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目的 评估高选择性α1受体阻滞剂坦索罗辛对肾结石体外震波碎石(ESWL)术后辅助排石作用的有效性及安全性.方法 140例单发的非下盏部位的肾结石患者,结石大小6~20 mm,ESWL碎石成功后随机分为两组,每组70例.对照组给予标准治疗包括中成药尿石通丸及司帕沙星,试验组接受标准治疗基础上加用坦索罗辛,随访2个月.结果 试验组(坦索罗辛组)单次ESWL后结石排出率、结石排出时间、石街形成率、肾绞痛发生次数及哌替啶的使用次数等指标均优于对照组(P值分别为0.009,0.000,0.028,0.012,0.002),但两组之间的结石排净率差异无统计学意义(P =0.125).按结石大小进行分组分析,结石≥10 mm患者中,坦索罗辛组的结石排净率高于对照组,差异有统计学意义(P=0.044),且其余各项指标均优于对照组(P<0.05).结石< 10 mm者,坦索罗辛组仅结石排出时间与肾绞痛发生次数两项指标优于对照组(P=0.001,0.026).坦索罗辛组药物副作用发生率与对照组相比差别无统计学意义(P =0.085),且症状轻微,无一例患者因副作用停止治疗.结论 坦索罗辛能够促进并加快肾结石单次ESWL术后碎石排出,减少石街形成并降低肾绞痛发生频率及止痛针使用,对于≥10 mm肾结石患者还能够提高结石排净率,用于辅助排石安全有效. 相似文献
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目的 探讨荧光原位杂交技术(FISH)在上尿路尿路上皮癌(UC-UT)诊断中的应用价值.方法 收集20名健康人尿液行FISH检查且建立阈值,再留取65名疑为UC-UT患者和55名上尿路结石患者尿液行FISH和尿脱落细胞检查.以病理结果为标准,比较这两种检查方法的准确性.结果 65例疑为UC-UT患者中58例病理确诊为UC-UT.FISH检测UC-UT总敏感性84.48%,与尿脱落细胞学检查的39.66%相比,差异有统计学意义(P=0.000);而特异性相仿,分别是92.72%和98.18% (P=0.363).FISH和尿脱落细胞学检查对低级别尿路上皮癌敏感性分别是63.64%和22.73%,对高级别尿路癌的敏感性分别是97.22%和50.00%,分别P=0.006和P=0.000;对非肌层浸润性癌敏感性分别是63.64%和27.27%,对肌层浸润性癌敏感性分别是89.36%和42.55%,分别P=0.087和P=0.000.结论 FISH检查具有较好的敏感性和特异性,可用于UC-UT早期诊断,对高分级、高分期的UC-UT的诊断价值更高. 相似文献
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目的:探讨良性前列腺增生长期膀胱造瘘患者的心理状态及干预措施。方法选择我科2011年1月~2013年5月因前列腺增生行长期膀胱造瘘的男性患者43例,膀胱造瘘术后3天内进行焦虑自评量表(SAS )及抑郁自评量表(SDS )评分后随机分为实验组21例和对照组22例。对照组给予常规出院指导。实验组在常规出院指导基础上给予心理干预。于膀胱造瘘术后6个月再次行SAS及SDS评分,并进行比较。结果膀胱造瘘术后6个月实验组SAS及 SDS评分分别为44.67±10.07分和47.56±11.72分,对照组术后6个月为58.37±13.13分和61.00±13.62分,两组比较有显著性差异(P<0.05)。结论实施心理干预可改善前列腺增生长期膀胱造瘘患者的生活质量。 相似文献
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荧光原位杂交(FISH)技术是一种使用荧光标记的DNA探针评估细胞基因改变的技术,其依据为癌症是一种基因缺陷性疾病,大多数癌症伴有染色体的异常改变,采用FISH技术可检测到这些异常改变。目前美国食品药品管理局(FDA)已批准的通过尿液诊断膀胱癌的技术中,包括BTA、NMP22、ImmunoCyt以及FISH等,灵敏度和特异性最高的是FISH。近来研究还发现FISH技术有助于评估表浅膀胱癌患者对卡介苗治疗的反应,另外,FISH还可用于上尿路尿路上皮癌的诊断。本文对FISH技术在尿路上皮肿瘤诊断和随访监测中的临床应用进行综述。 相似文献
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目的 评估肾透明细胞癌组织中碳酸酐酶IX(CA IX)表达在患者预后判断中的价值.方法 应用免疫组织化学P-V方法检测 120例肾透明细胞癌和25例正常肾组织石蜡标本中CA IX的表达.以肿瘤特异性生存率作为最终和主要的评估目标.运用Cox回归模型行CA IX表达与预后关系的单因素和多因素分析,以P<0.05为差异有统计学意义.结果 112例(93.3%)获随访,随访6~94个月,中位时间45个月,无瘤生存75例,带瘤生存3例,死亡34例,其中死于肿瘤28例.正常肾组织均不表达CA IX.120例肾透明细胞癌组织中CA IX高表达89例(74.2%),高表达者中获随访82例,无瘤生存62例(75.6%),带瘤生存2例(2.4%),死亡18例(22.0%),死于肿瘤13例(15.9%),复发和(或)转移9例(11.0%),中位生存期为92个月.肾透明细胞癌CA IX低表达31例(25.8%),其中获随访30例,无瘤生存13例(43.3%),带瘤生存1例(3.3%),死亡16例(53.3%),死于肿瘤15例(50.0%),中位生存期为53个月,复发和(或)转移8例(26.7%).2组肿瘤特异性生存率比较经log-rank检验,差异有统计学意义(P=0.000,χ2=15.950),CA IX高表达组1、3、5、7年肿瘤特异性生存率分别为95.2%、83.9%、81.2%、78.2%,CA IX低表达组分别为89.5%、63.9%、46.8%、40.1%.2组术后肿瘤复发和(或)转移率比较差异有统计学意义(P=0.040,χ2=4.200).多因素Cox 回归模型分析显示CA IX表达是影响肾透明细胞癌预后的指标(RR=0.186).