PKRP联合全雄激素阻断治疗伴膀胱颈梗阻的晚期前列腺癌（附50例报告）

目的观察经尿道双极等离子前列腺电切术（PKRP）联合全雄激素阻断（TAB）治疗伴膀胱颈梗阻（BOO）晚期前列腺癌的临床效果。方法研究对象为50例伴BOO的晚期前列腺癌患者,均应用Cyrus—PKS及电切镜行PKRP,记录手术时间、术中出血量等;同时联合抗雄激素受体＋去势TAB治疗。术前及术后3、6和12个月分别进行国际前列腺症状评分（IPSS）、生活质量评分（QOL）,采用尿流计检测最大尿流率（Qmax）,采用电化学发光法检测血清总前列腺特异抗原（tPSA）。结果手术均顺利,术中均未输血;与术前比较,术后3、6和12个月IP．SS、QOL及Qmax、tPSA均有显著差异,P均〈0．05。结论PKRP联合TAB治疗伴BOO的晚期前列腺癌,能迅速缓解下尿路梗阻症状、提高患者生活质量、降低血清tPSA水平,有望延长患者生存期。     

女性膀胱颈部梗阻14例诊治体会

1996-2005年，我们共收治14例女性膀胱颈梗阻患者，现将诊治体会报告如下。     

TUVP联合去势术及雄激素阻断治疗晚期前列腺癌疗效观察

应用经尿道前列腺汽化电切术（TUVP）联合去势术及雄激素阻断治疗合并膀胱出口梗阻的前列腺癌患者68例。结果68例患者手术成功,无并发症.术后随访3个月-3 a。国际前列腺症状评分（IPSS）由术前的（27.6±3.8）分下降到（9.4±2.1）分,P〈0.05;前列腺特异性抗原（PSA）术前为（67.2±5.3）μg/L,术后30min为（65.8±6.4）μg/L,术后2个月为（5.6±1.8）μg/L,两两比较,P均〈0.05。认为用TUVP联合去势术及术后雄激素阻断治疗合并膀胱出口梗阻前列腺癌的有效方法。     

甲磺酸多沙唑嗪缓释剂治疗膀胱出口梗阻术后膀胱痉挛的临床观察

目的 探讨甲磺酸多沙唑嗪缓释剂(可多华)对膀胱痉挛的防治作用,总结膀胱痉挛的治疗措施方法 256例患者分为两组.实验组:可多华4 mg临睡前服用,维生素K3 8 mg 3次/d;对照组:溴丙胺太林15 mg 2次/d,维生素K3 8 mg 3次/d.结果 实验组和对照组在治疗后的膀胱痉挛发生率不同,经卡方检验,差异有统计学意义(P<0.01).结论 可多华可降低膀胱三角区及后尿道的平滑肌张力,从而解除膀胱痉挛.     

TURP联合间断性雄激素阻断治疗晚期前列腺癌(附40例报告)

对40例晚期前列腺癌患者采用经尿道前列腺电切术（TURP）＋双侧睾丸切除术＋间断应用抗雄激素药物治疗。治疗后平均随访28个月。所有患者排尿通畅,无血尿,直肠指诊前列腺缩小,血清前列腺特异性抗原（PSA）明显下降,11例骨转移者骨痛减轻或消失,复查CT或X线显示转移灶缩小。带瘤生存〉3a者21例。死亡8例,其中3例死于心脑血管疾病,5例死于全身衰竭。认为TURP联合雄激素阻断（IAB）能显著缓解晚期前列腺癌患者的临床症状,改善其生活质量,延长寿命。     

康士得治疗晚期前列腺癌的临床观察

前列腺癌(PCa)的发生及发展依赖于雄激素的作用.切除睾丸可以去除体内大部分雄激素,但仍有肾上腺分泌的少量雄激素.     

膀胱颈梗阻56例误诊原因分析

原发性膀胱颈梗阻 (BOO)是近 10年来确定的一种原因不明的下尿路疾病 ,目前部分临床医师对其缺乏认识 ,常将其误诊为膀胱炎、前列腺炎、支原体性尿道炎等。近年来 ,我们收治 BOO患者 5 6例 ,在外院初诊时均误诊 ,现将误诊原因分析如下。资料与方法 :本组男 35例 ,年龄 2 4～ 88     

女性膀胱颈梗阻25例诊治体会

女性膀胱颈梗阻，多为慢性膀胱尿道炎所致的膀胱颈纤维挛缩引发的膀胱颈部不完全梗阻．病程迁延，症状不典型，临床少见。1980年～2002年，我院共收治25例。现将诊治体会总结如下。     

