前列腺小细胞神经内分泌癌诊治特点分析

Objective To review the clinical features of small cell neuroendocrine carcinoma of the prostate (SCPCa). Methods The ages of 4 cases were 25-77 years. Four cases had progressive dysuria with 2 cases had chronic urinary retention and 2 had upper urinary tract hydronephrosis. On admission, all cases were palpated a hard prostate mass in digital rectal examination. Serum tPSA were 0. 57-6.36 ng/ml with a ratio f/t PSA 0. 26-0.63. B ultrasound, CT and MRI detected 3.9 cm×3. 9 cm×1.6 cm-11.3 cm×7. 9 cm×9. 5 cm irregular shape mass in prostate. 2 cases had seminal vesicle involved, 2 cases had rectum involved, 2 had unilateral ureter involved, and 1 case had sacrum involved. Pelvic lymphonodes metastasis were seen in 3 cases. Bone scan detected multiple bone metastasis in 3 patients. Results The final diagnoses were accomplished by prostate biopsy. Under light microscope, tumor cells were orbivular-ovate or fusiform shape, small volume, and had little cytoplasm. The margin of tumor cells was not clear. Caryokinesis phase could be found with hyperchromatic chromatin. Immunohistochemistry showed positive ChA staining in 4 eases, positive NSE expression in 2 patients and negative PSA in 4 cases. 3 cases were given cisplatin-based chemotherapy, pelvic radiation, or chemotherapy plus radiotherapy. All patients appeared widespread metastasis quickly and died or lost visit within one year. Conclusions SCPCa is a rare, poor prognosis malignancy with early extensive metastasis. The diagnosis is based on pathology.     

浸润性和转移性膀胱癌的诊断和评价

一、膀胱癌的分级与分期 1.膀胱癌的组织学类型:尿路被覆的上皮统称为尿路上皮(urothelium).传统上将尿路上皮称为移行上皮(transitional epithelium).目前在文献和习惯上这两个名词常常被交替使用.膀胱癌的组织学类型包括尿路上皮癌、鳞状细胞癌和腺癌,其次还有较少见的转移性癌、小细胞癌和癌肉瘤等.     

《膀胱癌诊断治疗指南》解读——膀胱癌的治疗

本篇《膀胱癌诊断治疗指南》（以下简称“指南”）中,治疗部分分为非肌层浸润性膀胱癌的治疗、肌层浸润性膀胱癌的治疗、尿流改道术以及膀胱癌的化疗与放疗4个部分,对膀胱癌的治疗原则与方法做了全面的论述,以下分别就指南中有关膀胱癌治疗的各部分做一介绍。     

平均直径7cm肾癌腹膜后镜与开放根治性肾切除术5年经验比较

目的:判断腹膜后镜根治性肾切除术对于平均直径7cm肾癌的临床治疗价值。方法:回顾性分析36例2002年1月~2006年7月行腹膜后镜根治性肾切除术患者的资料,并与同期46例行开放根治性肾切除术患者的临床资料进行比较。腹膜后镜组肿瘤直径为4~9(7.4±1.5)cm,开放组为4~10(7.6±1.2)cm(P>0.01)。所有患者术后病理均证实为肾细胞癌。结果:腹膜后镜治疗组与开放治疗组的手术时间分别为80~220(172±35)min,60~190(165±40)min(P>0.01);术中出血量两组分别为40~300(210±30)ml,50~450(410±100)ml(P<0.01);术后进普食天数两组分别为3~8(3.9±1.0)天,5~11(7.4±2.0)天(P<0.01);术后平均住院日两组分别为5~8(7.0±1.3)天,7~13(8.5±1.8)天(P<0.01)。所有患者平均随访27(9~50)个月,随访期间均未出现手术切口种植转移。结论:腹膜后镜根治性肾切除术具有创伤小,出血少,术后恢复快的优点,随访中发现两种治疗方式对于患者短期的生存率没有影响。对于直径4~10cm肾肿瘤,腹膜后镜根治性肾切除术可以取代开放根治性肾切除术。     

