肾移植术后并发自体尿路上皮多器官癌六例的临床分析

Objective To analyze the etiology, clinical diagnosis and outcomes of 6 cases of multifocal urothelial carcinomas following transplantation. Methods A retrospective analysis was performed on 6 cases of multifocal urothelial carcinomas following renal transplantation in our center. Results Six patients were diagnosed as having multifocal urothelial carcinomas, including 1 case of related renal transplantation. Five cases were diagnosed by painless gross hematuria 2～48 months after renal transplantation, and I patient was diagnosed as having bladder tumors by B-uhrasound. All lesions happened un-simultaneously, from 1.5～16 months, and each case accepted operation 2～5 times. One case accepted radical cystectomy and cutaneous ureterostomy of the graft, and one accepted radical cystectomy, cutaneous ureterostomy of the graft and urethrectomy. All of 6 cases received OKT3 or Daclizumab as the induced-immunosuppressive therapy and tacrolimus or cyclosporine A + mycofenolate mofetil + steroid as the maintenance therapy. Intravesical chemotherapy started in all patients immediately after the surgery. All operations were successful and most patients got satisfactory results. Conclusions Kidney recipients have a higher rate of transitional cell carcinomas which are characterized by easy metastasis, and mostly have unsatisfactory prognosis. Kidney recipients with hematuria should be examined carefully with cystoscopy, retrograde pyelography and cystourethroscopy. A routine examination at regular intervals after transplantation is very important.     

女性复发性尿路感染发病机制研究现状

女性尿路感染是常见的细菌感染性疾病，且易复发。其发病受多因素影响，目前对其发病机制尚有争议，本文综述有关复发性尿路感染的发病机制，以便更好地预防和治疗。     

精神科护理人员睡眠状况及相关因素分析

目的 了解精神科护理人员睡眠状况及其影响因素,以及睡眠与职业倦怠相关性。方法 采 用匹兹堡睡眠质量指数（PSQI）、Epworth嗜睡量表（ESS）与职业倦怠量表（MBI-GS）对200名精神科护理人 员进行问卷调查;Logistic回归分析确定影响护理人员睡眠问题的因素。结果 精神科护理人员PSQI总 分高于常模（P＜ 0.05）,32.5%护理人员存在睡眠问题。ESS结果显示大部分护理人员日间存在嗜睡状况; ESS总分与睡眠质量、睡眠障碍、日间功能障碍、PSQI总分呈正相关。近一个月上中夜班护理人员与不 上中夜班护理人员两组PSQI总分、ESS总分及MBI-GS各维度总分的差异均无统计学意义（P＞ 0.05）。情 绪衰竭及去人性化维度得分与睡眠质量、入睡时间、催眠药物、日间功能障碍及PSQI总分呈正相关;个 人成就感维度得分与PSQI总分及因子分无相关性;MBI-GS各维度得分与ESS总分没有相关性。Logistic 回归分析显示年龄、护龄是影响精神科护士睡眠的主要风险因素,职称分布上主管护师发生睡眠问题的 风险远低于护士。结论 精神科护理人员存在睡眠及嗜睡问题。睡眠质量和职业倦怠密切相关,睡眠障 碍不仅影响身心健康,而且导致护理质量下降。年龄、护龄是影响精神科护士睡眠的主要风险因素。职 称为主管护师的护理人员出现睡眠问题的风险小于职称为护士的护理人员。     

前列腺增生症各区细胞EGF、EGF-R、bFGF和TGF-β1表达的意义

良性前列腺增生症(benign prostatic hyperplasia,BPH)是老年男性常见病,但病因至今尚无定论.1972年McNeal将前列腺的功能、病理变化与形态学联系起来,将其分为周边区(peripheral zone,PZ)、移行区(transitional zone,TZ)和中央区(central zone,CZ),并提出周边区为前列腺癌最常发生的区域,而移行区则是前列腺增生症发生的唯一部位.经过多年研究,这一理论已得到多数学者的认可.本研究通过对3个区组织的表皮生长因子(epidermal growth factor,EGF)及其受体(epidermal growth factor receptor,EGF-R)、碱性纤维细胞生长因子(basic fibroblast growth factor,bFGF)和转化生长因子-β1(transforming growth factor-β1,TGF-β1)分别进行检测,探讨其表达在BPH发病中的意义.     

重组人表皮生长因子凝胶在尿道下裂术后尿瘘中的应用效果观察

目的：探讨重组人表皮生长因子（rhEGF）凝胶在尿道下裂术后尿瘘早期处理中的应用效果。方法将2011年9月至2014年7月行尿道下裂手术后出现的44例尿瘘患者随机分为2组,2组患者在给予留置尿管、常规创面换药及对症处理的基础上,试验组瘘口表面应用 rhEGF 凝胶,对照组瘘口表面涂以0．9％氯化钠溶液,观察2组尿瘘愈合情况。结果试验组共愈合14例,总愈合率63．64％,其中大瘘口愈合9例,小瘘口愈合5例;对照组共愈合5例,总愈合率22．73％,其中大瘘口仅愈合2例,小瘘口愈合3例。与对照组比较,试验组总愈合率和大瘘口的愈合率明显提高,差异有统计学意义（ P ＜0．05）,而小瘘口的愈合率略高于对照组,但差异无统计学意义（ P ＞0．05）。结论尿道下裂术后尿瘘早期及时处理,小瘘口大部分能够愈合,应用 rhEGF 凝胶对瘘口愈合具有促进作用。     

