结果 对照组在拔管后有效排尿成功率为84.00％,观察组有效排尿成功率为96.00％,拔除尿管后尿道刺激程度两组比较差异有统计学意义(P＜0.05).结论 在膀胱充盈时缓慢抽净气囊内液体,再注入0.5 ml的生理盐水后顺时针旋转拔管优于膀胱空虚时拔管,抽出气囊内液体后再注入少许液体及缓慢旋转的手法可减少尿道刺激程度.观察组拔管方法简单易行,值得推广应用.     

Artificial urethral sphincter for incontinence in adults

The artificial urinary sphincter (AUS) has been in use for more than 2 decades. This review describes the history, evolution and use of the AUS in adults. Current rates of success and mechanical reliability are reviewed. (c) 2001 Prous Science. All rights reserved.     

Acellular pertussis vaccines for use among infants and young children

Pertussis is still one of the most common vaccine-preventable childhood diseases in developed countries. Infants, particularly those < 6 months, are the most susceptible and those who suffer the greatest disease burden and mortality. In the 1970s, concerns about the reactogenicity of whole-cell vaccines led to a decrease in vaccine coverage and later the re-emergence of the disease in many countries. The advent of acellular vaccines in recent years has constituted an important advance in the acceptance of this immunisation and consequently the control of the disease. The efficacy of acellular pertussis vaccines is ～ 59 – 93%, similar to whole-cell vaccines, but all available data confirm the substantial improvement in safety of the new vaccines. With the licensure of acellular pertussis vaccines and combined vaccines containing them, pertussis immunisation has become significantly developed. Furthermore, the possibility of continuing to vaccinate adolescents and adults with new diphtheria, tetanus, and pertussis (dTap) vaccines is an important step in achieving control and elimination of the disease.     

复方利多卡因乳膏对留置尿管手术患者术后尿道刺激的影响

目的 观察复方利多卡因乳膏对减轻手术留置尿管患者术后尿道刺激的效果.方法 将80例患者随机分为观察组和对照组,对照组采用石蜡油润滑导尿管,常规导尿法;实验组在常规导尿法基础上,采用复方利多卡因乳膏作为润滑剂,在插管前用复方利多卡因乳膏注入尿道的方法 .结果 两组患者在术后复苏清醒期、术后6 h、术后12h、术后24 h各时间点尿道疼痛感均有明显差异（P〈0.05）;睡眠质量差异有显著性（P〈0.01）.实验组患者在术后复苏清醒期、术后6h、术后12 h、术后24 h各时间点尿道疼痛感均明显减轻,睡眠质量好.结论 采用复方利多卡因乳膏导尿法可有效减轻手术后留置尿管患者的尿道刺激症状,改善患者的睡眠,明显提高患者的舒适度.     

局麻改良腔镜下尿道会师术早期治疗后尿道断裂

目的探讨局麻改良腔镜下会师术早期治疗后尿道断裂的疗效。方法局麻下B超引导在耻骨上经皮膀胱穿刺造瘘,腔镜沿造瘘口进入膀胱,找到尿道内口,向尿道远端插入斑马导丝,随后从尿道外口进镜至尿道,寻找并将斑马导丝钳出尿道,再沿斑马导丝将导尿管引入膀胱,适度牵拉尿管,保持尿道连续性。结果采用该术式行早期治疗的11例后尿道断裂患者均获成功,手术时间平均25min,均未出现明显手术并发症,麻醉效果良好。结论局麻改良腔镜下会师术早期治疗后尿道断裂具有安全、直观、快速、成功率高、并发症少等优点,可作为早期治疗后尿道断裂的首选方法。