超声引导侧方穿刺和头端穿刺在经皮肾镜碎石术中应用的比较

目的比较在经皮肾镜碎石术中超声引导侧方穿刺和头端穿刺的技术特点。 方法回顾性分析2017年4月至2019年7月北京大学首钢医院就诊的肾中组后盏无积水完全或部分鹿角型肾结石行经皮肾镜手术治疗的30例患者的临床资料，采用侧方穿刺和头端穿刺技术穿刺肾中组后盏的患者各15例。采用t检验比较2组患者在寻找穿刺盏拟定穿刺路径时间、穿刺成功时间、穿刺成功所需次数的差异，并观察2组患者有无严重并发症发生。 结果在寻找穿刺盏拟定穿刺路径的时间方面，侧方穿刺组所需的时间比头端穿刺组短［（37.82±8.94）s vs（51.83±13.16）s］；而在穿刺成功的时间方面，侧方穿刺组所需的时间比头端穿刺组长［（51.36±24.10）s vs（29.20±12.35）s］，差异均具有统计学意义（t=2.712、4.122，P=0.019、0.001）。在穿刺成功所需次数方面，侧方穿刺组和头端穿刺组分别为（2.13±0.74）次和（1.73±0.70）次，差异无统计学意义（t=1.382，P=0.189）。2组患者均未出现重要脏器损伤和术后大出血。 结论在经皮肾镜超声定位穿刺操作中，侧方穿刺和头端穿刺技术各有优缺点；无论掌握哪一种穿刺技术，都可以做到精准穿刺。     

比卡鲁胺150 mg单药与单独药物去势治疗局部晚期前列腺癌的随机对照研究

论 比卡鲁胺150 mg单药治疗局部晚期前列腺癌的安全性和耐受性良好,患者PSA下降程度和前列腺体积缩小程度与单独药物去势治疗相似,是一种新的治疗局部晚期、无远处转移前列腺癌安全、有效的方法.     

高级别T1期膀胱尿路上皮癌保留膀胱术后转归分析

背景与目的:对于经膀胱内治疗失败的高级别T1膀胱尿路上皮癌应积极采取膀胱全切术,但是部分患者由于某种原因接受了膀胱保留术式,其转归历程如何,到目前为止尚缺乏系统报道。本研究旨在分析高级别T1膀胱尿路上皮癌保留膀胱术后转归特点。方法:收集2005年1月—2006年2月首次在北京大学首钢医院行经尿道膀胱肿瘤切除或膀胱部分切除术的7例T1膀胱尿路上皮癌患者,术后膀胱肿瘤复发但未行膀胱全切术直至死亡全过程的临床资料。7例均采用入院诊治的方法随访。结果:7例T1膀胱癌患者均具有多发、高级别等高危因素,未行膀胱全切术原因分别是3例患者年龄过高(81、83和86岁)及4例严重心脏病。患者存活6～65个月(中位44.5个月),发生严重血尿7例、骨转移6例、肺转移5例、肝转移5例、肾上腺转移3例、胸壁转移1例,均死于膀胱癌相关事件。结论:高级别T1膀胱尿路上皮癌保留膀胱术后存活时间较短;易发生多处、远处转移,以骨、肺、肝最常见;血尿严重,无持续有效的治疗方法。     

