保留后尿道前列腺鞘形切除术60例报告

１９９３年１０月￣１９９６年１０月采用保留后尿道前列腺鞘形切除术前列腺增生症６０例，平均手术时间５０ｍｉｎ，术中平均出血量５０ｍｌ，切除腺体平均得量７０ｇ。术后无明显出血，感染、尿失禁，排尿困难等并发症；长期随访排尿通畅，最大尿流率〉１５ｍｌ／ｓ，残余尿量０￣１５ｍｌ，阴茎能勃起，认为保留后尿道前列腺鞘形切除术具有保留尿道连续性、操作简便、出血少、并发症少、术后恢复快等优点，值得推广应用。     

耻骨上经膀胱保留后尿道前列腺切除术

报告３２例耻骨上经膀胱保留后尿道前列腺切除术治疗良性前列腺增生症。手术顺利，手术时间平均４２分，术中平均出血４０ｍｌ，切除腺体平均５２．４ｇ，术后无出血、感染、尿失禁等并发症，随访半个月－２３个月，排尿通畅，剩余尿０－３１ｍｌ，平均最大尿流率〉１８ｍｌ／ｓ     

经尿道激光治疗前列腺增生症118例报告

报告采用Ｎｄ：ＹＡＧ非接触式激光治疗１１８例前列腺增生症（ＢＰＨ），随访６个月。结果术后前列腺症状评分降低，最大尿流率及平均尿流率增加，残余尿减少。手术时间短，术中术后出血少，操作简单，对患者全身影响小。术后无尿失禁，无膀胱、尿道穿孔等严重并发症。本法较适宜于前列腺Ⅰ°～Ⅱ°增生患者。对Ⅲ°以上，梗阻严重者效果欠佳，目前还不能代替开放性手术及经尿道前列腺电切除术（ＴＵＲＰ）。     

改良 Madigan 前列腺切除术在临床的应用(附53例报告)

为了提高前列腺切除术的治疗效果，１９９３年９月～１９９６年５月对５３例前列腺增生症患者采用改良Ｍａｄｉｇａｎ前列腺切除手术。术前留置尿管后作ＣＴ检查，按ＣＴ测量前列腺体积计算重量并分度，了解尿道走向。手术特点为锐性分离前列腺与尿道、膀胱颈之间的组织及前列腺包膜，切除增生的腺体组织，保留完整尿道与膀胱颈。术后恢复快，并发症少，随访１～３２个月，疗效满意。对手术操作要点及适应证进行了讨论。     

Madigan前列腺切除术中结扎膀胱下动脉的外科解剖及临床应用

在３２具成人尸体前列腺血管解剖基础上设计出Ｍａｄｉｇａｎ前列腺切除术中结扎膀胱下动脉的方法，以预防术中出血。临床应用此术治疗前列腺增生症３２例，结果术中出血明显减少，术后随访３￣２２个月，全部患者无再次排尿困难，疗效满意。对术中操作要点，适应证等进行了讨论，认为手术具有不损伤尿道，出血少，并发症少，保留性功能，简便易行等优点，值得推广。     

经尿道等离子体电切加剜除术治疗BPH(附230例报告)

目的:探讨经尿道等离子体双极电切(TUPKVP)加剜除术治疗BPH的安全性和疗效.方法:回顾性分析经尿道等离子体双极电切加剜除术治疗BPH 230例临床资料.结果:手术操作45～150 min,术中平均失血(1004±20)ml.切除前列腺重量约12～90 g,平均(30±9)g.无经尿道前列腺电切综合征发生.23例(10%)术后膀胱痉挛;2例(0.8%)继发术后出血再次电凝止血.随访2～24个月,IPSS评分平均降至5分.无剩余尿.结论:经尿道等离子体前列腺电切术加剜除术具有安全性高、出血少,手术时间短、并发症少、疗效确切等优点.     

