前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

膀胱癌阴茎转移致异常勃起一例报告

阴茎转移性肿瘤致阴茎异常勃起罕见,我院收治1例,现报告如下. 患者,61岁.因"膀胱癌术后18个月,阴茎异常勃起25 d",于2006年6月21日入院.     

一侧肾透明细胞癌并发乳头状肾细胞癌1例

患者,男,74岁.无痛性肉眼血尿半年,超声检查示左肾占位入院.B超示左肾中上方见一圆形无回声区,大小约58 mm×57 mm×76 mm,形态欠规则,略呈分叶状,边界清,见包膜回声.超声造影检查:上方无回声区未见增强.KUB IVP示左肾未显影,内见钙化灶.CT示左肾中上极占位,直径约75 mm,肿瘤经造影后增强,肾周未见肿瘤侵犯,未见肿大淋巴结.     

慢性精囊炎的介入治疗

目的 :探讨超声引导下经会阴精囊穿刺置管滴注抗生素在治疗慢性精囊炎中的价值。　方法 :4 2例血精症病人 ,均行直肠超声检查 ,其中 2例行超声引导下经会阴穿刺活检 ,5例行尿道镜检查 ,余 35例炎症性血精症采用超声引导下经会阴精囊穿刺滴注抗生素治疗。　结果 :35例炎症性血精症 (其中 17例合并前列腺炎 ) ,采用超声引导下经会阴精囊穿刺滴注抗生素治疗后 32例血精消失 (91.4 3% )。　结论 :超声引导下经会阴精囊穿刺和经导管滴注抗生素是一种诊断和治疗慢性精囊炎有效的方法。     

组织工程口腔黏膜尿道成形的临床应用

英国谢菲尔德的研究小组报道应用组织工程技术口腔黏膜治疗5例尿道狭窄患者.5例患者均为硬化性萎缩性苔藓所致尿道狭窄,其中3例为长段前尿道狭窄,2例为阴茎部及球部尿道狭窄.3例患者曾经历过1次失败的尿道成形术,2例曾多次行尿道内切开术.     

应用组织工程口腔黏膜重建尿道的初步实验研究

目的 探讨兔口腔黏膜细胞的体外培养方法,并以其为种子细胞与异体膀胱黏膜下脱细胞基质(bladder acellular matrix graft,BAMG)复合,构建组织工程尿道. 方法 18只10周龄雄性新西兰大耳白兔,体重0.3～0.5 kg.取其中12只兔口腔黏膜组织,分离获得口腔黏膜细胞.将口腔黏膜细胞分别接种于有3T3细胞及无3T3细胞的培养皿进行培养,接种后第2天于倒置相差显微镜下观察细胞形态变化,绘制细胞生长曲线,观察生长增殖情况,并行免疫荧光组织化学染色鉴定.取余6只兔膀胱,经脱细胞处理制备BAMG,随机取1 cm×1 cm组织行HE染色,观察脱细胞效果.将接种于有3T3细胞培养皿培养获得的第2代口腔黏膜细胞种植于BAMG上,培养1周后,行HE染色及扫描电镜观察口腔黏膜细胞与BAMG的复合状况. 结果 倒置相差显微镜下观察,接种于有3T3细胞培养皿的口腔黏膜细胞可传至7～8代,其细胞形态均一,功能良好;无3T3细胞培养皿的口腔黏膜细胞形态多样,传至第2代时,即开始出现老化.细胞生长曲线显示,两种方法培养的口腔黏膜细胞均于第8天开始呈对数增长,第14天达峰值.接种于有3T3细胞培养皿的口腔黏膜细胞,培养至融合时所获得细胞数量明显多于接种于无3T3细胞培养皿的u腔黏膜细胞.两种方法培养的口腔黏膜细胞行免疫荧光染色,均呈绿色荧光.HE染色观察,BAMG经脱细胞处理后未见细胞,脱细胞效果良好.复合培养1周后,HE染色及扫描电镜观察口腔黏膜细胞与BAMG复合良好. 结论 兔口腔黏膜细胞可在体外成功培养、扩增,与同种异体BAMG复合后生长良好,为构建组织工程尿道提供了一种新的选择.     

吡柔比星(THP)膀胱灌注预防腺性膀胱炎术后复发的疗效观察

目的 评价吡柔比星(THP)膀胱灌注预防腺性膀胱炎术后复发的疗效。方法 对30例腺性膀胱炎患者行经尿道汽化电切术,术后定期应用THP(40mg/50ml)膀胱内灌注化疗。结果 30例患者随访5～20个月,平均14.5个月,3例复发(10％)。未见有全身性药物不良反应,仅2例血白细胞降至3000个/ml。结论THP膀胱灌注预防腺性膀胱炎术后复发疗效满意,病人耐受性好,副作用小。     

前列腺切除术后膀胱颈部挛缩的诊断与治疗

膀胱颈部挛缩(bladder neck contracture,BNC)是前列腺良恶性病变术后一种常见的并发症,诸多因素导致了BNC的发生发展,治疗手段可根据患者的病情严重程度从简单的尿道扩张到复杂的经腹部-会阴联合径路重建手术,现将国内外对BNC治疗的现状及最新进展情况进行综述。     

建立前列腺特异性抗原灰区患者重复穿刺阳性的数学模型

目的:建立预测前列腺特异性抗原(PSA)灰区患者重复穿刺阳性的数学模型。方法:选择2004~2016年158例血清PSA位于4~10ng/ml且首次穿刺病理结果为阴性的患者行重复穿刺,记录并分析患者的年龄、前列腺体积(PV)、PSA、游离PSA(fPSA)/总PSA(tPSA)、前列腺特异性抗原速率(PSAV)、前列腺特异抗原密度(PSAD)、前列腺移行带特异性抗原密度(PSAD-TZ)、超声检查(TRUS)、直肠指检(DRE)、高级别上皮内瘤变(HGPIN)、不典型小腺泡增生(ASAP)等重复活检结果的潜在预测指标。将有统计学意义的变量行二分类Logistic回归分析和建立数学模型,该模型的预测价值通过ROC曲线下面积(AUC)来评估。结果:158例前列腺重复穿刺活检患者中,前列腺癌的检出率为25.9%(41/158),单变量分析结果中统计学上有意义的指标包括Age、PV、f/tPSA、PSAD、PSAD-TZ、DRE、TRUS、Previous HGPIN、Previous ASAP(P<0.05),对以上所有变量进行二分类Logistic回归分析并建立数学模型,预测指标ASAP、HGPIN、f/tPSA、TRUS、DRE被纳入该模型。该模型AUC为89.8%,预测价值较高。结论:该数学模型可以很好的预测PSA患者重复穿刺阳性的概率,能够帮助临床医师判断哪些PSA灰区患者更适合行超声引导下前列腺重复穿刺活检术。