男性乳腺癌临床特点及诊治体会

目的 探讨男性乳腺癌的发病因素及诊断治疗原则方法.方法 分析1992-2007年收治36例男性乳腺癌资料.结果 本文报告36例男性乳腺癌全部行手术治疗,其中单纯癌15例、腺癌7例、浸润性导管癌6例、髓样癌5例、黏液腺癌2例、硬癌1例,文中对其症状、诊断治疗进行了分析讨论,指出了男性乳腺癌预后差与就诊迟治疗晚有关,手术方式以扩大根治及改良根治为主,术前应做好植皮的准备,术后辅以化疗、内分泌治疗、免疫、放疗等治疗.     

138例食管胃结合部肿瘤病例分析

目的：通过分析138例食管胃结合部肿瘤的临床病理特征、手术方式,探讨食管胃结合部肿瘤不同Siewert分型和手术方式对预后的影响。方法：回顾性分析洛阳市中心医院2000年-2006年食管胃结合部肿瘤138例手术病例的临床病理特征及手术方式,将138例病例参照Siewert分类方法进行分类,分析不同Siewert分型和手术方式对预后的影响。结果：138例中AEGⅠ型10例,AEGⅡ型20例,AEGⅢ型108例,三种类型AEG预后存在明显差别,不同手术方式的5年生存率明显不同,脾切除的患者生存时间无明显改善,并发症增加。结论：三种类型的AEG预后不同,选择不同手术方式其5年生存率亦不同,根据AEG分型选择适当手术方式可以改善预后;脾脏切除并不能改善患者预后,保留脾脏的淋巴结清扫是可行的,但要确保做到肿瘤的根治切除和严格的淋巴结清扫。     

辽宁省农村幽门螺杆菌根除术利用情况分析

目的了解辽宁省农村幽门螺杆菌(Hp)根除术利用情况。方法采取随机抽样的方法,在辽宁省庄河、本溪两县调查540例慢性胃病患者及78名医生对Hp根治疗法的知晓和利用情况。结果两县慢性胃病患者及医生对Hp根治疗法知晓率分别为4·4%和78·9%,两县患者对Hp根治法的知晓率间差异有显著性意义(P<0·05),两县医生对Hp根治疗法的知晓率间差异无显著性意义(P>0·05),两县患者的Hp根治疗法使用率间差异无显著性意义(P>0·05),但两县医生Hp根治疗法的使用率间差异有显著性意义(P<0·05)。结论辽宁省农村大多数慢性胃病患者不了解Hp感染与慢性胃病的关系,且医生对Hp根治疗法的知晓率和使用率较低,故Hp根治疗法的普及亟待提高。     

Modifiable Factors to Decrease the Cost of Robotic-Assisted Procedures

In 2000, the US Food and Drug Administration approved the da Vinci Surgical System® for use in the United States. Since that time, the number of surgical robotic systems throughout the United States has continued to grow. The costs for using the system include the initial purchase ($1 million to $2.3 million) plus annual maintenance fees ($100,000 to $150,000) and the cost of limited-use or disposable instruments. Increasing the number of procedures that are performed using the robotic system can decrease the per-procedure costs. Two modifiable factors that contribute to increasing the annual caseload are increasing the number of surgeons capable of using the system and having a properly educated perioperative nursing team. An educated surgical team decreases turnover time, facilitates proper flow of each surgical procedure, and is able to actively and passively solve intraoperative problems.     

Electrical stimulation versus extracorporeal magnetic innervation for urinary incontinence after radical prostatectomy

Nurses use several conservative methods for treating urinary incontinence after radical prostatectomy. Functional electrical stimulation (FES) has a recognized role, while extracorporeal magnetic innervation (ExMI) is still under evaluation in the international guidelines. Few data are available in literature, regarding comparisons between these two treatments. The aim of the study is to compare electrical stimulation and magnetic innervation for treating urinary incontinence after radical prostatectomy. Twenty‐two patients treated with ExMI and 18 treated with FES were enrolled in a retrospective study. ExMI was available for 6 weeks; the number of times ExMI was required by the patients to reduce their leakages to 10 g/d or less was compared. The groups had comparable age and body mass index. Initial leakages showed clinically relevant differences (median = 80 g/d in the ExMI patients and 150 g/d in the FES group). After 6 weeks, 71·9% of ExMI patients and 29·2% of FES patients had completed rehabilitation. The difference was statistically significant even after adjusting the analyses for initial leakages (p = 0·008). Six patients treated with ExMI had already undergone FES, with no clinically relevant results after five sessions (leakages reduction <50 g/d). The difference remained even after removing the data of these patients from the analysis (p = 0·004). Both FES and ExMI produce muscle strengthening, which is just one step of rehabilitation. Our findings suggest the possibility of using ExMI instead of FES to reduce the times required to improve muscular performance. Pelvic muscle exercises remain essential to develop the ability to automatically perform the contractions needed to avoid leakages.     

HOLMIUM LASER VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE: A RANDOMIZED PROSPECTIVE TRIAL WITH 1-YEAR FOLLOWUP

PURPOSE: The high-powered holmium:YAG laser can be used for incision, ablation and resection of the prostate. The technique of holmium laser resection of the prostate is compared to transurethral prostatic resection for surgical management of benign prostatic hyperplasia in this prospective randomized study. MATERIALS AND METHODS: A total of 120 urodynamically obstructed cases were randomized to holmium laser or transurethral prostatic resection. All eligible patients were assessed preoperatively and at 3 weeks, and 3, 6 and 12 months postoperatively with an American Urological Association symptom score, peak urinary flow rate, and questionnaires concerning sexual function and continence. Preoperative pressure flow study, ultrasound prostate volume assessment and post-void residual volume measurement were repeated at the 6-month visit. All complications were noted. RESULTS: Holmium laser and transurethral resections resulted in significant improvements in symptom score, quality of life score, peak urinary flow rate and post-void residual urine measurements. Operating time was significantly longer in the holmium group but nursing contact time, catheter time and hospital stay were significantly less compared to the transurethral prostatic resection group. Urodynamic results were equivalent at 6 months. There were fewer side effects in the holmium group. Effects on continence, potency and symptoms were similar with 1-year followup. CONCLUSIONS: Holmium and transurethral resections of the prostate appear to be equivalent in surgical management of bladder outflow obstruction due to benign prostate hyperplasia. Perioperative morbidity was less in the holmium group.     

