原发性输尿管癌的诊断与治疗（附40例报告）

目的 提高输尿管癌诊断和治疗水平。方法 回顾分析40例原发性输尿管癌病例，对诊治中的问题进行讨论。结果 肉眼血尿、腰痛是其主要临床表现。逆行输尿管插管造影、CT、IVP、B超检查的阳性率分别是86．7％、50％、12．5％、12．5％。40例患者中行患肾 全段输尿管?膀肮部分切除术31例，输尿管下段切除术 膀胱吻合术3例，输尿管肿瘤切除 输尿管端端吻合术2例，单纯输尿管肿瘤切除术2例。残余段输尿管 膀胱部分切除术2例。结论 B超发现肾积水可作为初步筛选检查，逆行输尿管插管造影、CT是术前诊断输尿管癌的重要手段。患肾 全段输尿管 膀胱部分切除术仍是治疗输尿管癌的主要方法。     

B超引导经皮内镜碎石术治疗上尿路结石

目的探讨输尿管短镜和胆道硬镜两套内镜系统在经皮肾镜手术中的应用价值。方法2002年1月￣2005年3月期间,运用输尿管短镜或胆道硬镜代替传统的肾镜对183例上尿路结石患者施行B超引导经皮内镜碎石术,观察两套内镜系统在治疗上尿路结石中的疗效及安全性。结果应用输尿管短镜施行经皮肾镜碎石术,临床治愈率为89.3%,平均手术173.5min,手术相关严重出血发生率6.8%,腔内灌流为高压低流量型;应用胆道硬镜施行经皮肾镜碎石术,临床治愈率为87.5%,平均手术104min,手术相关严重出血发生率16.3%,腔内灌流为低压高流量型。结论对于肾脏实质较厚、肾积水较轻的患者,扩张至16F后用输尿管短镜进行碎石取石,手术安全性较高;对于肾实质较薄、肾脏集合系统积水较重的患者,扩张到24F,在胆道硬镜观察下将结石整枚取出或击成数枚较大碎石后取出,可提高取石效率。     

欧洲癌症研究与治疗组织风险评分表在非肌层浸润性膀胱尿路上皮癌中的临床应用初探

Objective To evaluate the feasibility of European Organization for Research and Treatment of Cancer (EORTC) risk tables in non-muscle invasive bladder cancer in Chinese patients.Methods A retrospective analysis was performed on the data from 185 patients with non-muscle invaaive urothelial bladder cancer from January 2003 to February 2009. Among the 185 patients, 128 patients were stage Ta compared with 57 patients who were stage T1. There were 87, 53 and 45 patients with grade G1, G2 and G3 respectively. Transurethral resection of the bladder tumor was performed on all the patients and all the patients received routine post-operative intravesical instillation. A telephone interview follow-up was conducted on all the patients, and the average follow-up period was 36 months. EORTC risk tables were used to calculate risk scores for recurrence and progression for each patient. The recurrence and progression rates of different risk groups were recorded and compared with the estimated rates by EORTC risk table. Statistical analysis was used for comparison. ResultsTotal 1-year recurrence rate and progression rate for these patients were 25.9% and 3.8% respectively. According to calculated values of the patients, the 1-year recurrence rates of Group 0, Group 1-4, Group 5-9, Group 10-17 were 10.4%(5/48), 21. 5%(14/65), 35. 2% (19/54), 55.6%(10/18), respectively. The 1-year progression rates of Group 0, Group 2-6, Group 7-13, Group 14-23 were 0% (0/43), 1.5% (1/67), 6. 7% (4/60), 13. 3% (2/15). There was no significant difference between the real rates and estimated rates of the EORTC risk tables (P＞0. 05). However,the 1-year recurrence and progression rates between the low risk group, the medium risk group and the high risk group showed significant differences respectively (P ＜ 0. 05 ). Conclusions The EORTC risk tables are feasible to evaluate the recurrence and progression risk of non-muscle invasive bladder cancer in the present cohort. Nevertheless, the long term value and feasibility need more research to confirm.     

