肾上腺畸胎瘤一例报告

患者,男,36岁。因反复右上腹疼痛不适2个月,B超检查示右肾上腺囊性占位于2005年8月入院。体检：腹部未及包块,双肾区叩痛(一)。B超示右肾上腺囊性占位3 cm×4 cm。CT示右肾上腺区囊性占位,中有分隔,注射造影剂后占位无明显强化。全麻下行右肾上     

外伤性脾破裂72例治疗体会

目的:对外伤性脾破裂的临床特点和,临床诊治方法进行探讨.方法:对我院收治的72例外伤性脾破裂病例的临床资料进行回顾性分析.结果:所有病例全部治愈出院,术后无并发症.结论:针对脾损伤伤情分别实施不同的脾手术方式,术中尽量保留脾脏及其功能,能收到意想不到的效果.     

前列腺特异性抗原相关指标在前列腺良恶性疾病诊断中的运用比较

目的比较前列腺特异性抗原密度(PSAD)、前列腺移行带抗原密度(PSAD-TZ)、前列腺特异性抗原(PSA)及游离前列腺特异性抗原和总前列腺特异性抗原比值(FPSA/TPSA)、在良性前列腺增生(BPH)和前列腺癌(PCa)鉴别诊断中的作用。方法55例BPH和23例PCa病人,PSA为4～20ng/ml,比较PSA、PSAD、FPSA/TPSA、PSAD-TZ指标,并进行统计学分析比较。结果BPH和PCa两组PSA平均值分别为(9.41±3.25)ng/ml和(11.29±2.50)ng/ml,两组比较P>0.05。两组PSAD平均值分别为(0.14±0.09)和(0.23±0.11),两组比较P<0.05。两组FPSA/TPSA平均值分别为(0.61±0.23)和(0.25±0.14),两组比较P<0.05。两组PSAD-TZ平均值分别为(0.25±0.19)和(0.52±0.25),两组比较P<0.01。结论PSAD、FPSA/TPSA、PSAD-TZ对PSA<20ng/ml的前列腺良、恶性病变具有鉴别作用,其中尤以PSAD-TZ更为准确。     

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.     

复杂性前尿道狭窄的治疗(附78例报告)

目的　探讨复杂性前尿道狭窄手术方法的选择及成功的关键。　方法　对 78例复杂性前尿道狭窄患者采用不同手术方法的尿道成形术 ,其中不同黏膜重建尿道 4 0例 ,带蒂皮瓣一期尿道成形 2 6例 ,狭窄段尿道劈开、二期尿道成形 (Johanson术 ) 12例。　结果　术后随访 6～ 36个月 ,平均 16 .5个月。 6 7例排尿通畅 ,11例效果欠佳。其中黏膜重建尿道组发生尿道皮肤瘘 1例 ,尿道外口狭窄 2例 ,阴茎弯曲 1例 ;带蒂皮瓣尿道成形组发生尿道狭窄 3例 ,尿道皮肤瘘 1例 ,尿道皮肤瘘合并成形段尿道内毛发生成和结石形成 1例 ;Johanson术组发生阴茎弯曲 2例 ,其中 1例合并成形段尿道内毛发生成。　结论　复杂性前尿道狭窄手术方法的选择应根据尿道狭窄段长短、位置和严重程度。尿道狭窄段 <8～ 10cm者宜选用阴茎皮肤 (包括包皮 )带蒂皮瓣 ,阴茎皮肤取材有困难时可选用膀胱或口腔黏膜 ;尿道狭窄段 >10cm者可选用结肠黏膜 ,尤其在膀胱黏膜取材有困难时。     

