原发性附睾腺癌一例报告

患者　 5 7岁。因右睾丸肿胀、坠痛40ｄ于 2 0 0 0年 4月 5日入院。曾以附睾炎处理 ,无效 ,肿块渐增大 ,且疼痛加剧。查体 :右附睾肿大 ,尾部可及一肿块约2ｃｍ× 2ｃｍ× 1ｃｍ ,质硬 ,触痛明显 ,结节感 ,与阴囊皮肤无粘连。右侧精索增粗。双腹股沟区未扪及明显肿大淋巴结。直肠指检 :前列腺Ⅱ度增生 ,质中等 ,中央沟变浅 ,两侧叶未扪及结节。Ｂ超检查 :右侧睾丸后下方及上极见低回声区 ,肿瘤待排。诊断 :右侧附睾占位病变 ,肿瘤待排除。给予抗感染治疗 1周 ,症状体征未改善。血清甲胎蛋白 (ＡＦＰ)和绒毛膜促性腺激素 (β ＨＣＧ)正常 ,血…     

盐酸奥昔布宁缓释片临床疗效观察

目的:评价盐酸奥昔布宁缓释片与奥昔布宁片对尿频、尿急和急迫性尿失禁病人的有效性和安全性。方法:120例尿频、尿急和急迫性尿失禁病人,(男性42例,女性78例,年龄41.90±12.51岁),随机分成试验组60例予盐酸奥昔布宁缓释片10mg,po.qd,42d,对照组60例予奥昔布宁片5mg,po,bid,42d。试验采用随机、双盲、双模拟、阳性药物平行对照方法。结果:以用药前后24 h平均排尿次数、平均每次排尿量和尿失禁次数的变化评估,各组治疗前后疗效差异有显著性(P<0.05),两组间比较疗效差异无显著性(P>0.1)。不良反应轻。结论:盐酸奥昔布宁缓释片是治疗尿频、尿急和急迫性尿失禁的有效和安全的药物。     

比卡鲁胺治疗激素抵抗性前列腺癌

目的观察比卡鲁胺(bicalutamide,康士得,casodex)治疗激素抵抗性前列腺癌(HRPC)的疗效。方法经睾丸切除加氟他胺或福至尔治疗后前列腺特异性抗原(PSA)再次升高,病变进展的前列腺癌患者28例,年龄52～82岁。Gleason评分2～4分4例,5～6分7例,7～10分17例。临床分期C期6例、D期22例。比卡鲁胺治疗,50mg或150mg每日1次口服,疗程3～25个月,观察治疗前后血清PSA及临床症状的变化。结果比卡鲁胺治疗后,18例患者PSA由治疗前(92.6±34.5)ng/ml降至(32.6±11.4)ng/ml,持续4～22个月,平均8.5个月。其中10例患者PSA(27.2±6.0)ng/ml,下降>50%,临床症状改善8例,前列腺结节较前缩小7例,骨转移有好转5例。结论比卡鲁胺作为二线激素治疗药物对于激素抵抗性前列腺癌有一定疗效。     

肾移植术后存活5年以上死因分析

我院1987年12月至1996年1月共施行同种肾移植术306例，有21例存活5年以上的的患者死亡。我们对其死因作了回顾性分析，报告如下。     

苗勒管永存综合征（2例报告并文献复习）

目的：探讨苗勒管永存综合征（PMDS）的病因、临床表现、诊断和治疗。方法：报告2例PMDS。1例伴睾丸横过异位；另1例伴隐睾。伴隐睾者予隐睾切除，两者均接受子宫体大部切除和睾丸固定术。结果：随访1.5-2年，2例患者睾丸质地、血流均正常。结论：PMDS为一种男性假两性畸形，治疗应力求保护睾丸的血供和生殖功能，并密切随访。     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

低龄儿童 DCD 单侧供肾用于成人肾移植的单中心经验

目的：分析低龄儿童单侧供肾在成人肾移植中的临床效果。方法：回顾性分析南京医科大学第一附属医院2013年11月—2016年9月期间6例低龄儿童公民逝世后器官捐献（donation after citizen’s deceased,DCD）单侧供肾肾移植的临床资料。结果：6例成人受体接受了来自5例低龄儿童DCD单侧供肾。供体中位月龄50个月（20~60个月）,中位体重15.5 kg（12.0~17.0 kg）。受体中位年龄25岁（18~31岁）,中位体重43.5 kg（34.0~55.0 kg）,中位体重指数（body mass index,BMI）18.3 kg/m2（14.7~22.0 kg/m2）。随访期间,术后受体的血肌酐水平逐渐下降,估算的肾小球滤过率（estimated glomerular filtration rate,eGFR）水平稳步升高,术后半年至3年内肾功能稳定在正常范围。移植肾长径在术后2周内迅速增长（P=0.042）,术后1年内进一步生长。移植肾及人6 个月及1年存活率均为100%。结论：低龄儿童单侧供肾用于成人肾移植是可行、有效的,这将为扩大供肾来源带来希望。     

泌尿系统吻合性血管瘤临床特点及诊治分析

【摘要】目的探讨泌尿系统吻合性血管瘤（AH）的临床特点及诊治经验。方法回顾性分析2015年6月至2021年11月南京医科大学第一附属医院收治的泌尿系统AH患者的一般情况、影像学检查、治疗经过、病理及随访结果等临床资料。结果共收集10例AH患者临床资料。6例为体检发现,3例因腰痛、1例因肉眼血尿就诊;输尿管AH患者有2年前行输尿管镜碎石手术史;术前CT检查见肿瘤位于左侧5例,右侧5例（左肾上腺区2例,右肾上腺区2例,左肾门旁1例,左肾盂内1例,右肾下极2例,左腹膜后1例,右输尿管1例）;肿瘤直径10～43 cm;肿瘤呈类圆形6例,形态不规则4例;CT平扫呈低密度6例,混杂密度4例;所有患者顺利完成手术治疗,开放手术1例,腹腔镜手术9例,其中机器人辅助手术3例;术后病理证实为肾脏AH4例,肾上腺AH4例,输尿管AH1例,腹膜后AH1例;术后病理与影像诊断一致率50%（5/10）,为肾肿瘤2例,肾上腺肿瘤2例,腹膜后肿瘤1例;随访11～79个月,未见肿瘤转移及复发。结论泌尿系AH是一种罕见的良性血管瘤,术前确诊困难,腹腔镜及机器人辅助腹腔镜手术切除泌尿系统AH安全有效。AH患者应予个体化诊治,注意避免过度治疗。     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.