不同方式的睾丸切除术在进展期前列腺癌治疗中的疗效比较

目的比较保留附睾的睾丸切除术（A组）与传统睾丸切除术（B组）在进展期前列腺癌治疗中的疗效,探讨睾丸去势治疗的最佳选择方式。方法进展期前列腺癌60例,A、B组各30例。均在局麻下行单切口双侧睾丸切除术,术后第1天起口服非类固醇类雄激素阻断剂。分别于术前、术后1周及1、3、6、9、12个月,观察2组血清总睾酮、前列腺特异性抗原（PSA）变化;了解患者手术满意度等。结果去势术后12个月,A、B组血清睾酮平均水平分别为0．2nmol／L（95％置信区间0．1～0．9nmol／L）、0．3nmol／L（95％置信区间0．2～0．9nmol／L）,均〈1．9nmol／L,2组均数比较,P〉0．05;A组PSA平均值0．22ng／ml,B组0．27ng／ml,2组均数比较,P〉0．05。问卷调查示A组满意度为96．7％（29／30）,B组为53．3％（16／30）。结论2种睾丸切除术在进展期前列腺癌治疗中疗效无明显差异,但保留附睾的睾丸切除术、附睾成形术有助于满足患者的阴囊外观形态和心理需要。     

青春期睾丸扭转的临床探讨

目的 探讨青春期睾丸扭转的诊治特点,为临床提供有效支持。方法 30例青春期睾丸扭转患者,根据首发症状将其分为对照组和实验组,每组15例。对照组为阴囊痛,实验组为腹痛,两组均给予泌尿外科常规手术治疗。观察两组睾丸切除情况。结果 实验组睾丸切除率为46.7%,明显高于对照组的13.3%,差异有统计学意义(P<0.05)。结论 首发症状为腹痛的睾丸扭转危害更大,临床应快速准确地对此类疾病予以确诊,为治疗争取时间,降低睾丸切除率。     

补骨胶囊对去睾丸大鼠骨代谢影响的定量研究

目的观察补骨胶囊防治大鼠去睾丸致骨质疏松的作用及其机理的探讨。方法２１只３月半龄ＳＤ雄性大鼠,随机分成年龄对照组、去睾丸组和补骨胶囊用药组（含淫羊藿,黄芪,白术）按５ｍｌ．ｋｇ＾－１。ｄ＾－１ｉｇ,持续９０天。实验结束,取胫骨近心端行不脱钙骨制片进行骨组织形态计量学分析。结果去睾丸９０天大鼠的骨量与年龄对照组比明显下降（骨小梁面积百分率％Ｔｂ．Ａｒ－５０％）;补骨胶囊用药组骨量高于去睾丸组（％Ｔｂ     

睾丸扭转手术方式的选择

目的 :探讨手术治疗睾丸扭转时的发病时间对手术方式选择的意义。方法 :对本院 1993～ 2 0 0 0年间收治的 19例睾丸扭转患者的发病至手术时间和手术效果进行观察。结果 :发病至手术时间 10 h内的 8例扭转复位患者 ,术后睾丸均存活 ;发病至手术时间 10～ 2 4h的 4例睾丸扭转复位患者 ,3例睾丸存活 ;发病至手术时间 >2 4h的 2例睾丸扭转复位患者 ,1例睾丸存活。结论 :10 h以内的扭转均应行睾丸扭转复位固定术 ;10～ 2 4h的扭转睾丸复位存活的可能性尚存在 ;>2 4h者应行手术切除 ,不宜保留     

全雄激素阻断与单纯睾丸切除治疗前列腺癌的疗效比较

目的　探讨全雄激素阻断治疗前列腺癌的有效性及必要性。方法　 19例确诊前列腺癌的患者 ,随机分为单纯睾丸切除组和睾丸切除 +全雄激素阻断组 (简称全雄激素阻断组 ) ,分别观察比较术前、术后PSA、前列腺肿块、前列腺体积、患者生存期等情况。结果　两组术后 1个月PSA均呈快速下降 ,但术后 3～ 6个月全雄激素阻断组PSA下降 (P <0 0 5 ) ,前列腺肿块、前列腺体积缩小明显优于单纯睾丸切除组 ,生存期亦长于单纯睾丸切除组 (P <0 0 5 )。结论　全雄激素阻断治疗方法明显优于单纯睾丸切除 ,患者生存期明显长于单纯睾丸切除     

Timing and surgical management of neonatal testicular torsions

Background

The timing and surgical management of neonatal testicular torsions (NTTs) remain controversial, varying from immediate orchiectomy with empirical contralateral orchiopexy to expectant management with resulting atrophy of the affected testicle. The goal of the present study is to review the management of this entity at our institution.

Materials and methods

A retrospective study of all patients with NTT from 1989 to 2007 was undertaken. The age, clinical presentation, investigation, management, and short- and long-term outcomes were noted.

