64层螺旋CT尿路成像技术在泌尿系统疾病中的临床应用

目的探讨64层螺旋CT尿路成像技术对泌尿系统疾病的诊断价值。方法收集50例手术或临床确诊的泌尿系统疾病患者,均进行64层螺旋CT尿路成像检查,对影像资料进行回顾性分析。结果 50例中,泌尿系统结石29例,泌尿系先天性畸形8例,输尿管炎性狭窄5例,肾盂癌3例、输尿管癌3例,膀胱癌2例。CT尿路成像技术能够清晰显示输尿管走行、腔内情况、梗阻部位和原因。结论 64层螺旋CT尿路成像技术能够准确的诊断泌尿系统疾病,图像清晰直观,可以作为早期确诊泌尿系统疾病的有效影像检查方法。     

MUC1在泌尿系肿瘤的相关研究进展

MUC1是一种高相对分子质量糖蛋白,属于黏蛋白家族成员,正常情况下存在于许多人上皮细胞膜的腺腔面,具有多种功能,其核心肽由胞外段、跨膜段和胞内段组成。短的跨膜段和胞内段在不同种属间的结构是高度保守的,长的胞外段含有20~125个连续重复序列,连续重复序列由20个氨基酸组成,富含丝氨酸、苏氨酸和脯氨酸残基。在多种肿瘤组织中,MUC1异常表达和异常糖基化。虽然,在泌尿系肿瘤,如膀胱癌、肾癌、前列腺癌,其确切功能尚不清楚,但MUC1可作为肿瘤标志物和靶点应用于放免诊断和治疗,MUC1同这些肿瘤的浸润、转移和预后也密切相关。其在泌尿系肿瘤中特征性变化具有一定的临床应用价值。     

Are Coffee, Tea, and Total Fluid Consumption associated with Bladder Cancer Risk? Results from the Netherlands Cohort Study

Objectives: Coffee, tea, and fluid consumption have been thought to influence bladder cancer incidence. In a large prospective study, these associations were investigated. Methods: In 1986, cohort members (55–69 years) completed a questionnaire on cancer risk factors. Follow-up was established by linkage to cancer registries until 1992. The multivariable case–cohort analysis was based on 569 bladder cancer cases and 3123 subcohort members. Results: The incidence rate ratios (RR) for men consuming <2 cups of coffee/day was 0.89 (95% CI 0.51–1.5) using the median consumption category (4–<5 cups/day) as reference. This RR increased to 1.3 (95% CI 0.94–1.9) for men consuming 7 cups/day, although no clear dose–response association was found. The RRs decreased from 1.2 (95% CI 0.56–2.7) for women consuming <2 cups of coffee/day to 0.36 (95% CI 0.18–0.72) for women consuming 5 cups/day compared to the median consumption category (3–<4 cups/day). Men and women who abstained from drinking tea had a RR of 1.3 (95% CI 0.97–1.8) compared to those consuming 2–<3 cups of tea per day (median consumption category). The RR for men and women comparing highest to lowest quintile of total fluid consumption was 0.87 (95% CI 0.63–1.2). Conclusion: The data suggest a possible positive association between coffee consumption and bladder cancer risk in men and a probable inverse association in women. Tea consumption was inversely associated with bladder cancer. Total fluid consumption did not appear to be associated with bladder cancer.     

双J管内引流在尿路手术中的应用（附64例报告）

为探讨双Ｊ管内引流在尿路手术中的应用效果，于１９９０年４月～１９９４年１２月，在尿路手术中采用国产ＰＶＣ双Ｊ管内引流６４例。病种包括：复杂性尿路结石、输尿管狭窄、肾盂输尿管连接部狭窄和输尿管膀胱移植等。置管方法分手术中和内窥镜下置管二种。置管引流时间１周～２年。置管引流后，伤口漏尿、伤口感染等手术并发症减少。对置管后对上尿路的影响、置管的适应证、置管引流的时间和并发症进行了讨论。认为采用双Ｊ管内引流具有操作简便、引流效果好、并发症少等优点，宜推广使用。     

Kidney folding: the Y-plasty--a means of creating a dependent ureteropelvic junction in the child with giant hydronephrosis

PURPOSE: Occasionally, in the presence of severe dilatation and parenchymal thinning, postoperative obstruction or stasis may secondarily occur even after creation of a funneled ureteropelvic junction. Preferential filling of a severely dilated lower pole may kink or distort the ureteropelvic junction, causing this problem. MATERIALS AND METHODS: A requirement for renal folding is a large hydronephrotic kidney with severe mid renal parenchymal thinning. After pyeloplasty if it is apparent that secondary obstruction is a possibility, and simple lateral or posterior fixation of the lower pole to retroperitoneal fascia will not resolve the problem, the lower pole can be brought superiorly adjacent to the upper pole and fixed in position with 2 or 3, 2-zero or 3-zero polyglactin sutures, creating a "Y" configuration with the ureteropelvic junction dependent from all calices. We reviewed the records of 5 children who underwent this procedure. RESULTS: Five patients with severe upper tract dilatation were treated successfully. Four underwent primary pyeloplasty with concomitant renal folding, and 1 had persistent hydronephrosis with recurrent pyonephrosis before undergoing this procedure secondarily. All patients achieved excellent results with normal drainage postoperatively. CONCLUSIONS: Renal folding is a simple surgical maneuver that can be applied easily and successfully when the situation warrants. It allows creation of a dependent, funneled ureteropelvic junction in the presence of giant hydronephrosis.     

