延胡索酸水合酶缺陷型肾细胞癌伴瘤栓的诊治经验和预后分析

目的探讨延胡索酸水合酶缺陷型肾细胞癌(FH-deficient RCC)伴瘤栓的诊治经验和预后。方法回顾性分析2019年8月至2022年10月北京大学第三医院收治的6例FH-deficient RCC伴瘤栓患者的病例资料, 男4例, 女2例。年龄22～57岁, 其中<40岁2例。肿瘤位于左侧5例, 右侧1例。肿瘤最大径8(4.8, 14.0)cm。完善增强CT等相关检查后行手术治疗。本组6例中, 1例行开放手术, 术中发现下腔静脉粘连重, 仅姑息切除左肾;余5例中, 1例行后腹腔镜根治性右肾切除术+瘤栓切除术, 1例行经腹腔途径腹腔镜根治性左肾切除术+瘤栓切除术, 3例行机器人辅助腹腔镜根治性左肾切除术+瘤栓切除术。结果手术时间293(185, 366)min。2例术中需要阻断腔静脉, 阻断时间分别为13 min和28 min。肾肿瘤和瘤栓病理诊断为FH-deficient RCC。病理检查:大体标本切面为灰白、灰黄色, 实性, 常伴坏死, 局灶可见囊腔;镜下观察见肿瘤广泛累及肾实质, 肿瘤呈乳头状、筛状和管囊状结构。免疫组化染色检查FH(-), 2SC(+)。术后住院时间8(4...     

胰液膀胱引流式胰肾联合移植长期存活15例随访

背景:胰肾联合移植是治疗1型糖尿病合并终末期肾病的首选疗法,但由于移植风险高,并发症多,国内开展并不广泛.目的:总结胰液膀胱引流式胰肾联合移植长期存活的临床经验,观察其远期效果并分析影响因素.方法:对15例患者行胰液膀胱引流式胰肾联合移植,均采用心脏死亡的供体.HLA配型平均为2.13.均选择胰液膀胱引流式和体循环回流血管吻合方式,免疫抑制剂方案均用他克莫司,霉酚酸酯和泼尼松治疗.观察移植后患者移植物肾功能、血糖、淀粉酶等及并发症.结果与结论:最短随访8.5个月,最长随访105.5个月,平均住院时间为37.7 (13～82) d.移植后13例患者胰腺功能恢复,2例于移植后即切除移植胰腺.移植后除1例患者肾脏功能延迟恢复外,其余患者肾脏功能立即恢复.2例患者因慢性排斥反应丢失移植胰腺和移植肾.移植后主要并发症为排斥反应,返流性胰腺炎和血栓形成.提示胰肾联合移植是治疗终末期糖尿病并发肾功能衰竭的一种安全而有效地治疗方法,其远期效果理想,完善的围移植期管理、预防和及时处理并发症、合理应用免疫抑制剂是影响患者和移植物长期存活的重要因素.     

Expression and significance of estrogen receptor α and β in prostate cancer and peri-cancer tissue

Objective To investigate the expression of estrogen receptor (ER) α and β in human prostate cancer (PC), peri-cancer tissue and benign prostatic hyperplasia (BPH) tissue, and to discuss the role of estrogen receptor in prostate cancer. Methods The expression of ERα and ERβ in PC (n=28), peri-cancer tissue (n=28) and BPH (n=29) were detected by immunohistochemistry with En vision method. The ERα and ERβ expression were compared among different tissues by chisquare. The relationship between ER expression and related clinicopathologic features was statistically analyzed by spearman rank collection. Results ERα was localized dominantly in the stromal cell of PC. There were significant differences of the expression of ERα in PC, peri-cancer tissue and BPH tissue (epithelial cell 0%, 14%, 24%, P＜0. 05; stromal cell 57%, 68%, 31%,P＜0. 05). ERβ was localized in both epithelial and stromal cell of PC. There were significant differences of the expression of ERβ in PC, peri-cancer tissue and BPH tissue (epithelial cell 39%, 64%, 29%, P＜0.01; stromal cell 50%, 75%, 79%, P＜0.05). There was a significant difference of the expression of ERβ in different Gleason scores of PC tissue. Conclusions ERα is localized in the stromal cell of PC tissue.ERβ is localized in both epithelial and stromal cell of PC tissue. The ERβ might be related to the tumor differentiation of PC.     