欧洲癌症研究与治疗组织风险评分表在非肌层浸润性膀胱尿路上皮癌中的临床应用初探

目的 评价欧洲癌症研究与治疗组织风险评分表(European Organization for Research and Treatment of Cancer risk tables,EORTC风险评分表)用于非肌层浸润性膀胱尿路上皮癌患者预后评估的可行性.方法 回顾性分析2003年1月至2009年2月收治的185例非肌层浸润性膀胱尿路上皮癌患者临床资料,其中Ta128例、T1 57例;G1 87例、G253例、G345例;肿瘤数目为单发、2～7个、≥8个者分别120、36、29例;肿瘤直径＜3 cm者131例、≥3 cm者54例;伴发原位癌者6例.185例均行经尿道膀胱肿瘤电切术,术后均行常规膀胱灌注化疗.采用电话随访方式,随访6～77个月,平均36个月.应用EORTC风险评分表进行预后风险评分,计算各评分组患者的1年复发率和进展率,并与EORTC评分表的预计值进行比较.结果 185例中1年内复发48例(25.9%),1年内出现肿瘤进展者7例(3.8%).根据患者实际情况计算,0、1～4、5～9、10～17分4组患者1年实际复发率分别为10.4%(5/48)、21.5%(14/65)、35.2%(19/54)、55.6%(10/18);0、2～6、7～13、14～23分患者1年实际进展率分别为0(0/43)、1.5%(1/67)、6.7%(4/60)、13.3%(2/15).经x2检验,结果与评分表的预计值差异无统计学意义(P＞0.05);而低危、中危、高危3组患者1年复发率及进展率差异有统计学意义(P＜0.05).结论 EORTC风险评分表可用于非肌层浸润性膀胱尿路上皮癌术后复发和进展风险的短期预测,对长期预测的应用及广泛人群的适用性尚待进一步验证.

Abstract：

Objective To evaluate the feasibility of European Organization for Research and Treatment of Cancer (EORTC) risk tables in non-muscle invasive bladder cancer in Chinese patients.Methods A retrospective analysis was performed on the data from 185 patients with non-muscle invaaive urothelial bladder cancer from January 2003 to February 2009. Among the 185 patients, 128 patients were stage Ta compared with 57 patients who were stage T1. There were 87, 53 and 45 patients with grade G1, G2 and G3 respectively. Transurethral resection of the bladder tumor was performed on all the patients and all the patients received routine post-operative intravesical instillation. A telephone interview follow-up was conducted on all the patients, and the average follow-up period was 36 months. EORTC risk tables were used to calculate risk scores for recurrence and progression for each patient. The recurrence and progression rates of different risk groups were recorded and compared with the estimated rates by EORTC risk table. Statistical analysis was used for comparison. ResultsTotal 1-year recurrence rate and progression rate for these patients were 25.9% and 3.8% respectively. According to calculated values of the patients, the 1-year recurrence rates of Group 0, Group 1-4, Group 5-9, Group 10-17 were 10.4%(5/48), 21. 5%(14/65), 35. 2% (19/54), 55.6%(10/18), respectively. The 1-year progression rates of Group 0, Group 2-6, Group 7-13, Group 14-23 were 0% (0/43), 1.5% (1/67), 6. 7% (4/60), 13. 3% (2/15). There was no significant difference between the real rates and estimated rates of the EORTC risk tables (P＞0. 05). However,the 1-year recurrence and progression rates between the low risk group, the medium risk group and the high risk group showed significant differences respectively (P ＜ 0. 05 ). Conclusions The EORTC risk tables are feasible to evaluate the recurrence and progression risk of non-muscle invasive bladder cancer in the present cohort. Nevertheless, the long term value and feasibility need more research to confirm.     