女性膀胱出口梗阻

女性膀胱出口梗阻（FBOO）是发生于膀胱颈部至尿道外口的任何部分尿道管腔狭窄所引起的排尿功能障碍件疾病,是由不同原因、不同发病机制所引起的膀胱出口梗阻综合征;在足够力量、速度、时间的逼尿肌收缩下只产生一个弱的尿流。FBOO可发生于任何年龄,年龄越大、发病率越高。     

尿动力学检查对前列腺增生症所致膀胱出口梗阻的诊断价值

目的探讨尿动力检查对前列腺增生症（BPH）所致膀胱出口梗阻（BOO）的诊断价值。方法对274例BPH患者行尿动力学检查,联合应用A-G图和LinPURR图诊断BOO并分等级。结果诊断为BOO225例（82．1％）,可疑BOO31例（11．3%）,无BOO18例（6．6%）;逼尿肌不稳定（DI）93例,逼尿肌低顺应性82例,逼尿肌活动低下（DUA）68例,逼尿肌—括约肌协同失调（DSD）19例。随着BOO程度加重,IPSS评分、残余尿、DI和DUA发生率呈升高趋势,而逼尿肌顺应性、最大尿流率（Qmax）呈下降趋势。结论尿动力学检查是诊断BOO的金标准,BPH患者可根据术前的尿动力学检查结果选择治疗方案。     

Gastric outlet obstruction in carcinoma gall bladder.

BACKGROUND: Gastric outlet obstruction is occasionally reported to occur in advanced gall bladder malignancy and may require palliative surgery. A review of 39 patients who required gastroenterostomy for symptomatic or incipient gastric outlet obstruction in carcinoma gall bladder is presented. METHODS: This retrospective review included 24 women and 15 men over nine years who underwent gastrojejunostomy for locally advanced neoplasms of the gall bladder. RESULTS: Twenty two patients with carcinoma gall bladder had symptomatic gastric outlet obstruction whereas in 17 patients gastrojejunostomy had been performed for intraoperatively assessed impending obstruction. Thirty-four patients had concomitant jaundice. In most cases, there was obstruction of the first two parts of the duodenum, mostly by direct tumoral infiltration (64%). All patients underwent anterior gastrojejunostomy, with billoenteric bypass in 15 patients. There were two postoperative deaths. Eight patients developed postoperative delayed gastric emptying; all settled on conservative management, though two patients had recurrent refractory vomiting. Thirty patients had no vomiting till a follow up ranging from 36 days to 11 months. CONCLUSIONS: Gastric outlet obstruction may frequently complicate gall bladder cancer and a satisfactory palliation can be achieved in most patients by gastrojejunostomy.     

前列腺增生患者逼尿肌中碱性成纤维细胞生长因子的变化

目的探讨前列腺增生症患者膀胱逼尿肌中碱性成纤维细胞生长因子(bFGF)的表达及其意义。方法前列腺增生患者54例,分为逼尿肌稳定组(33例)和逼尿肌不稳定组(21例)；对照组15例为同期在我院因膀胱癌施行开放手术的男性患者。分别应用逆转录聚合酶链反应(RT-PCR)和免疫组化的方法检测各组逼尿肌中bFGFmRNA和bFGF蛋白的表达。结果稳定组和不稳定组bFGFmRNA的表达水平分别为0．5814±0．2362、0．6098±0．1829,明显高于对照组的0．3469±0．2986,差异有统计学意义(P＜0．05和0．01)；bFGF亦高于对照组。稳定组和不稳定组间差异无统计学意义(P＞0．05)结论前列腺增生患者致膀胱出口梗阻后膀胱逼尿肌细胞中bFGF表达水平升高,但与膀胱逼尿肌不稳定的发生无直接关系。     

Endoscopic duodenal stent versus surgical gastrojejunostomy for gastric outlet obstruction in patients with advanced pancreatic cancer

Background

Malignant gastric outlet obstruction (GOO) often develops in patients with advanced pancreatic cancer (APC). It is not clear whether endoscopic duodenal stenting (DS) or surgical gastrojejunostomy (GJJ) is preferable as palliative treatment.