腹腔镜肾部分切除术中值得关注的几个问题

随着影像学检查的普及,许多无临床症状的小体积肾癌被早期发现.保留肾单位手术因具有与根治手术相近的远期疗效且可最大限度保留患者肾功能,成为治疗早期特别是T1a期肾癌的常规术式~([1]).近年,腹腔镜肾部分切除术(laproscopic partial nephrectomy,LPN)的疗效及并发症发生率已接近开放手术.随着国内LPN开展的增多,以下临床常遇问题值得关注.     

弱精子症大鼠模型的建立及左旋肉碱对其改善作用的相关研究

目的 研究弱精子症大鼠模型的建立及左旋肉碱(L-肉碱)与精子质量的关系.方法 24只雄性SD大鼠随机均分成3组,分别连续灌胃20d,A组(对照组):0.5%羟甲基纤维素钠(溶剂);B组:400mg/kg奥硝唑悬液:C组:400mg/kg奥硝唑悬液+100mg/kg左旋肉碱.末次给药24h后,麻醉处死所有大鼠,分别检测各组精子密度、活力、形态正常率以及附睾总L-肉碱和游离L-肉碱浓度.结果 A组、B组及C组的精子密度差异无统计学意义(P＞0.05);A组、C组精子活力、精子形态正常率及附睾总L-肉碱、游离L-肉碱浓度均明显高于B组(P＜0.05),A组与C组精子活力、精子形态正常率及附睾总L-肉碱、游离L-肉碱浓度比较,差异均无统计学意义.精子活力与附睾总L-肉碱、游离L-广肉碱浓度呈正相关(r=0.645,P＜0.05:r=0.676,P＜0.05),精子形态与附睾总L-肉碱、游离L-肉碱浓度呈正相关(r=0.557,P＜0.05;r=0.583,P＜0.05),均相关性其具有统计学意义.结论 奥硝唑可以降低大鼠精子活力、精子形态正常率,以及附睾L-肉碱水平,附睾L-肉碱浓度与精子活力、精子形态正常率呈正相关,L-肉碱对精子质量有改善作用.     

我国现阶段人群中自慰行为的状况及相关分析

目的 了解我国现阶段人群中自慰行为的发生率及对其认识的状况,为性健康教育提供理论支持.方法 基于人们对自慰话题的隐讳性,本次研究利用网络对网络用户就主题为"你‘会'自慰吗?"的问卷展开调查,内容包括年龄、性别、是否有过自慰、自慰的原因、自慰后是否有心理负担、自慰对健康有无影响以及怎样才算自慰过度七个大项的调查.结果 共有7077人参与这次调查,其中(1)中青年人群是本次调查的主体,86.31%的为35岁以下的中青年人:(2)男性参与者比率为75.74%,女性为24.26%;(3)96.38%的调查者有过一次以上的自慰,其中75.96%的人每月有一次以上的自慰;(4)大多数人自慰是因为"没有固定性伴侣,需要释放性冲动"和"希望从中获得性高潮",分别为33.33%和33.25%;(5)22.99%的人认为自慰有害健康;(6)9.28%的人认为"有了性生活还自慰,就是过度";(7)仅有29.96%的人自慰从来没有过心理负担,12.69%则经常受精神负担的困扰.结论 尽管越来越多的人的能够正确看待自慰,但还有许多人尚缺乏正确的认识,要进一步加强性健康知识教育,帮助人们树立正确的性生殖健康观念.     

Expression and significance of estrogen receptor α and β in prostate cancer and peri-cancer tissue

Objective To investigate the expression of estrogen receptor (ER) α and β in human prostate cancer (PC), peri-cancer tissue and benign prostatic hyperplasia (BPH) tissue, and to discuss the role of estrogen receptor in prostate cancer. Methods The expression of ERα and ERβ in PC (n=28), peri-cancer tissue (n=28) and BPH (n=29) were detected by immunohistochemistry with En vision method. The ERα and ERβ expression were compared among different tissues by chisquare. The relationship between ER expression and related clinicopathologic features was statistically analyzed by spearman rank collection. Results ERα was localized dominantly in the stromal cell of PC. There were significant differences of the expression of ERα in PC, peri-cancer tissue and BPH tissue (epithelial cell 0%, 14%, 24%, P＜0. 05; stromal cell 57%, 68%, 31%,P＜0. 05). ERβ was localized in both epithelial and stromal cell of PC. There were significant differences of the expression of ERβ in PC, peri-cancer tissue and BPH tissue (epithelial cell 39%, 64%, 29%, P＜0.01; stromal cell 50%, 75%, 79%, P＜0.05). There was a significant difference of the expression of ERβ in different Gleason scores of PC tissue. Conclusions ERα is localized in the stromal cell of PC tissue.ERβ is localized in both epithelial and stromal cell of PC tissue. The ERβ might be related to the tumor differentiation of PC.     