不同入路腹腔镜手术与开放手术治疗大体积肾癌临床疗效的对比研究

目的 探讨腹腔镜下不同入路手术与开放式切除术治疗大体积肾癌(＞7cm)的疗效及安全性.方法 回顾性分析我院2009年1月-2015年1月经腹腔镜手术切除治疗的60例肾脏肿瘤患者的临床资料,根据手术入路不同分为经腹腔入路手术组与经腹膜后入路手术组,每组30例.选择同期30例接受开放式切除术的肾脏肿瘤患者作为对照.比较三组患者的术前检查情况、围术期资料以及术后恢复情况.结果 术前CT扫描显示肿瘤位置、与周围组织的关系三组间比较差异无统计学意义(P＞0.05).经腹腔入路组和经腹膜后入路的手术时间显著高于开放手术组,并且经腹腔入路组明显高于经腹膜后入路组,差异有统计学意义(P＜0.05).开放手术组患者出血量显著高于经腹腔入路组和经腹膜后入路组(P＜0.05),而经腹腔入路组与经腹膜后入路组比较差异无统计学意义(P＞0.05).经腹腔入路组和经腹膜后入路组的术后住院时间显著低于开放手术组,差异有统计学意义(P＜0.05).输血例数、术中与术后并发症以及转ICU情况三组间比较差异均无统计学意义(P＞0.05).术后病理结果显示,经腹腔入路组患者肿瘤TNM分期显著高于经腹膜后入路组,差异有统计学意义(P＜0.05),两组病理状态和肿瘤分级比较差异无统计学意义(P＞0.05).结论 腹腔镜手术治疗大体积肾癌是安全可行的.     

Effect of Intraoperative Paracetamol on Catheter-Related Bladder Discomfort: A Prospective,Randomized, Double-Blind Study

Background

The insertion of urinary catheters during urinary surgical interventions may lead to catheter-related bladder discomfort (CRBD) in the postoperative period.

Objective

We aimed to evaluate the effect of single-dose intravenous paracetamol on CRBD.

Methods

In this randomized, controlled, double-blind study, 64 patients (age >18 years, American Society of Anesthesiologists Physical Status I–II) requiring urinary bladder catheterization for percutaneous nephrolithotomy were assigned to groups that received either intravenous paracetamol (15 mg/kg) (group P) or NaCl 0.9% solution (control group [group C]) 30 minutes before the end of surgery. Patients received patient-controlled analgesia (10-mg bolus of meperidine, without infusion, 20-minute lock out) postoperatively. CRBD and pain status were assessed at 30 minutes and 1, 2, 4, 6, and 12 hours postoperatively. Postoperative meperidine requirement and patient and surgeon satisfaction were assessed.

Results

Group P had significantly lower CRBD scores at all time points except at 12 hours postoperatively compared with group C (P < 0.05). Total meperidine consumption was significantly higher in group C (P < 0.05). Patient and surgeon satisfaction scores were significantly higher in group P (P < 0.05).

Conclusions

Intraoperative single-dose paracetamol was found to be effective in reducing the severity of CRBD and pain in urologic surgery. We suggest that it may be an efficient, reliable, easy-to-apply drug for CRBD. ClinicalTrials.gov identifier: NCT01652183.     

单孔多通道腹腔镜泌尿外科手术单中心临床应用总结

目的总结单中心100例次泌尿外科单孔多通道腹腔镜手术的临床疗效和经验。方法自2008年12月至2011年5月,98例患者先后在我科接受单孔多通道(TriPort TM)腹腔镜手术,其中2例患者行双侧手术,共完成各类手术100例次;其中肾癌根治术24例,肾脏部分切除术3例,无功能肾切除术10例,肾囊肿去顶减压术21例,单侧肾上腺切除术12例,输尿管切开取石术6例次,经膀胱前列腺剜除术9例,其他手术15例。收集患者基本信息、围手术期各项临床指标及随访资料并进行分析。结果 100例次单孔多通道腹腔镜手术中,87例手术在不增加任何辅助孔的情况下顺利完成,9例手术增加1个5mm的辅助孔,1例中转传统腹腔镜手术,3例中转开放手术。总体并发症发生率为15%(术中6%,术后9%)。前50例总体并发症发生率为5%,后50例为10%。手术疗效满意,美容效果好,肿瘤患者术后平均随访9.9±5.61(3～24)个月,未出现复发或转移。结论单孔腹腔镜技术在泌尿外科的应用安全、可行,创伤小,切口隐蔽。但早期应用阶段仍有一定的并发症发生率,应严格把握手术适应证。随着手术器械的进一步改进、临床经验的不断积累以及优化设计的前瞻性大样本多中心临床随机对照研究的完成,单孔腹腔镜技术将在泌尿外科疾病的诊治中发挥更大的优势。     

Food and Drug Administration process for development and approval of drugs and radiopharmaceuticals: Treatments in urologic oncology

Regulatory advice and assessment play an important role in the successful development of new drugs and radiopharmaceuticals for the treatment of urologic malignancies. Cooperation between the US Food and Drug Administration (FDA) and the pharmaceutical industry has led to the approval of more than 20 new urologic oncology products in the last 2 decades. Despite these advances, more effective treatments need to be developed and approved for the treatment of urologic malignancies. This review provides general information about the FDA׳s role in the development of investigational new drugs, with an emphasis on the regulatory process and the requirements for marketing approval. In addition, this review summarizes the products for the treatment of urologic malignancies that were approved by the FDA in the last 30 years and the key issues concerning urologic oncology products that were discussed publicly at Oncologic Drug Advisory Committee meetings in the past 10 years.