Role of angiogenesis in bladder response to partial outlet obstruction

Benign prostatic hyperplasia (BPH) is a disease that has its etiology in the abnormal growth of the adult human prostate gland that accompanies the aging process in men. The symptomatic presentation of this disease, however, is related largely to degenerative changes in the bladder that occur as a result of the increasing urethral resistance and partial bladder outlet obstruction (PBOO) caused by the growing prostate gland. BPH is characterized by bladder hypertrophy, significant decreases in urinary flow and compliance, presence of residual urine after voiding, voiding urgency and incontinence (). Obstructed bladder dysfunction secondary to BPH is a slow, progressive disease that is so strongly associated with human aging that it is an expected occurrence of the male aging process. Although the symptoms of BPH are usually not life threatening, they effect an extremely negative quality of life for men who suffer from them. However, many men delay seeking medical treatment for early BPH since bladder function can remain relatively normal as the hypertrophying bladder initially compensates for the progressive increase in urethral resistance caused by prostatic obstruction. The limited changes in micturition pressure and flow characteristics that occur during compensated function are not usually disabling enough to motivate seeking medical attention, which, often, is not sought until the symptoms become typical of advanced disease. Recent advances in detection methods enable identification of patients with significant BPH during compensation before the bladder becomes dysfunctional (decompensated). A more complete understanding of the disease processes that underlie the loss of bladder function associated with BPH might enable the development of treatments that better protect these early-stage BPH patients from the more debilitating aspects of the disease. This review updates the understanding of obstructive bladder dysfunction via the use of animal models.     

结肠癌并急性肠梗阻49例诊治体会

目的 探讨结肠癌并急性肠梗阻的外科处理方法.方法 总结分析49例结肠癌并发急性肠梗阻的治疗及预后.结果　Ⅰ期切除吻合38例,Ⅰ期切除近端造口6例,单结肠造口术 5 例.并发症切口感染5例,术后吻合口瘘3例,死亡2例.结论 重视围手术期处理,根据患者的具体情况选择手术方式十分重要.在条件允许的情况下,Ⅰ期切除吻合仍是安全可行的.     

胰腺癌合并胃出口及胆管梗阻的内镜治疗及疗效

目的探讨胰腺癌伴胃出13及胆管梗阻的内镜治疗策略及疗效。方法回顾性分析2010年1月至2013年12月沈阳军区总医院收治的106例晚期胰腺癌伴胃出口及胆管梗阻患者的一般临床资料、内镜治疗方法、术后并发症及疗效。结果106例患者中男性57例,女性49例,平均年龄（63±6）岁。共行134次内镜治疗,平均1．3次／人。共放置肠道支架112枚,胆管支架89枚,胰管支架55枚,其中肠道支架均为一次性放置成功。胆管、胰管及肠道3种支架同时放置者55例（51．9％）,胆管、肠道双支架同时放置23例（21．7％）,28例（26．4％）因内镜无法通过狭窄段而先放置肠道支架,再经肠道支架完成胆管支架置入。83例（78．3％）患者于支架置人术后9—14d恢复正常饮食。术后并发黑便9例,高淀粉酶血症6例,呕血1例,均经对症治疗后治愈;1例术后第3天支架经肛门排出。83例获得24周随访,死亡49例（59．0％）,平均生存期（128±33）d。随访期发生肠道支架堵塞6例,4例放置第2枚肠道支架,2例取出肠道支架后重新放置。结论多支架治疗胰腺癌伴胃出口及胆管梗阻是安全的,并发症发生率低,近期疗效确切,并能明显改善患者的生活质量。     

兔不全梗阻性膀胱一氧化氮合酶神经和内皮素-1含量的改变及意义

目的　研究一氧化氮合酶 (NOS)神经、内皮素 (ET) - 1在兔不全梗阻性膀胱中的改变和意义。方法　运用 NADPH组织化学及放射免疫分析技术对 1 0只成年雄性新西兰白兔不全梗阻性膀胱及 1 0只同龄雄性新西兰白兔无梗阻性膀胱的兔血浆、尿液及膀胱平滑肌组织中 ET- 1和膀胱平滑肌中 NOS神经进行研究。结果　实验组兔膀胱体、膀胱颈部粘膜及膀胱体平滑肌 NOS神经均明显减少 (膀胱体粘膜为 P<0 .0 5,膀胱颈粘膜为 P<0 .0 1 ,膀胱体平滑肌为 P<0 .0 5) ;实验组较对照组血浆与尿液中 ET- 1含量均明显增高 (血浆 3 w组与血浆 6 w组均为 P<0 .0 5;尿液 3 w组与 6 w组均为 P<0 .0 0 1 ) ;实验组较对照组膀胱体部平滑肌组织 ET- 1含量明显升高 (P<0 .0 5)。结论　 NOS神经的减少和 ET- 1的上调对兔不全梗阻性膀胱的功能和结构变化具有一定作用 ,为梗阻性膀胱的病理生理变化提供了一个较为合理的解释。血浆、尿液中 ET- 1在兔不全梗阻性膀胱中的含量上调 ,并可作为膀胱出口梗阻诊断的重要参数。