前列腺体积和前列腺特异抗原密度与前列腺穿刺阳性率的关系

目的:探讨前列腺体积及前列腺特异抗原密度与前列腺穿刺阳性率的关系并分析其原因.方法:选择2004～2007年间于我院行超声引导下经直肠前列腺系统8针穿刺的患者192例.以前列腺体积<30 ml、30～50 ml、>50 ml为界,计算并比较各组问前列腺穿刺的阳性率及PSAD≥0.15时,前列腺穿刺阳性率的变化.结果:前列腺体积与前列腺穿刺阳性率呈负相关(r＝0.237,P<0.01),前列腺体积<30 ml组,穿刺阳性率为39.1%(18/46);30～50 ml组,阳性率为21.7%(13/60);>50 ml组,阳性率为9.3%(8/86).各组间差异有统计学意义(P<0.01,P<0.05).前列腺特异抗原密度≥0.15时,三组间阳性率差异仍有统计学意义(P<0.01).但三组漏诊率分别为11.1%(2/18)、30.8%(4/13)、62.5%(5/8),差异有统计学意义(P<0.01).结论:前列腺体积是前列腺穿刺阳性率的独立影响因素,应根据前列腺体积制定穿刺方案.     

Ta期膀胱癌经尿道电切加膀胱内灌注治疗后的长期随访

目的　研究Ta期膀胱移行细胞癌(BTCC)经尿道电切加膀胱内灌注治疗的预后及相关因素。　方法　88例初发TaBTCC患者。男62例,女26例。平均年龄61岁(41 ~81岁)。G1 26例、G2 61例、G3 1例。单发者62例(G1 16例,G2 45例,G3 1例),多发者26例(G1 10例,G2 16例)。均行经尿道膀胱肿瘤电切术及膀胱内灌注治疗。平均随访113个月(56 ~168个月),分析肿瘤复发和进展情况及与初发肿瘤分化及数目间的关系。　结果　全组复发53例(60% )。单发肿瘤组16例G1 肿瘤者中复发4例(25% ), 45例G2 者中复发28例(62% ),总复发率为52% (32 /62);多发肿瘤组10例G1 中复发8例(80% ), 16例G2 者中复发12例(75% ),总复发率77% (20 /26)。原发肿瘤为多发者手术后复发率明显高于单发者(P<0. 01),单发肿瘤组中G2 患者复发率明显高于G1 者(P<0. 001)。多发肿瘤组中肿瘤分级与复发率无明显相关差异。G1 肿瘤组复发病例中无肿瘤进展, 40例G2 者中17例(42. 5% )复发时出现肿瘤进展,其中进展为T1G2 者12例,进展为T2G2 者5例。术后膀胱灌注噻替哌、丝裂霉素、卡介苗各组肿瘤复发率分别为75% (12 /16)、68% (30 /44)、40% (11 /27)。1例因癌特异死亡者为TaG3。　结论　多发的Ta膀胱移行细胞癌在经尿道膀胱肿瘤电术加膀胱内灌注治疗后有较高的复发     

老年偶发肾癌保留肾单位手术的临床研究

目的探讨对于老年偶发肾癌行保留肾单位的肾部分切除手术的意义。方法回顾性分析32例老年偶发肾癌病例,患者行保留肾单位的肾部分切除手术,术后平均随访53.6个月(4~97个月)。结果32例患者手术顺利,术中肾血管阻断时间皆小于30 m in。术后病理报告肿瘤切除完整,切缘阴性。术后4周复查时28例肾功能恢复至手术前水平,4例的血清肌酐水平比术前高1.0~1.3 mg/d l。术后随访无肿瘤局部复发和远处转移病例。结论保留肾单位的肾部分切除手术对高龄局限性小肾癌患者是安全有效的。     