结扎前列腺动脉尿道外前列腺切除术疗效观察

采用结扎前列腺动脉尿道外前列腺切除术（Ｍａｄｉｇａｎ术式）治疗前列腺增生症５０例，结果５０例均无手术并发症，失血量平均为２１８ｍｌ，无输尿管损伤，保留了前行射精功能。认为尿道外前列腺切除术可保持尿道的完整性，不会有尿液外渗和血液进入尿路；预先结扎前列腺动脉，可提供一个无血的操作环境，使手术从容进行。进一步证实Ｍａｄｉｇａｎ术式疗效较好，并发症少，值得临床应用。     

经尿道前列腺电切术止血方法的体会

为探讨经尿道前列腺电切术的止血方法，对采用经尿道前列腺电切术治疗前列腺增生症５５０例进行总结。手术时间３０～８０分钟，平均４０分钟。术中输血１８５例，输血量２００～１２００ｍｌ，平均每例输血２５２ｍｌ。术后继发出血５例。手术初期有７例切穿前列腺包膜、切破静脉窦大出血。认为防止术中术后大出血的关键是沿前列腺外科包膜切除、避免切穿外科包膜。术中保留一小部分膀胱粘膜，有助于减少手术出血     

高能选择性绿激光汽化术治疗良性前列腺增生(附200例报告)

目的：探讨经尿道高能选择性绿激光前列腺汽化术（PVP）治疗良性前列腺增生（BPH）的有效性和安全性。方法：采用连续硬膜外麻醉、骶管麻醉或全麻，应用PVP治疗BPH患者200例，观察术中组织汽化效果、出血情况、手术时间、术后尿管留置时间、手术前后尿流率、国际前列腺症状评分（IPSS）、生活质量评分（QOL）等变化情况。结果：PVP汽化效果良好，手术时间15～120min，平均55min，术中基本无出血。术后195例留置尿管时间1～5天，平均3天，其中拔出尿管后4例出现短暂排尿困难，无尿失禁等并发症发生；5例未留置尿管。术后随访3～6个月，最大尿流率、IPSS及QOL较术前均有明显改善。结论：PVP治疗BPH安全有效，操作简单，时间短，出血少，尤其适合于高龄、高危患者。     

TUVP结合TURP治疗前列腺增生45例报告

目的：探讨治疗前列腺增生（BPH）的有效手术方法。方法：采用经尿道前列腺电气化术（TUVP）结合经尿道前列腺切除术（TURP）治疗BPH45例。结果：术中出血少,术后随访3－6个月,排尿功能均恢复良好,国际前列腺症状评分（IPSS）平均9．2分,生活质量评分（QOL）平均1．5分,最大尿流率（Qmax)平均14．1ml/s,未出现严重并发症。结论：本方法是一种操作较简易、出血少、安全性高、疗效确切的新手术方法。     

Three-dimensional display of the prostate based on transrectal ultrasonogram]

A software for a lap top computer to display prostatic contour three-dimensionally based on transrectal ultrasonograms was developed, and its clinical usefulness was examined. The prostatic contour of a case with prostatic cancer showed a typical irregular surface, and that of a case with prostatic hypertrophy had a smooth spherical shape, while that of a normal case had a flat shape. Each showed its characteristic shape. Estimation of the prostatic weight by assuming that the prostatic contour has ellipsoidal contour is a simple method for prostatic weight measurement, but it has a tendency to underestimate the weights, especially in normal cases. Three-dimensional display of the contour of prostatic cancer, prostatic hypertrophy, and normal prostate revealed that it could be estimated as ellipsoid in prostatic cancer or hypertrophy, while the normal prostatic contour was too flat to be calculated as such. Among 52 patients with benign prostatic hypertrophy who underwent transrectal ultrasonotomography before and during the anti-androgen therapy more than three time, nine cases showed transient reduction of more than 30% in prostatic weight and then reenlargement of more than 30%. In these cases, three-dimensional display of prostatic contour was done. The display was useful to visualize clearly which part reenlarged. Therefore, usefulness of the three-dimensional display of the prostate was verified.     

Clinical evaluation of serum gamma-seminoprotein in patients with prostatic cancer

The level of serum gamma-seminoprotein (gamma-Sm) was measured by enzyme immunoassay in 62 patients with untreated prostatic cancer and 89 patients with benign prostatic hypertrophy histologically diagnosed to assess the clinical usefulness as a tumor marker. The level of serum prostatic acid phosphatase (PAP) was also measured by radioimmunoassay in these patients simultaneously. Serum gamma-Sm levels in prostatic cancer were significantly higher than in benign prostatic hypertrophy. There was a tendency for serum gamma-Sm levels in prostatic cancer to increase with statistically significant difference as the stage progressed. A gamma-Sm level of over 5.0 ng/ml was considered to be positive. The positive rate of gamma-Sm was 56.5% in prostatic cancer (stage A.B: 32.3%, stage C: 75.0%, stage D: 90.9%) and 19.1% in benign prostatic hypertrophy. In stage A.B cases, the positive rate of gamma-Sm was higher than that of PAP. Therefore, the measurement of gamma-Sm is considered to be useful in the diagnosis of early prostatic cancer.     