经皮肾镜技术治疗上尿路肿瘤的初步经验

目的 评价经皮肾镜技术在上尿路肿瘤中的应用效果.方法 2006年6月至2010年6月经皮肾镜治疗上尿路肿瘤患者8例(10侧).男6例(7侧),女2例(3侧).年龄52～72岁,平均61岁.孤立肾4例,慢性肾功能不全2例,双侧肾盂肿瘤2例.高级别肿瘤4侧,低级别肿瘤6侧.肿瘤直径0.5～3.5 cm,平均2.6 cm.患者均接受经皮肾镜激光或电刀肿瘤切除术,术中留置输尿管支架管,术后经肾造瘘管灌注化疗药物.结果 8例手术均获成功,手术时间45～95 min,平均73 min;术中出血量20～300 ml,平均50 ml,术后SCr水平较术前下降或无明显变化.随访10～36个月,采用CT、MRI及输尿管镜检观察肿瘤复发情况.1例死于肿瘤转移,2例肿瘤局部复发.余5例未见肿瘤复发.结论 经皮肾镜技术治疗上尿路肿瘤安全可行,手术效果良好,对不宜行肾输尿管切除术的上尿路肿瘤患者来说是一种良好的选择.

Abstract：

Objective To evaluate the application of percutaneous nephroscopy in the treatment of upper urinary tract transitional cell carcinoma, particularly renal pelvic carcinoma. Methods From June 2006 to June 2010, eight cases (with 10 sides) of renal pelvic carcinoma received percutaneous nephroscopy tumor resection. There were six males (with 7 sides) and two females (with 3 sides) in the study group. There were six cases with solitary kidney and two cases with bilateral renal pelvic tumors. There were four cases with high-grade tumors and six cases with low-grade tumors. The age of patients ranged from 52 to 72 yrs (average 61.2 yrs). Tumor sizes ranged from 0.5 to 3.5 cm (average 2.6 cm). Patients were treated with laser or electrocautery through percutaneous nephroscopy. A ureteral stent was placed in the patients after the procedure. Chemotherapy was administered postoperatively through the nephrostomy tube. Results All the operations were successfully completed uneventfully. The operative time was 45-95 min (average 73 min), estimated blood loss was 20-300 ml (average 50 ml). No remarkable differences were found in serum creatinine levels before and after operation. After 10 to 36 mon. follow-up by CT, MRI, and ureteroscopy, one patient died of tumor metastasis and two patients had local tumor recurrence. The remaining patients had no local recurrence. Conclusions Percutaneous nephroscopy in treating renal pelvic tumor is safe and feasible. This is a better choice for the renal pelvic carcinoma patients who are unsuitable for ureteronephrectomy.     

青年肾细胞癌患者的临床病理特点及诊治分析

肾细胞癌是肾脏最常见的恶性肿瘤,约占所有成人恶性肿瘤的3%,近年来其发病率也有升高的趋势[1].本病多见 于中老年,高发年龄为40～70岁,40岁及以下的患者较少.我科诊治40岁以下的青年肾细胞癌患者22例,现将诊断治疗经验报告如下.     

胰液膀胱引流式胰肾联合移植长期存活15例随访

背景：胰肾联合移植是治疗1型糖尿病合并终末期肾病的首选疗法,但由于移植风险高,并发症多,国内开展并不广泛。目的：总结胰液膀胱引流式胰肾联合移植长期存活的临床经验,观察其远期效果并分析影响因素。方法：对15例患者行胰液膀胱引流式胰肾联合移植,均采用心脏死亡的供体。HLA配型平均为2.13。均选择胰液膀胱引流式和体循环回流血管吻合方式,免疫抑制剂方案均用他克莫司,霉酚酸酯和泼尼松治疗。观察移植后患者移植物肾功能、血糖、淀粉酶等及并发症。结果与结论：最短随访8.5个月,最长随访105.5个月,平均住院时间为37.7（13～82）d。移植后13例患者胰腺功能恢复,2例于移植后即切除移植胰腺。移植后除1例患者肾脏功能延迟恢复外,其余患者肾脏功能立即恢复。2例患者因慢性排斥反应丢失移植胰腺和移植肾。移植后主要并发症为排斥反应,返流性胰腺炎和血栓形成。提示胰肾联合移植是治疗终末期糖尿病并发肾功能衰竭的一种安全而有效地治疗方法,其远期效果理想,完善的围移植期管理、预防和及时处理并发症、合理应用免疫抑制剂是影响患者和移植物长期存活的重要因素。