嗜铬细胞瘤围术期单独应用尼卡地平的价值

目的 探讨钙通道阻滞剂尼卡地平在嗜铬细胞瘤摘除术前、中的应用价值。方法1999-10/2002-7收治嗜铬细胞瘤患者10例。术前口服尼卡地平(40～80mg,2次)10～14d作为手术前控制血压的药物,术中控制收缩压在16.0-21.3kPa之间,调节尼卡地平静脉注射浓度[(1-μg/kg.min)],在结扎肿瘤的引流静脉前停药。结果2例在术中分离肿瘤时出现高血压危象(收缩压>26.7kPa),但被尼卡地平有效地控制住。另4例术中血压波动不大。所有患者术后均无须使用升压药。结论 钙离子通道阻滞剂尼卡地平是安全、有效、副作用小的药物,可以替代常规的α-受体阻滞剂作为嗜铬细胞瘤手术前、术中控制高血压。     

结肠粘膜重建尿道的动物实验与临床应用

目的　探讨结肠粘膜代尿道治疗复杂性前尿道长段狭窄或闭锁的可行性。　方法　 6条雌性杂种成年狗在全麻下切开尿道 ,剥离全段尿道粘膜 ,取相等长度的结肠粘膜替代尿道粘膜 ,12周后将狗处死 ,取尿道组织作病理检查。采用结肠粘膜替代尿道一期尿道成形术治疗 1例复杂性前尿道长段狭窄患者 ,术后 3个月分别行逆行尿道造影 ,尿道镜和尿流率检查。　结果　 6条狗移植于尿道的结肠粘膜全部成活 ,部分腺上皮转变为移行上皮细胞。采用结肠粘膜替代尿道的患者术后排尿通畅 ,移植段尿道无狭窄 ,最大尿流率 30ml/s。　结论　结肠粘膜代尿道是治疗复杂性前尿道长段狭窄或闭锁的一种有效方法 ,可用于不适合应用包皮或膀胱粘膜及颊粘膜时的尿道重建     

膀胱内粘膜沟固定法增强缩窄回肠控制的实验研究

我们将输尿管与代膀胱再吻合时常用的膀胱内粘膜沟固定法作为可控膀胱的控制机制的一种新方法 ,现报道如下。一、材料与方法雌性杂种成年犬 8条 ,重 13～ 2 3ｋｇ ,平均 17.6ｋｇ。全麻下 ,取末段回肠 7ｃｍ左右 ,并以 14Ｆ号导管为基点缩窄后作为输出管。在膀胱侧壁切一小口 ,分离并剪开粘膜长 2ｃｍ ,将缩窄回肠的一端套入膀胱 ,并放在无粘膜的沟内 ,长 2ｃｍ ,其内口的下半部分与膀胱粘膜作间断吻合 ,已分离的膀胱粘膜与输出管的两侧壁作间断缝合 ,另一端作腹壁防狭窄造口。术后 10周作尿动力学和Ｘ线检查 :先排空膀胱 ,注入 2 0ｍｌ生理…     

血及尿DKK3在造影剂所致急性肾损伤中的预测价值

目的:探讨外周血及尿液中Dickkopf相关蛋白3(DKK3)对冠脉造影术后造影剂诱导的急性肾损伤(CI-AKI)的预测价值。方法:纳入2019年8月至2021年8月在东南大学附属中大医院行冠脉造影和经皮冠脉介入治疗(PCI)的患者466例,根据患者冠脉造影前后的血肌酐水平评估患者是否发生CI-AKI。采用ELISA法检测患者血及尿液中DKK3含量,单因素及多因素Logistic回归分析筛选CI-AKI的危险因素,受试者工作特征(ROC)曲线评估DDK3对CI-AKI的诊断价值。结果:466例患者中共有35例发生CI-AKI,发生率为7.5%。CI-AKI患者血DDK3和尿DKK3/尿肌酐值均高于非CI-AKI患者(均P<0.05)。Logistic回归分析结果显示尿DKK3/尿肌酐值是CI-AKI的独立危险因素(OR=3.24, 95%CI 2.61～4.92)。ROC曲线分析显示尿DKK3/尿肌酐值预测CI-AKI的曲线下面积(AUC)是0.659(95%CI 0.544～0.775,P=0.002)。结论:CI-AKI患者血DKK3和尿DKK3/尿肌酐值较未发生CI-AKI...