原发性精囊癌1例报道并文献复习

目的探讨原发性精囊癌的诊治方法。方法分析收治的原发性精囊癌1例,结合文献进行复习。结果经CT、MRI及经直肠超声（transrectalultrasound,TRUS）引导下穿刺活检确诊为精囊腺癌,行左侧精囊肿物切除、右侧精囊切除、膀胱与前列腺部分切除及左输尿管膀胱再吻合术,术后恢复良好。现已随访23个月,未见复发转移。结论原发性精囊癌临床罕见,术前诊断较为困难,TRUS引导下穿刺活检可明确诊断,应根据患者个体情况选择不同的根治性切除术。术后定期随访,注意是否复发转移。     

α_(1A)受体阻滞药治疗慢性前列腺炎疗效观察

目的：观察α１Ａ受体阻滞药合用抗生素治疗慢性前列腺炎的疗效,探讨α１Ａ受体阻滞药在缓解慢性前列腺炎综合征中的作用与机制。方法：将１７８例慢性前列腺炎患者随机分为两组,实验组口服α１Ａ受体阻滞药（盐酸坦格新）及氧氟沙星,对照组仅口服氧氟沙星．治疗６周,观察治疗前后尿动力学指标、前列腺液常规及前列腺炎症状评分的变化。结果：合用α１Ａ 受体阻滞药治疗慢性前列腺炎较单用抗生素更为有效。结论;α１Ａ受体阻滞药可降低后尿道压力,缓解尿液前列腺反流．改善慢性前列腺炎患者的症状。     

一次性输尿管软镜与可重复使用输尿管软镜治疗上尿路结石疗效的前瞻性多中心随机对照研究

目的比较一次性电子输尿管软镜和可重复使用纤维输尿管软镜治疗上尿路结石的有效性和安全性。方法本研究采用前瞻性、多中心、单盲、随机对照的试验方法,2018年4—12月按1∶1的比例将符合入组条件的上尿路结石患者通过分层区组随机方法分为试验组和对照组。本研究纳入标准:①年龄18~60周岁,性别不限;②经彩色多普勒超声、X线和CT检查确诊最大径≤2 cm的单侧单发上尿路结石,或单侧肾多发结石且最大径之和≤2 cm;③术前无泌尿系感染或感染已经控制;④肝肾功能正常。排除标准:①患侧合并泌尿系畸形,如肾盂输尿管连接处梗阻、输尿管狭窄等;②肾盏憩室结石;③肾下盏结石同时肾下盏肾盂夹角<30°;④合并肾功能不全;⑤妊娠或哺乳期;⑥心肺功能异常;⑦确诊为出血体质或处于高凝状态。试验组术中使用PU3022A一次性电子输尿管软镜行钬激光碎石,对照组使用Flex-X^2可重复纤维输尿管软镜行钬激光碎石。比较两组的术中手术视频图像质量(以李克特量表为基础并结合临床实践工作制订图像质量评价量表,以此对术中影像资料进行评级,并计算每组图像质量优良率)、碎石成功率、围手术期并发症发生率等。结果本研究共纳入93例患者,其中90例完成试验(广州医科大学附属第一医院、中山大学附属第一医院、南方医科大学附属珠江医院各30例),试验组和对照组各45例。试验组与对照组基线资料比较,单发结石最大径差异有统计学意义[(11.6±5.0)mm与(8.7±3.0)mm,P=0.023],男女比例(29/16与29/16,P=1.000)、年龄[(45.1±9.3)岁与(44.5±8.5)岁,P=0.583]、身高[(164.8±7.8)cm与(164.8±9.0)cm,P=0.978]、体重[(65.3±9.6)kg与(67.5±13.0)kg,P=0.359]、中重度积水比例[31.1%(14/45)与26.7%(12/45),P=0.816]、结石部位(上盏6例与3例,P=0.485;中盏7例与4例,P=0.334;下盏16例与17例,P=0.827;肾盂15例与11例,P=0.352;输尿管24例与25例,P=0.832)、合并高血压病(10例与12例,P=0.623)、合并糖尿病(4例与5例,P=0.725)差异均无统计学意义。手术效果方面,试验组术中手术视频图像质量优良率为100.0%(45/45),对照组图像质量优良率为15.6%(7/45),差异有明显统计学意义(P<0.001)。试验组碎石成功率为68.9%(31/45),对照组碎石成功率为71.1%(32/45),组间比较差异无统计学意义(P=0.818)。两组患者在血红蛋白下降值[(3.91±9.71)g/L与(3.62±8.40)g/L,P=0.880]、术前血肌酐[(84.46±20.00)μmol/L与(83.52±24.58)μmol/L,P=0.451]、术后血肌酐[(92.38±25.38)μmol/L与(89.03±25.71)μmol/L,P=0.536]及术后并发症发生率[6.7%(3/45)与6.7%(3/45),P=1.000]方面差异无统计学意义。结论一次性电子输尿管软镜治疗上尿路结石安全、有效,其安全性和有效性与可重复使用纤维输尿管软镜相似。在手术图像质量方面,一次性电子输尿管软镜明显优于可重复使用纤维输尿管软镜。     