腺病毒介导的HSV-tk/GCV系统在hTERT启动子调控下治疗人膀胱癌的实验研究

目的观察人端粒酶逆转录酶（hTERT）启动子调控的腺病毒介导单纯疱疹病毒胸苷激酶（HSV-tk）基因/丙氧鸟苷（GCV）系统在体外及荷瘤裸鼠体内对人膀胱癌的治疗作用。方法利用hTERT启动子及小鼠巨细胞病毒（CMV）启动子调控的携带HSV-tk基因的重组腺病毒（Ad-hTERT-HSV/tk与Ad-CMV-HSV/tk）分别感染人膀胱癌细胞253 J和人正常肺成纤维细胞MRC-5,加入GCV,MTT法观察受染细胞的存活率。建立人膀胱癌裸鼠移植瘤模型,随机分为4组,A组（Ad-hTERT-HSV/tk＋GCV组）、B组（Ad-hTERT-HSV/tk＋PBS组）、C组（PBS＋GCV组）和D组（PBS对照组）,观察各组肿瘤生长状况、重要脏器病理变化及裸鼠存活情况。结果体外实验表明,应用GCV处理后,Ad-CMV-HSV/tk对253 J和MRC-5细胞均有杀伤作用,而Ad-hTERT-HSV/tk只对膀胱癌细胞253 J具有杀伤作用。动物实验显示,A组移植瘤的体积和瘤重低于其他3组（P〈0.01）。A组裸鼠平均存活期长于其他3组（P〈0.01）。结论 hTERT启动子调控的重组腺病毒介导HSV-tk/GCV系统是一种安全、有效且靶向性高的基因疗法。     

后腹腔镜肾部分切除术治疗早期肾肿瘤近期疗效观察

目的观察后腹腔镜下肾部分切除术治疗早期肾肿瘤的近期疗效。方法对12例早期肾肿瘤患者实施后腹腔镜肾部分切除术。肿瘤直径（2．5±0．8）cm。结果12例手术均顺利完成,无中转开放手术者。手术时间为（137．9±31．1）min。2例未阻断肾蒂,10例单纯阻断肾动脉,热缺血时间为（34．4±7．5）min,术中出血（122．1±47．3）ml,术后住院（11．8±3．1）d。术后无出血、漏尿等并发症。病理检查示肾血管平滑肌脂肪瘤2例,肾透明细胞癌10例,切缘均为阴性。随访5—14个月,患肾功能正常,肿瘤无局部复发、转移。结论后腹腔镜肾部分切除术治疗直径≤4cm的早期肾肿瘤安全可行,具有创伤小、患者恢复快等优点,但远期疗效需进一步观察。     

2μm激光与电切治疗良性前列腺增生的效果比较

良性前列腺增生（BPH）是引起中老年男性排尿障碍的一种常见良性疾病。重度前列腺增生患者的下尿路症状较为明显,影响患者的生活质量。经典的外科手术方式有经尿道前列腺电切术（TURP）、经尿道前列腺切开术、开放性前列腺摘除术[1]。经尿道前列腺2μm激光切除术是一项新技术,对前列腺组织汽化切割具有操作简便、微创高效的特点。本研究比较2μm激光切除术和经尿道前列腺电切术的效果,现报告如下。     

肾移植术后并发自体尿路上皮多器官癌六例的临床分析

Objective To analyze the etiology, clinical diagnosis and outcomes of 6 cases of multifocal urothelial carcinomas following transplantation. Methods A retrospective analysis was performed on 6 cases of multifocal urothelial carcinomas following renal transplantation in our center. Results Six patients were diagnosed as having multifocal urothelial carcinomas, including 1 case of related renal transplantation. Five cases were diagnosed by painless gross hematuria 2～48 months after renal transplantation, and I patient was diagnosed as having bladder tumors by B-uhrasound. All lesions happened un-simultaneously, from 1.5～16 months, and each case accepted operation 2～5 times. One case accepted radical cystectomy and cutaneous ureterostomy of the graft, and one accepted radical cystectomy, cutaneous ureterostomy of the graft and urethrectomy. All of 6 cases received OKT3 or Daclizumab as the induced-immunosuppressive therapy and tacrolimus or cyclosporine A + mycofenolate mofetil + steroid as the maintenance therapy. Intravesical chemotherapy started in all patients immediately after the surgery. All operations were successful and most patients got satisfactory results. Conclusions Kidney recipients have a higher rate of transitional cell carcinomas which are characterized by easy metastasis, and mostly have unsatisfactory prognosis. Kidney recipients with hematuria should be examined carefully with cystoscopy, retrograde pyelography and cystourethroscopy. A routine examination at regular intervals after transplantation is very important.