400例肾移植后随访五年的临床分析

环孢素A的使用大大降低了急性排斥反应的发生率，使肾移植术后近期人、肾存活率显著提高，但中长期人、肾存活率并无显著改善。我们对400例肾移植受者的随访资料进行了回顾性分析，并着重分析不同免疫抑制方案对人、肾长期存活率的影响，现报告如下。     

尿道内尖锐湿疣的治疗

我院自１９９２年９月至１９９５年５月诊治尿道内尖锐湿疣８例，均经病理证实，现报道如下。一、临床资料本组８例患者，男７例，女１例。年龄１７～４２岁，平均２４岁。排尿困难１例，血尿２例，尿痛３例，自尿道排出糜烂组织２例，８例发病前均有非婚性接触史，均患有...     

肾移植术后直肠结核一例

患者,男,因慢性肾小球肾炎、尿毒症于 2000 年在我院接受同种肾移植术。术后应用环孢素 A(CsA)、硫唑嘌呤(Aza)及泼尼松(Pred)预防排斥反应。术后 20 d 出院。术后7 个月出现尿频、排尿不适感,会阴部坠胀伴发热,体温37.9℃~38.4℃,在外院诊断为慢性前列腺炎,予以抗生素治疗     

协同信号途径阻断和供体脾细胞输注诱导预存同种记忆性T淋巴细胞大鼠心脏移植物的耐受

Objective To induce the tolerance to cardiac allograft by combined blockade of OX40/OX40L and CD28/B7 co-stimulatory signaling and donor specific spleen cell transfusion in rat mod-els of pre-existent allogenic reactive memory T lymphocytes. Methods Lewis rats that underwent 3 days of adoptive transfer of donor specific CD8+ memory T cells, separated by immunomagnetic bead separation kit, received either separate or combined transfusion of AdCTLA4Ig, AdOX40Ig, donor spleen cells (DST) and transplantations of hearts of DA rats at the same time. Cardiac allografts were taken out 48 h after transplantation for histological analysis and cytokines expression ,and survival time of cardiac allografts with different treatments was observed. Results Compared with AdCTLA4Ig, AdOX40Ig and DST groups, AdCTLA4Ig + AdOX4OIg + DST group showed lower cardiac pathological grade with much lower expression level of IL-2 and IFN-γ,and much longer heart survival time. Conclusion Combined blockade of OX40/ OX40L and CD28/B7 and donor specific spleen cell transfusion could induce rat cardiac graft tolerance.     

神经肽Y在肾移植围手术期与血压的关系

目的终末期尿毒症患者血浆神经肽Y（NPY）异常升高，与血压的变化呈正相关。本研究探讨血浆NPY水平在成功肾移植围手术期的临床意义及其与患者血压的关系。方法采集116例终末期尿毒症患者手术前、术后24h、出院前1d外周静脉血标本5ml，测定血浆NPY和肌酐（Cr）水平，同时测量记录平均动脉压。对照组为20例健康志愿者。结果在成功肾移植手术后出院前1d，血Cr水平恢复正常，血浆NPY水平有明显降低，与手术前比较，有显著性差异（P〈0．05）；但又明显高于健康志愿者血浆NPY平均值，比较有显著性差异（P〈0．05）；手术后患者平均动脉压无明显降低，个别反而较手术前更高，与手术后血浆NPY水平的变化无相关性。结论终末期尿毒症患者成功接受肾移植后，在出院前1d，肾功能恢复正常情况下其血浆NPY水平明显下降，但与患者的平均动脉压无相关性。     

B超引导下经皮肾镜取石术治疗上尿路结石1289例临床总结

目的 探讨B超引导下PCNL治疗上尿路结石的有效性与安全性. 方法 2004年6月至2009年7月行超声引导下PCNL 1289例.其中输尿管上段结石386例;肾单发结石463例,多发结石355例,鹿角形结石85例.结石大小0.8 cm×1.2 cm～9.0 cm×5.3 cm,平均2.1 cm×3.1 cm.伴不同程度肾积水935例. 结果 1289例无中转开放及死亡.平均手术时间90(55～220)min,平均术中出血量175(60～800)ml.术中、术后输血31例,术后因出血行超选择性肾动脉栓塞术14例(1.09%).一期单通道取石1105例,二通道取石108例,三通道取石76例.一期结石取净率85.03%(1096/1289);193例结石残留者中,67例行ESWL,126例行二期PCNL,其中85例结石取净.总结石取净率91.62%(1181/1289).结论 B超引导下PCNL治疗上尿路结石具有定位准确、工作通道建立安全简便、结石取净率高、创伤小、并发症少等特点,手术适应证选择、手术技巧掌握、相应配套设施的保障是PCNL成功的关键.     