改良低压可控性回肠代膀胱术

目的建立一种更接近生理的回肠代膀胱术。方法１９９１～１９９８年实施５例全膀胱切除,回肠膀胱与尿道吻合,由外括约肌控制,经尿道排尿的新手术方法。结果术后随访３～８４个月,平均２８．６个月。至随访日,５例无吻合口狭窄,排尿通畅。３个月后４例完全控制排尿,１例仍有不完全性尿失禁。结论该术式具有贮尿囊内压低（２０～３０ｃｍＨ２Ｏ）,容量略小（２５０～３００ｍｌ）,可控性和原位排尿的优点,且无电解质紊乱和肾功能损害。     

Radical cystectomy in septuagenarian patients with bladder cancer

Introduction: Clinical results of radical cystectomy performed on elderly bladder cancer patients over 70 years old were assessed to determine whether age is one of the critical points for the application of this type of surgery. Materials: From January 1992 to December 2002, 41 radical cystectomy performed in septuagenarian population were compared with 197 performed in patients less than 70 years of age. Results: The early and late complication rate for septuagenarians was 29.7% and 12%, compared with 26.9% and 9.6% for patients younger than 70 years respectively. The overall mortality rate for septuagenarians was 4.9%, compared with 8.6% for patients younger than 70 years. There was no significant difference between the two groups with regard to pathologic stage or length of hospital stay. The 5-year overall survival rate for septuagenarians was 53% compared with 59% for patients younger than 70 years. Conclusions: When indicated after adequate preoperative assessment and optimization of the patient, radical cystectomy is a safe procedure in the septuagenarians and patient should not be denied surgery dependent on chronologic age.     

The role of complete surgical resection in stage IV neuroblastoma

The purpose of this study was to examine the outcome of attempted radical surgical resection in patients with stage IV neuroblastoma. Between 1989 and 2003, 20 (median age 2.4 years, range 0.5–8.7 years) children with stage IV neuroblastoma were treated at the Department of Pediatrics. Surgery was performed in 7 consecutive children (6 male and 1 female) between July 1997 and February 2002 at the Department of Urology in Bonn. Mean age at diagnosis was 57 months (21–104 months). Mean age at the time of surgery was 54 months (8–390 months). Follow-up was available for all patients (100%) and mean follow-up after the operation was 32.5 months (4–56 months). Primary localization of the tumor was retroperitoneal in all cases; 4 out of 7 patients (57%) also had additional adrenal, 3 out of 7 (42%) paraganglion and 1 out of 7 (14%) thoracic primaries. Bone marrow and lymph node metastases were found in all patients (100%). Surgery led to complete tumor resection in 6 out of 7 patients (85%). Surgical approach was abdominal (chevron incision) in 6 out of 7 (85%) of the patients, in one patient the approach was thoraco-abdominal. After induction chemotherapy and delayed surgery, 6 out of 7 (86%) patients showed a complete remission (CR) and the mean CR lasted for about 27.7 months (range 3.1–55.4 months). At the last time of follow-up 5 out of 7 (71%) patients were alive, 2 had died due to recurrent disease. Mean time to recurrent disease was 24 and 51 months, respectively. Mean overall survival time since diagnosis was 38.3 months (11–64 months) and mean event-free survival was 34.5 months (11–60.3 months). The final outcome, overall survival and event-free survival time was influenced by metastatic or local relapse. Tumor resection is beneficial but the value of surgery can only be judged when we are able to control metastatic disease in stage IV neuroblastoma. The final outcome may rely on the extent of complete surgical resection, but is also related to treatment of metastases. A longer follow-up period is indicated to detect long term outcome.     

An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series

PURPOSE: Positive surgical margins adversely affect biochemical recurrence-free survival after radical retropubic prostatectomy (RRP) for prostate cancer. We retrospectively reviewed a large series of men who underwent RRP at a single academic university urology program to define the change in the incidence of organ confined (OC) disease and positive surgical margin (SM+) during the last 2 decades. MATERIALS AND METHODS: Between 1982 and 2001, 9,035 men underwent RRP for clinically localized prostate cancer (T1 to T3a) at a single institution. We compared the incidences of OC disease and SM+ in this population. RESULTS: An increasing proportion of men presented with OC disease over time. The incidence of SM+ in the overall RRP population decreased dramatically over time. However, in men with nonorgan confined disease (pT3), the proportion with SM+ was stable and consistently elevated (22.7% to 27.8%), after the initial decrease from the early 1980s (53%). CONCLUSIONS: Widespread early detection programs for prostate cancer resulted in a downward stage migration in men presenting with clinically localized prostate cancer at our institution during the last 2 decades. The decrease in the percentage of men with SM+ was due to the increasing number of men with organ confined disease. These results imply that the decrease in surgical margin rates in the overall RRP population is most likely due to stage migration and improved patient selection, rather than major improvements in surgical technique. The stable percentage of SM+ among men with pT3 disease dictates the need for continued evaluation of surgical technique and the need for effective adjuvant therapy.