1995-2008年北京医院前列腺癌诊断状况变迁

目的 了解血清前列腺特异抗原(PSA)临床应用推广后前列腺癌诊断状况的变化.方法 回顾性分析1995-2008年北京医院新诊断的前列腺癌病例资料,对诊断例数、确诊年龄、PSA水平以及临床分期状况进行分析.结果 14年间共新诊断前列腺癌患者432例,确诊年龄40～90岁,平均(72.0±7.8)岁.新诊断例数逐年增加,尤以2007-2008年显著.与1995-1999年相比,2004-2008年局限性前列腺癌比例由23.9%上升至36.3%,转移性前列腺癌比例由49.3%下降至32.1%;PSA 4～10 ng/ml者比例由12.7%上升至29.2%,PSA＞100 ng/ml者比例由22.5%下降至13.2%.结论 1995-2008年北京医院新诊断前列腺癌例数上升,早期诊断率增加,诊断年龄无明显偏移.前列腺癌的早期诊断率仍有待提高.

Abstract：

Objective To evaluate the morbidity trend of prostate cancer since the clinical usage of PSA was introduced in Beijing Hospital.Methods Retrospectively we analyzed prostate cancer cases diagnosed in Beijing Hospital from 1995 to 2008.The incidence, age, PSA and clinical stage at diagnosis were taken into account.Results Four hundred and thirty-two cases were enrolled into the study.Who were aged 40 - 90 years old, mean age 72.0 ± 7.8 years.The most frequent age at diagnosis was 70 to 79 years.The incidence increased annually with the most significant increase taking place in 2007 and 2008.Compared with the period 1995 to 1999, the localized prostate cancer rate between 2004 and 2008 increased from 23.9% to 36.3%; the metastatic prostate cancer rate decreased from 49.3% to 32.1%; the rate of patients with PSA 4 - 10 ng,/ml increased from 12.7% to 29.2%; the rate of PSA ＞ 100 ng/ml decreased from 22.5% to 13.2%.Conclusions The incidence and early detection rate of prostate cancer in Beijing Hospital increased from 1995 to 2008.The age at diagnosis had not significantly changed.However, the early detection rate should be improved.     

门诊患者对软性膀胱镜和硬性膀胱镜的耐受性比较

目的:为进一步阐明软性膀胱镜在门诊检查中患者耐受性方面的优势。方法:132例门诊患者随机接受软性膀胱镜检查(77例)和硬性膀胱镜检查(55例),用数字分级法对患者检查前、检查中、检查后15min和3天的疼痛指数进行评估。结果:85%的软镜组患者为检查中轻微疼痛(评分为0~3),而硬镜组仅为47%(P<0.05)。检查中疼痛评分软镜组为2.3vs硬镜组3.4(P<0.05)。软镜组检查后15min疼痛评分恢复到检查前水平(0.5vs0.2),而硬镜组(2.3vs0.3)3天后才恢复到检查前水平。结论:软性膀胱镜的耐受性明显好于硬镜,更适于门诊患者的检查。     

Long-term follow-up of Ta transitional cell carcinoma of bladder after treatment of TURBt plus intravesical therapy

Long-term follow-up of Ta transitional cell carcinoma of bladder after treatment of TURBt plus intravesical therapy@朱生才$Dept Urol,Beijing Hosp,Beijing 100730     

CT对膀胱癌局部分期的准确性及影响因素分析

目的：探讨CT对膀胱癌局部分期的准确性以及影响因素。方法：回顾性分析44例肿瘤直径大于1cm且CT、上无明显其他盆腔脏器侵犯的膀胱癌患者临床资料，对比CT的局部分期与手术后病理分期。结果：CT对膀胱癌局部分期总的准确率为43．2％，有52.3％患者存在过高分期。直径1～2cm或大于4cm肿瘤CT分期较直径2～4cm肿瘤更为准确；原位复发的肿瘤分期准确性低于初发或异位复发的肿瘤；移行细胞癌的分期水确件高于非移行细胞癌；有蒂的肿瘤分期准确性高于广基肿瘤。结论：CT对膀胱癌局部分期的作用有限，受到肿瘤大小、基底情况、复发位置以及肿瘤病理类型的影响。     

