微创经皮肾穿刺取石术治疗输尿管上段结石

目的 探讨微创经皮肾穿刺取石术(mini—PCNL)治疗输尿管上段结石的手术适应证、方法及疗效。方法 采用X线定位下行微创肾盂输尿管连接处经皮肾穿刺术后，应用输尿管镜和气压腔内碎石机进行碎石取石术。结果 32例患中30例1次取净结石，2例因术中出血，改期行第2次手术取净结石。结石1次取净率93．8％，结石总取净率为100％。结论 mini—PCNL术治疗输尿管上段结石具有取石成功率高、创伤小、恢复快、住院时间短等优点。     

自发性包膜下肾破裂的诊断和处理

目的 提高自发性包膜下肾破裂的诊断和处理水平。方法 对8例自发性包膜下肾破裂进行回顾性分析，8例均行B超和CT检查，均可显示包膜下血肿和积尿，B超、CT、数字减影血管造影(DSA)结合诊断肾内病变。结果 肾错构瘤3例，在DSA下行选择性肾动脉栓塞术(SS—RAE)；肾血管瘤1例，经DSA证实，行SSRAE；肾癌和肾母细胞瘤各1例，行根治性肾切除术；肾盂输尿管积水1例行手术探查，证实肾盂输尿管交界处狭窄，肾实质破裂，行肾修补 肾盂输尿管整形术；1例患拒绝进一步检查治疗。结论 包膜下肾破裂临床症状和影像学表现有其特点。DSA下SSRAE是治疗肾内良性和血管性病变所致包膜下肾破裂的理想方法。     

机器人辅助腹腔镜根治性膀胱切除术的预后风险因素

目的:探讨机器人辅助腹腔镜根治性膀胱切除术(RARC)后的预后风险因素。方法:回顾性分析南京鼓楼医院2014年12月至2018年12月收治的224例行RARC患者的临床和随访资料,男193例,女31例。平均年龄68(36~92)岁。7例(3.1%)接受新辅助化疗。125例(55.8%)美国麻醉医师协会(ASA)评分>2...     

保留性神经的根治性全膀胱切除术探讨

报告6例多发性或浸润性生长的膀胱肿瘤患者行保留阴茎勃起神经的根治性全膀胱切除术，6例中有5例术后保持了阴茎勃起功能，取得满意的效果。报告6例临床资料及手术方法的同时，结合文献复习，着重介绍性神经血管束（NVB）的解剖三维关系及术中如何识别并有效地保护NVB的体会。     

肾移植后骨代谢改变

肾移植已经成为治疗终末期肾脏疾患的一种最为有效方法.由于免疫抑制药物的使用,移植患者存活率逐年提高的同时,骨质疏松甚至骨折的发生率也在增加,不仅降低生活质量,并会使术后生存时间缩短.为了预防骨代谢异常,因此有必要在移植前检测骨密度、脊柱摄片和进行有关的生化检测,早期发现,接受抗骨代谢异常的药物治疗,防止骨量丢失和骨折发生.     

中老年男性血清催乳素水平与良性前列腺增生的关系

目的　探讨中老年男性血清催乳素 (PRL)和睾酮 (T)的变化 ,研究PRL与良性前列腺增生的关系。　方法　将 84例健康中老年男性分为 4个年龄组 ,测定血清PRL和T水平 ,分析不同年龄组的数值变化。采用B超测定其中 38例的前列腺体积 ,与PRL进行相关性分析。　结果　 5 0、6 0、70和 80岁年龄组的T水平分别为 (2 5 .92± 2 .5 4)、(2 1.0 0± 1.92 )、(18.37± 2 .49)和 (14.75±2 .38)nmol/L ,不同年龄组之间T水平比较 ,差别有显著性意义 (F =3.44 ,P <0 .0 5 ) ;PRL水平分别为 (1.11± 0 .16 )、(0 .96± 0 .2 0 )、(0 .99± 0 .18)和 (0 .91± 0 .2 9)nmol/L ,组间比较差别无显著性意义(F =0 .12 ,P >0 .0 5 ) ;PRL水平与前列腺体积无显著相关性 (r =0 .2 5 ,P >0 .0 5 )。　结论　PRL通过雄激素在前列腺的生长过程中产生作用 ,但中老年男性雄激素水平不断降低 ,削弱了PRL在前列腺增生中的作用。     

开放冷循环射频消融治疗孤立肾肾细胞癌

孤立肾或功能性孤立肾肾癌的治疗是一个比较棘手的问题,随着肿瘤局部治疗技术的发展,多种微创的治疗方式被应用于临床,冷循环射频是在传统射频基础上发展起来的一种新型治疗技术.2006年5月至2008年3月,我院应用该技术治疗9例孤立肾肾细胞癌,临床疗效较满意,现报告如下.     

后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

开放性冷循环射频消融治疗近肾门处肾错构瘤的临床疗效

目的：探讨开放性冷循环射频消融治疗近肾门处错构瘤的可行性及临床疗效。方法：对4例近肾门处错构瘤患者实施开放性错构瘤切除,肿瘤基地部行冷循环射频消融治疗。肿瘤位于左肾l例,右肾3例。肿瘤最大径5～8．5cm。术后采用CT、超声造影定期随访。结果：平均手术时间（95i20）min,平均出血量（100±28）ml,术中均未输血。术后疼痛3例,术后均有发热,体温（39．0±0．5）℃。术后6周,4个病灶均完全消融。术后有1例患者血红蛋白降低明显但未输血,术后血肌酐、红细胞沉降率较术前无明显变化;肿瘤较大者术后短期内肾小球滤过率减低。4例患者获得3个月后CT复查,4例病灶完全消融,随访时间2～18个月,未见肿瘤复发。结论：冷循环射频消融是一种安全有效的治疗新方法;采用开放性射频消融保留肾单位手术治疗近肾门处肾错构瘤是一种可供选择的方法,临床效果比较理想。