结论 CA IX高表达与肾透明细胞癌患者术后死亡率及肿瘤复发和(或)转移率呈负相关,CA IX可作为判断肾透明细胞癌预后的指标.Abstract: Objective To evaluate the prognostic significance of carbonic anhydrase IX (CA IX) expression in patients with clear cell renal cell carcinoma (ccRCC). Methods CA IX expression in a cohort of 120 patients with ccRCC was evaluated by P-V immunohistochemistry with a rabbit CA IX polyclonal antibody. Twenty-five normal kidney tissues were used as a control. The relationship between CA IX expression and prognosis was analyzed by univariate and multiple-factor analysis (Cox regression model). The primary end point was cancer specific survival. Results One hundred and twelve (93.3%) patients were followed up with the median follow-up time of 45 months (range, 6 to 94 months). Seventy-five patients survived without evidence of tumor recurrence, 3 patients survived with tumor recurrence, and 34 patients died, 28 of the 34 died of cancer. CA IX expression was negative in all normal renal tissue. High CA IX expression was observed in 89 (74.2%) patients, among which 82 patients were followed up, and the disease free survival was 75.6% (62/82). Two (2.4%) patients survived with tumor recurrence, and 18 (22.0%) patients died, of which 13 (15.9%) died of cancer. Tumor recurrence and (or) metastasis occurred in 9 (11.0%) patients, with a median survival of 92 months in this high expression group. Low CA IX expression was observed in 31 (25.8%) patients, among which 30 patients were followed up, and the disease free survival was 43.3% (13/30). One (3.3%) patient survived with tumor recurrence, and 16 (53.3%) patients died, of which 15 (50.0%) died of cancer. Tumor recurrence and (or) metastasis occurred in 8 (26.7%) patients with a median survival of 53 months in this low expression group. Cancer specific survival between CA IX high expression group and low expression group was significantly different (P=0.000, χ2=15.950), and tumor relapse and (or) metastasis rates were significantly different (P=0.040, χ2=4.200). The 1, 3, 5 and 7 year cancer specific survival rates were 95.2%, 83.9%, 81.2% and 78.2% respectively in the high CA IX expression group, and 89.5%, 63.9%, 46.8% and 40.1% respectively in the low expression group. Multivariate analysis with Cox regression model showed that CA IX expression was a prognostic factor (RR=0.186). Conclusions High CA IX expression is negatively correlated with postoperative mortality, relapse and (or) metastasis in ccRCC. CA IX expression could be used as a prognostic biomarker in ccRCC. 相似文献
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目的总结经腹腔途径行腹腔镜肾上腺切除术治疗肾上腺外科疾病的手术体会及经验。方法 2006年6月至2012年5月,行经腹腔腹腔镜肾上腺切除术108例。男性48例,女性60例;年龄22~76岁;病变位于右侧40例,左侧63例,双侧5例;切除肿瘤/肾上腺大小0.5~11cm,平均4.5cm;其中18例有下腹部经腹腔手术史。结果除1例因膈肌损伤中转开放外,107例腹腔镜手术均顺利完成,术中出血0~200mL,平均20mL,手术时间45~150min,平均70min。术后1~2d肛门排气,2d内下床活动,术后住院时间3~7d。术后无严重并发症发生。术后病理检查:嗜铬细胞瘤38例,醛固酮腺瘤20例,原醛结节性增生6例,皮质醇增多症5例,无功能腺瘤20例,髓质脂肪瘤10例,肾上腺假性囊肿3例,节细胞神经瘤3例,肾上腺皮质癌2例,转移癌1例。结论经腹腔腹腔镜肾上腺切除术,具有手术空间大、视野清晰、解剖标志清楚、便于较早结扎处理肾上腺静脉、符合人体工效学等优点,适合于嗜铬细胞瘤、较大的肾上腺肿瘤及恶性肾上腺肿瘤等的切除。 相似文献
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目的探讨膀胱副神经节瘤的临床特点及诊治经验。方法回颐性分析我院2010年5月至201i年7月诊治的4例膀胱副神经节瘤患者的临床资料。其中女3例,男I例,年龄41~63岁。临床表现为高血压者2例,间歇性无痛肉眼血尿者1例,无症状者1例。4例中仅l例患者血去甲肾上腺素值明显高于正常。4例均行CT及膀胱镜检查。术前均按嗜铬细胞瘤做准备。结果3例行膀胱部分切除术,1例行肿瘤剜除术。术前2例高血压者术后血压恢复正常。术后随访6~20个月,未见肿瘤复发。结论膀胱副神经节瘤临床表现常缺乏特异性,膀胱非上皮肿瘤鉴别诊断时应考虑本病可能。血儿茶酚胺测定对膀胱副神经节瘤的定性诊断价值有限。CT和膀胱镜检查在肿瘤定位、定性诊断中起重要作用。膀胱部分切除术是首选的治疗方法,疗效确切,术前应充分扩容。 相似文献
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