西施泰与吡柔比星联合灌注减少膀胱灌注化疗所致膀胱并发症的多中心临床研究

目的 验证西施泰膀胱灌注减少非肌层浸润性膀胱癌TURBt术后灌注化疗并发症的疗效和安全性.方法 对120例符合入选/排除标准患者进行多中心、随机、空白对照的疗效和安全性临床研究.患者均先行TURBt,之后观察组联合灌注吡柔比星和西施泰,对照组仅灌注吡柔比星.以膀胱疼痛直观模拟分级(VAS)评分为主要疗效指标,以血尿、膀胱刺激症状为次要疗效指标,严密观察不良事件、实验室检查、治疗前后生命体征的变化,评价其疗效和安全性. 结果 2组患者人口学特征与基线资料相似,具有可比性.观察组治疗前后VAS评分差值和改善率分别为2.24±1.70与(92.92±14.76)%,对照组分别为0.70±1.82与(20.59±87.34)%,2组比较差异均有统计学意义(P＜0.01);2组VAS总分变化值差异也有统计学意义,并且2组VAS评分灌注前后改善率的比较从访视2开始差异就有统计学意义.观察组尿频次数从治疗前的(9.06±4.09)次减少至(6.69±2.89)次,对照组从(8.85±3.32)次增加至(10.15±4.40)次,组间比较差异有统计学意义(P＜0.01).观察组夜尿次数从治疗前的(2.88±1.74)次减少至(1.47±1.62)次,对照组从(3.22±2.30)次减少至(2.91±1.73)次,差异亦有统计学意义(P＜0.01).2组治疗前后尿急、排尿困难及血尿方面的改善不明显,未发现与西施泰有关的不良事件. 结论西施泰与化疗药物联合灌注能明显改善膀胱灌注化疗患者VAS评分状况,迅速、持续缓解患者的膀胱疼痛,并改善患者尿频与夜尿症状,提高患者生活质量.VAS评分高的患者改善效果更明显.西施泰与化疗药联合灌注安全性与临床耐受性良好.

Abstract：

Objective To verify the efficacy and safety of intravesical instillation of Cystistat in reducing complications caused by intravesical chemotherapy after TUR-BT in non-muscle invasive bladder cancer patients. Methods One hundred and twenty patients who met the inclusion/exclusion criteria were enrolled into this multi-centered, randomized and blank controlled clinical study. Selected patients were randomized into the observation group and control group. TUR-BT was carried out in both groups followed by pirarubicin (THP) and Cystistat intravesical instillation in the observation group, and THP intravesical instillation alone in control group. Visual analog scale (VAS) was used as the primary efficacy variable. The secondary efficacy variables were assessments of hematuria and bladder irritation symptoms. Adverse events, laboratory tests and changes of vital signs before and after treatment were strictly observed during observation to evaluate the efficacy and safety of Cystistat.Results Demographics and baseline characteristics were comparable in both groups. The differences and the improvement rate of VAS score in the 2 groups were significant, both P＜0.01. The changes of VAS score and the improvement rate before and after treatment were (2. 24±1.70) and (92. 92±14.76) % in observation group and (0. 70±1.82) and (20. 59±87.34)% in control group respectively. According to the covariance analysis, there were significant differences in changes of VAS score between the observation group and the control group. Also, the improvement rate of VAS score was significant from visit 2. The urine frequency decreased from 9.06±4.09 to 6. 69±2.89 in observation group and increased from 8. 85±3. 32 to 10. 15±4.40 in control group, P＜0.01. There were also significant differences in changes of nocturia before and after treatment between these two groups (P＜0.01), the nocturia decreased from 2. 88±1.74 to 1. 47±1.62 in observation group and 3. 22±2.30 to 2.91±1.73 in control group, respectively. The changes of WHO assessment for hematuria,urgency and dysuria were not significantly different between the 2 groups. No Cystistat related adverse event was observed. Conclusions Cystistat combined instillation can significantly improve the VAS score of patients with chemotherapeutic agent instillation. Relief of bladder pain, frequency and nocturia are more rapidly and more durable in Cystistat combined instillation group. The improvement is more effective in patients with a high VAS score. Cystistat instillation with chemotherapeutics agents is both well tolerated and safe.     

DC肿瘤疫苗在泌尿系统肿瘤中的应用

树突状细胞（dendritic cells,DC）是体内最活跃、功能最强大的专职抗原递呈细胞,在天然免疫和获得性免疫中均发挥着极其重要的作用。DC最大的特点是能够刺激初始型T细胞增殖,因此,DC是机体免疫反应的始动者,在诱导特异性抗肿瘤细胞免疫中起关键作用。近年来DC细胞介导的抗肿瘤细胞免疫引起了广泛的关注。