ATF3在前列腺癌中的表达及意义

目的：探讨激活转录因子3（ATF3）在前列腺癌的表达和意义。方法：采用免疫组化和Western Blot检测正常前列腺、良性前列腺增生及前列腺癌组织中ATF3的表达。结果：ATF3在前列腺癌组织中的表达较正常前列腺组织和前列腺增生组织高（P〈0．05）。ATF3的表达与临床分期、病理分级、是否伴有转移有关。结论：ATF3可能与前列腺癌的发生、发展、侵袭和转移有关，可以作为预测前列腺癌的恶性程度和预后的指标。     

Metabolism of testosterone in the human prostate and seminal vesicles

Tissue from the normal, hyperplastic and the cancerous human prostate as well as tissue from the human seminal vesicles are capable of metabolizing testosterone in vitro. By incubating minced tissue with 3H-testosterone for 2 hours at 37 degrees C the following radioactive metabolites were identified: testosterone (17 beta-hydroxyl-4-androsten-3-one), androstenedione (4-androstene-3,17-dione), androstanedione (5alpha-androstane-3,17-dione), 5alpha-dihydrostestosterone (17 beta-hydroxy-5alpha-androstane-3-one, DHT), 3alpha-androstanediol (5alpha-androstane-3alpha,17beta-diol), 3beta-androstanediol (5alpha-androstane-3beta-17beta-diol) and androsterone (3alpha-hydroxy-5alpha-androstane-17-one). When normal human prostatic tissue was incubated with 3H-testosterone approximately 40% of the hormone was metabolized and 30-35% of the metabolites were identified as DHT. There were apparently no differences in testosterone metabolism between the dorsal and lateral prostatic lobes. A much lower conversion of 3H-testosterone was observed in the seminal vesicles (24%). The same metabolites were formed by prostatic carcinoma tissue, although distinctive quantitative differences from the normal prostate were observed. Thus, only 23% of the testosterone was metabolized by cancerous tissue of which 15% was present as DHT. The formation of 17-keto metabolites and androstanediols in the prostatic carcinoma tissue was approximately the same as in the normal prostatic tissue. The most extensive metabolism of testosterone was found by incubation of tissue from benign nodular prostatic hyperplasia. About 65% of the testosterone was metabolized, and 40% of the metabolites were identified as DHT. Hyperplastic prostatic tissue also showed a significantly higher formation of 5alpha-androstanedoils and the other tissues examined. The high formation of DHT and 5alpha-androstanediols in benign nodular prostatic hyperplasia in comparison with normal and cancerous prostatic tissue and seminal vesicle tissue might indicate that these metabolites should be studied more closely as possible aetiological factors for prostatic hyperplasia. The very low metabolism of testosterone in prostatic carcinoma tissue should be examined further in relation to tumour differentiation and clinical effect of endocrine therapy.     

前列腺癌组织中微血管密度测定及其意义

应用ＡＢＣ免疫组织化学技术对３９例前列腺癌和１０例前列腺增生症组织中微血管密度进行检测，结果发现前列腺癌组织中微血管密度明显高于ＢＰＨ；高分化前列腺癌组织中微血管密度明显低于低分化和未分化前列腺癌；发生转移的前列腺癌中微血管密度明显于未转移的前列腺癌。     