超声引导经直肠前列腺穿刺活检个体化方案的探讨

目的探讨个体化前列腺直肠径路穿刺活检方案的可行性。方法回顾性分析325例疑为前列腺癌患者首次穿刺的临床资料。采用系统12针组合穿刺方案,对可疑病变处补充1～2针,根据穿刺结果,分析穿刺阳性率与针数、体积的关系。结果126例患者确诊为前列腺癌。6、8、10针最大阳性率分别与12针穿刺阳性率比较,差异均有统计学意义。3个不同体积组比较,体积〈40ml组8针与10针阳性率差异无统计学意义,而40.1～60ml组8针与10针,〉60ml组10针与12针阳性率差异均有统计学意义。结论根据前列腺体积和超声表现制定个体化穿刺方案是可行的,体积〈40ml前列腺采用8针,40.1～60ml采用10针和〉60ml采用12针穿刺是合适的。     

肾透明细胞癌组织IRS-5和IRS-6表达及其临床意义的探讨

目的：探讨肾透明细胞癌组织和对应癌旁正常组织中胰岛素受体底物IRS-5和IRS-6基因表达差异及其临床意义。方法：收集经病理确诊的52例肾透明细胞癌患者标本,取肾癌组织和对应的癌旁正常组织,采用实时荧光定量PCR法检测IRS-5和IRS-6基因的表达,并分析两者与临床病理参数之间的关系。结果：IRS-5在肾透明细胞癌组织中的表达水平显著高于对应癌旁正常组织（0．864±0．112VS0．762±0．104）,P=0．021。IRS-5mRNA的表达与肿瘤大小、临床分期及病理分级相关,P〈0．05;而与患者年龄、性别无关,P〉0．05。IRS-6在肾透明细胞癌组织和对应癌旁正常组织中均有表达,两者比较差异无统计学意义（01647±0．116vs0．6124±0．122）,P＝0．32。IRS-6mRNA的表达与患者年龄、性别、肿瘤大小、病理分级及临床分期亦无相关性,P〉0．05。结论：IRS－5基因在肾透明细胞癌中过表达,可能与肿瘤发生发展有关,对临床评价肿瘤恶性度有一定价值;IRS－6基因在肾透明细胞癌和癌旁组织中表达无差异,提示IRS－6基因在肾透明细胞癌中可能不起作用。     

前列腺4区12点系统穿刺活检术诊断前列腺癌

目的 :探讨前列腺系统穿刺活检改进方法的临床价值。　方法 :对 91例疑为前列腺癌的患者进行经直肠B超引导前列腺 4区 12点系统穿刺活检 ,观察其对前列腺癌病灶的检出率 ,并与 6点系统穿刺法比较并发症的发生率。　结果 :前列腺 4区 12点系统穿刺活检 ,可提高前列腺癌的检出率 ,而并发症发生率与标准 6点法相类似。结论 :前列腺体积大于 4 0ml的可疑前列腺癌患者 ,可选择经直肠B超引导前列腺 4区 12点系统穿刺活检术。