老年活体供肾移植术后供者安全性及受者移植效果的分析

Objective To investigate the safety for donors and the effectiveness for recipients of living-related donor (LRD) kidney transplantation from elder donors. Methods 251 cases of LRD kidney transplantation were reviewed. According to the age of LRDs, the patients were divided into 2 groups:≥55 years group (group A) and <55 years (group B). The parameters studied included serum creatinine (Cr), glomerular filtration rate (GFR), creatinine clearance (Ccr), perioperative complications, average hospital stay, and acute rejection rate of LRDs and recipients were compared. Results (1)There was no significant difference in serum Cr between groups A and B at different time points (P>0.05). (2)There was no significant difference in Ccr between two groups pre-donation (P = 0.45). But at the 10th day after the donor nephrectomy, Ccr level in group A was significant lower than in group B (P<0.01). (3)Total GFR pre-donation, remaining renal GFR, and remaining renal GFR on the day 10 after donation had no significant difference in both groups A and B (P>0.05). Remaining renal GFR on the day 10 before and after donation had no significant difference in group A (P>0.05), but on the day 10 after donation that was significantly increased in group B as compared with that pre-donation (P<0.01). (4) The serum Cr of recipients at different time points after transplantation had no significant difference between two groups (P>0.05). (5) The mean hospital stay after donation of LRDs and recipients had no significant difference between two groups. (6) The incidence of recipients" acute rejection was 6.50 % (5/77) in group A, and 5.75%(10/174) in group B within 6 months after operation (P = 0.95). Conclusion Transplantations performed from the elderly donors will yield similar results from younger donors if the eider donors are evaluated or assessed as the standards.     

多层螺旋CT与超声检查诊断急诊老年血管源性急腹症患者的临床价值对比

目的探讨多层螺旋CT诊断方法在急诊老年血管源性急腹症中特征及其临床研究意义。方法回顾性分析了2014年2月至2015年1月在我院急诊科就诊的急腹症老年患者,选取同时行超声和多层螺旋CT两项检查且临床确诊为血管源性急腹症的患者36例。比较两种诊断方法的准确性。结果超声诊断腹主动脉瘤5例,动脉夹层8例,肠系膜上静脉血栓1例,肠系膜上动脉血栓2例,肾动脉主干及分支栓塞4例,门静脉栓塞3例,假性动脉瘤3例。多层螺旋CT诊断腹主动脉瘤5例,动脉夹层8例,肠系膜上静脉血栓2例,肠系膜上动脉血栓3例,肠系膜扭曲5例,肾动脉主干及分支栓塞4例,门静脉栓塞6例,假性动脉瘤3例。超声的诊断准确率为72.2%;螺旋CT的诊断准确率为100%;经统计学比较,两种诊断方法的准确率有显著差异(χ2=11.61,P0.01)。结论多层螺旋CT诊断方法在急诊老年血管源性急腹症中具有较好的成像效果,对血管源性的病变范围及情况的确定具有重要意义。     

后腹膜腔扩张球囊的改良制作与应用

建立腹膜后腔是泌尿外科后腹腔镜手术成功的关键。腹膜后腔是一个潜在腔隙,怎样最简便地扩张出一个有利于腹腔镜操作的空间一直是泌尿外科探索的问题。1992年Gaur利用特制水囊先行后腹膜间隙扩张,再建立气腔,扩大了术野、改善了腹腔镜工作空间,使腹膜后腔入路的腔内手术变成了现实。目前国内主要采用水囊或气囊扩张法[1]。在使用过程中,我们发现有多处不便,对其进行了改良。并从2004年10月至2005年11月对187例后腹腔镜泌尿外科手术采用该方法扩张后腹膜腔,效果良好,现介绍如下。1材料与制作方法10mm穿刺套管1个、一次性灭菌指套1个、50ml针…     

膀胱移行细胞癌环氧化酶-2表达与血管生成的相关性研究

目的探讨环氧化酶-2（COX-2）及微血管密度（MVD）与膀胱移行细胞癌生物学行为的关系及其临床意义。方法采用免疫组化S-P法对103例膀胱移行细胞癌、21例慢性膀胱炎、13例正常膀胱组织标本中COX-2进行检测，同时对上述标本中微血管进行计数。结果膀胱移行细胞癌组织COX-2阳性表达率70．9％，慢性膀胱炎及正常膀胱组织COX-2表达均为阴性。低分化、侵润性、有淋巴转移以及复发癌组织中COX-2阳性表达率显著高于对照组（P〈0．05）。膀胱移行细胞癌组织中MVD与COX-2表达呈正相关（P〈0．05），但COX-2表达及MVD与肿瘤的数量、大小无关（P〉0．05）。结论COX-2表达在膀胱移行细胞癌的发生、发展、转移及复发过程中起重要作用。膀胱移行细胞癌COX-2表达与肿瘤间质微血管的形成密切相关。