Results

Forty-four patients were included. Most presented with a firm testicular mass, scrotal discoloration, and hydrocele (42), whereas a few presented with testicular atrophy (2). The median age at presentation was 1 day of age (range, 0-84 days), with NTT occurring on the right side in 22 patients and the left side in 20. Two patients (5%) had bilateral torsion at presentation. In 33 patients, the diagnosis was confirmed by Doppler ultrasonography, whereas 11 patients did not undergo any additional investigation. Surgical management included ipsilateral orchiectomy and contralateral orchiopexy (IOCO) (27), orchiopexy of the contralateral testis (CO) (7), bilateral orchiopexy (4), orchiectomy of the ipsilateral testis (1), orchiopexy of the ipsilateral testis (2), and observation (1). The 2 bilateral torsions underwent bilateral orchiectomy (2). The median age at surgery was 25 days (range, 1-912 days). Postoperative complications occurred in 8 patients (18%), mainly in those with IOCO (4) and CO (4) operated before 12 days of age, and included recurrent hydrocele (3), wound infection (2), urinary tract infection (1), and others (2). Upon follow-up, patients who underwent CO developed ipsilateral testicular atrophy (6). No patients were readmitted for recurrence of torsion or other complications.

Conclusion

At our institution, the most frequent management of unilateral neonatal testicular torsions is IOCO or CO, but this carries an 18% complication rate, particularly if surgery is performed early. There seems to be no advantage to early intervention, and the need for orchiectomy is debatable because torsion leads to ipsilateral testicular atrophy. Contralateral orchiopexy done to decrease the incidence of bilateral asynchronous torsion should, at the very least, be deferred until the risks of anesthesia and surgery are improved, given its rarity. Given the fact that most patients underwent IOCO or CO, we cannot conclude which strategy is the best for neonatal testicular torsions. A prospective study is welcomed.     

Tumores testiculares en la edad pediátrica: indicaciones de la cirugía conservadora

Introduction and objectives

Although standard surgical treatment of a testicular tumour is orchiectomy, use can be made of testis-sparing surgery in selected cases, based on tumour markers, tumour size, and histopathological findings. Our objective is to become acquainted with the indications of testis-sparing surgery as a treatment for the incidental finding of a palpable and non-palpable testicular mass.

经尿道前列腺汽化电切加联合内分泌疗法治疗老年高危晚期前列腺癌

目的：探讨老年高危晚期前列腺癌患者的治疗。方法：21例病人均采用经尿道前列腺汽化电切术，病理确诊为前列腺癌后加行双侧睾丸切除术和每2个月交替口服氟他胺、康士得的联合内分泌疗法。结果：所有患者术后均排尿通畅，下尿路梗阻情况明显缓解，最大尿流率（Qmax）由术前（7．7＋2．4）mL／S上升至术后（14．6＋3．5）mL／S，膀胱残余尿由术前（180＋80）mL下降至术后（30＋101mL，6例骨痛患者治疗后疼痛消失。术后治疗3个月PSA下降至正常范围19例，6个月后PSA均下降至正常。术后生存2年以下的2例，超过3年的5例，超过5年的2例，仍健在的12例。结论：老年高危晚期前列腺癌患者行经尿道前列腺汽化电切术，能解除下尿路梗阻，联合内分泌疗法明显抑制肿瘤生长而延长生命。     

老年前列腺癌去势患者性激素水平变化及血栓危险因素分析

目的研究老年前列腺癌患者去势后性激素水平变化,进一步探讨性激素对血栓危险因素的影响。方法选择247例>65岁老年患者,其中122例去势前列腺癌患者(去势组)、61例行根治性前列腺癌切除术的未去势前列腺癌患者(未去势组)和64例非前列腺癌(非前列腺癌组)患者。分别测定睾酮、雌激素、黄体生成素(LH)、卵泡刺激素(FSH)、泌乳素、孕激素,同时测定了血小板计数(PLT)、花生四烯酸(AA)诱导的血小板聚集率、二磷酸腺苷(ADP)诱导的血小板聚集率、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、D-二聚体(DD)、抗凝血酶-Ⅲ(AT-Ⅲ)、纤维蛋白原(FIB)、国际标准化比值(INR)。结果老年前列腺癌患者接受去势手术治疗后睾酮、雌激素、孕激素水平明显降低,LH、FSH显著升高,但泌乳素无明显变化,雌、雄激素比显著升高;同时AA诱导的血小板聚集率、ADP诱导的血小板聚集率、DD及FIB显著升高,INR显著降低,PT和APTT显著缩短;但PLT和AT-Ⅲ无明显变化。结论老年前列腺癌患者去势治疗后性激素水平紊乱,主要表现为睾酮、雌激素水平明显降低,但雌激素降低幅度小于雄激素;血小板和凝血活性显著增强,提示性激素水平紊乱可能参与凝血系统激活,增加血栓事件危险。     

The effects of orchiectomy,oestrogens and cyproterone-acetate on the antithrombin-III concentration in carcinoma of the prostate

Summary The incidence of thromboembolic complications is increased in patients with oestrogen-treated prostatic carcinoma. Because reduced antithrombin-III (AT-III) levels are associated with increased risk of thromboembolism we have determined AT-III concentrations during oestrogen therapy and other treatments. Forty-six patients with carcinoma of the prostate were allocated to either treatment with subcapsular orchiectomy, oestrogen administration, or cyproterone acetate. AT-III was determined before treatment, at 2 weeks and 2 months later. During oestrogen therapy there was a significant reduction in AT-III to 77% of the base-line value. No significant changes were found after orchiectomy. During cyproter one-acetate treatment there was a slight but significant increase in AT-III at 2 months. The reduction in AT-III could indicate an increased risk of thromboembolism during oestrogen treatment of patients with carcinoma of the prostate. On the other hand, the unchanged AT-III levels after orchiectomy and the increased levels during cyproterone acetate therapy could mean that the risk of thromboembolism is less with these two forms of treatment.