腹腔镜肾上腺切除术（经腹腔途径）的早期经验

目的：介绍腹腔镜下经腹腔途径肾上腺切除术的早期经验,包括手术技术、影响因素及并发症。方法：回顾性分析2002年2月～2006年12月收治的47例腹腔镜肾上腺切除手术资料。结果：46例成功完成腹腔镜手术,1例转为开放手术。1例右肾上腺术中失血量达到1800ml,1例左肾上腺手术中造成胰尾损伤。肿瘤体积较大者手术时间及术中失血量有增加的趋势。肿瘤的病理类型、手术方式（全切／部分切除）、患者既往腹部手术史、体重指数与手术及术后相关指标无明显相关性。结论：虽然腹腔镜肾上腺切除手术是微创手术方式,但也是高技术含量手术,尤其在开展此项技术的早期,有一定并发症的比例。     

酶联免疫吸附法测定血小板反应素1及其对前列腺癌诊断价值的研究

Objective To use enzyme-linked immunosorbent assay (ELISA) for measuring thrombospondin-1 (TSP-1),and to analyze its diagnostic value for prostatic carcinoma.Methods The possible difficulties and the way to solve the difficulties with ELISA spot were explored first.Three agents which could segregate idio-antigen and one technique which could depurate proteinum were designed and developed.The non- idio- proteinum cross reaction problems were solved and the routine method to measure TSP-1 with ELISA was set up successfully.The serum TSP-1 was measured in 14 patients with benign prostatic hyperplasia (BPH) and 18 patients with prostatic carcinoma.Results The TSP-1 values were (73.77±12.72)% and (121.86±-19.47)% in prostatic carcinoma group and benign prostatic hyperplasia group,respectively (t= 8.44,P＜0.01).The diagnostic sensitivity and specificity of TSP-1 and prostate specific antigen (PSA) for prostatic cancer were 92.7%,88.9% and 85.7%,66.7%,respectively (P＜0.01).The area under the receiver operating characteristic curve (ROC) of TSP-1 and PSA were 0.9663 and 0.7421 (P＜0.05).Conclusions The determination of TSP-1 with ELISA is feasible.TSP-1 is an ideal diagnostic parameter for prostatic carcinoma and it may distinguish BPH from malignant prostatic disease more exactly than PSA.     

经腹腔完全腔镜下肾输尿管膀胱袖状切除中输尿管末段处理的经验总结

目的:探讨完全腹腔镜下肾输尿管膀胱袖状切除术治疗上尿路肿瘤的手术技巧(尤其是末段输尿管的处理技术)及围手术期临床指标。方法:回顾性分析2012年1月～2017年7月在我院接受经完全腹腔下肾输尿管膀胱袖状切除术的87例上尿路尿路上皮癌(UTUC)患者的临床资料,其中男43例,女44例,平均年龄(67.25±9.90)岁;肾盂癌47例,肾盂癌合并输尿管癌10例,输尿管癌30例(输尿管上段癌12例,输尿管中段癌9例,输尿管下段癌11例);左侧49例,右侧38例;肿瘤平均直径(3.24±1.47)cm。87例患者均行全麻下经腹腔完全腹腔镜下肾、输尿管及膀胱袖状切除术,采用健侧卧位,术中无需改换体位。记录手术时间、术中出血量、术中输血情况、引流管留置时间、尿管留置时间、术后并发症。结果:87例手术顺利,无中转开放手术。平均手术时间(162.50±45.64)min,平均术中失血(113.33±59.74)ml,无围手术期输血。术后引流管平均留置(4.56±1.12)d,尿管平均留置(5.63±2.17)d。无术中并发症,术后出现并发症2例手术标本切缘均为阴性。术后病理分期T_1～T_4N_0M_0(T_1期24例,T_2期19例,T_3期37例,T_4期7例)。随访时间1～44个月,平均13个月,术后肿瘤复发8例。结论:经腹腔完全腹腔镜下肾输尿管膀胱袖状切除术对于UTUC的治疗安全有效,在处理下段输尿管时预先切断脐内侧襞可以增加操作空间,降低手术难度。