Analysis of Protooncogene c-erbB-2 in Benign and Malignant Human Prostate

In this report, we characterized the c-erbB-2 gene and its product in prostatic cancer cells. Three prostatic cancer cell lines (PC3, DU145 and TSU-Pr1), one primary prostatic cancer and four benign prostatic hyperplasias (BPH) were studied. In reverse transcribed polymerase chain reaction, c-erbB-2 mRNA was demonstrated in all three cell lines and prostatic cancer tissues as well as BPH. The c-erbB-2 protein was expressed higher in prostatic cancer cells and tissues as compared with benign tissue by enzyme immunoassay, but it was not statistically significant. Immunohistochemical study, with the monoclonal antibody SV2-61 that recognizes the extracellular domain of c-erbB-2, showed that all the prostatic tissues and cells had reactivity. Antigenicity was mainly in the cytoplasm. Analysis of genomic DNA failed to disclose gene amplifications or rearrangements of c-erbB-2 in both prostatic cancer and BPH. The sequence of amplified c-erbB-2, which corresponds to transmembrane domain, disclosed wild type in all prostatic cancer cells. These results demonstrate that although the number is limited, c-erbB-2 gene and protein are expressed in prostatic cancers and benign prostates. In the previous studies on c-erbB-2 expression in prostatic tissue, mainly conducted by immunohistochemistry, its frequency varies among each study, ranging from less than 0% to 100%. Therefore, to evaluate the c-erbB-2 in prostatic tissue precisely, it is also necessary to detect mRNA of c-erbB-2 as demonstrated in our study.     

Flow cytometric analysis of comedocarcinoma of the prostate: an uncommon histopathological variant of prostatic adenocarcinoma

Pathological data from 321 patients who underwent radical prostatectomy or cystoprostatectomy with a diagnosis of prostatic adenocarcinoma were reviewed. Of these specimens 4 (1.2 per cent) demonstrated histopathological findings consistent with prostatic comedocarcinoma. Prostatic acid phosphatase and prostate specific antigen detected by immunoperoxidase technique confirmed the prostatic origin of all comedocarcinomas studied. Flow cytometric analysis of deparaffinized sections from these specimens as well as a total of 40 representative specimens from normal prostate, and low, intermediate and high grade prostatic carcinomas was performed. Frequency of aneuploidy in low, intermediate and high grade prostatic adenocarcinoma was 0, 43 and 75 per cent, respectively. All cases of prostatic comedocarcinoma studied had distinctly aneuploid deoxyribonucleic acid histograms and the mean deoxyribonucleic acid content in comedocarcinoma was the highest of all groups analyzed. The mean time to recurrence in patients with comedocarcinoma was 13 months. Our flow cytometric data suggest that prostatic comedocarcinoma represents a potentially aggressive tumor demonstrating cytogenetic aberration shown to be associated with poor clinical outcome in prostatic adenocarcinoma.     

Exfoliative cytology of prostatic carcinoma using a prostatic fluid collecting catheter

In 152 patients who were suspected to have prostatic disease prostatic fluid obtained by a specially designed catheter was examined cytologically. Cytology was positive in 16 of 20 patients who initially were diagnosed clinically as having prostatic carcinoma, in 10 of 41 patients with suspected carcinoma and in 3 of 91 patients with clinical prostatic hypertrophy or other benign diseases. All but one of these cytologically positive cases finally were confirmed histologically to have prostatic carcinoma. In 4 patients initially diagnosed as having prostatic carcinoma cytology was not positive but in one the initial clinical diagnosis was incorrect and only 3 were false negative. This method of diagnosis is simple and highly effective in detecting prostatic carcinoma.     

前列腺癌组织中Skp2、PTEN的表达及临床意义

目的：探讨Skp2和第10号染色体缺失的磷酸酶和张力蛋白同源物基因（Phosphatase and tensin homologue deleted on chromosome 10．PTEN）在前列腺癌中的表达及临床意义。方法：用免疫组织化学EnVision^TM办法检测Skp2和PTEN蛋白在41例前列腺癌和20例BPH组织中的表达情况。结果：在前列腺癌中的Skp2蛋白染色阳性率显著高于BPH（P〈0．01）,Skp2蛋白表达与前列腺癌术前血清前列腺特异抗原（PSA）水平、局部浸润、肿瘤分期、病理分级呈密切正相关（P〈0．05）。在前列腺癌中的PTEN蛋白染色阳性率显著低于BPH（P〈0．01）,PTEN蛋白表达与上述临床病理特征呈负相关（P〈0．05）。前列腺癌中Skp2蛋白与PTEN蛋白表达呈负相关（P〈0．01）。结论：Skp2蛋白在前列腺癌的发生发展中起重要作用,抑癌基因PTEN可能参与Skp2表达的调节。