红激光与等离子经尿道前列腺剜除术治疗大体积良性前列腺增生的疗效及安全性比较

目的比较经尿道前列腺红激光剜除术(diode laser enucleation of the prostate,Di LEP)和经尿道前列腺等离子剜除术(bipolar plasmakinetic enucleation of the prostate,PKEP)治疗大体积良性前列腺增生(benign prostatic hyperplasia,BPH)的疗效及安全性。方法回顾性分析2012年6月到2014年1月收治的70例大体积BPH患者,分别采用等离子或红激光行经尿道前列腺剜除术。比较两组手术时间、血红蛋白值下降值、手术前后国际前列腺症状评分(IPSS)、残尿量(PVR)、最大尿流率(Qmax)。结果两组手术均获成功;术后随访12个月,两组IPSS、Qmax、生活质量评分(Qo L)无差异。Di LEP组术后血红蛋白下降值、膀胱灌注时间、留置尿管时间及住院时间均显著低于PKEP组。两组手术时间[(123.5±27.2)min vs.(102.7±20.4)min]、切除组织重量[(64.7±16.8)g vs.(61.2±20.5)g]、术后血红蛋白下降值[(0.92±0.43)g/dl vs.(1.24±0.55)g/dl]、膀胱灌注时间[(28.9±14)h vs.(38.5±16.6)h]、导尿管留置时间[(2.6±1.8)d vs.(3.8±2.3)d]和住院时间[(4.84±1.8)d vs.(6.2±2.3)d]比较差异均有统计学意义(P<0.05);刺激症状、逆行射精亦有差异(P<0.05);但尿潴留、输血、压力性尿失禁发生率无差别;且术后均未发生经尿道电切综合征。PKEP组1例因术后出血给予输血治疗。结论与PKEP相比,Di LEP治疗大体积BPH出血风险更小,膀胱灌注、留置尿管及住院时间更短,具有良好的疗效及安全性。     

水泡口炎病毒在人前列腺癌模型的溶瘤效应

目的 探讨利用水泡口炎病毒(VSV)作为一种新型药物治疗前列腺癌的可能性.方法 (1)确定VSV-绿色荧光蛋白(GFP)在不同时段对癌细胞的细胞毒性作用;(2)利用DU145细胞在裸鼠建立动物肿瘤模型,荷瘤动物经注射不同剂量的VSV-GFP(1×106、1×107 PFU/100μ1)后,观察不同时间点肿瘤的变化及治疗效果,并确定瘤体内病毒的复制水平、肿瘤大小变化及动物生存期的相关性.结果 VSV-GFP能选择性地杀伤前列腺癌细胞,在转染倍数(MOI) =0.1时,DU145细胞死亡率＞85％,与之比较,RWPE-1细胞死亡率＜20％,而RPMI 1640对照组细胞死亡率＜5％.体内实验中,移植瘤体内不同时间点(12、24、48 h)病毒复制滴度分别为2.36×107 PFU/g、3.82×107 PFU/g、4.38×107 PFU/g,1×107 PFU剂量组,1×106 PFU剂量组,RPMI 1640对照组在治疗48 d后,移植瘤平均体积分别为(1470.54±480.67)、(903.40±3245.50)、(408.54±224.40)mm3,3组比较差异有统计学意义(P＜0.05),与注射不含病毒RPMI 1640对照组比较,肿瘤明显缩小,动物生存期延长.结论 溶瘤病毒VSV-GFP在DU145为模型的体内、外实验中具有较好的治疗效果.     

MDT模式下1例肠吻合口瘘术后行结肠造口并发坏疽性脓皮病患者的整体干预（造口伤口失禁护理专栏）

目的 总结MDT模式下1例肠吻合口瘘术后行结肠造口并发坏疽性脓皮病患者的整体干预。方法 评估患者全身及局部情况,根据创面的不同分期,选用银离子敷料通过自溶性清创清除坏死组织,控制伤口感染、维持湿性平衡;做好疼痛管理、造口护理、激素免疫治疗,同时加强营养支持、心理护理、随访与教育。结果 护理81天,患者可以正常佩戴造口底盘;伤口面积由16*15cm2 缩小至13*10cm2;疼痛评分由10分下降至2分。伤口历经坏死溃疡期,红色肉芽生长[ 第一作者 2通讯作者]期进入上皮爬行期;同时纠正低血容量、水电解质紊乱及低蛋白血症、控制感染、改善血糖及营养状况,患者病情稳定出院。结论 在患者为中心的多学科团队合作模式下开展坏疽性脓皮病的整体干预,利于患者早日康复。     

HSD3B1基因突变对去势抵抗型前列腺癌发生的影响

目的:评估HSD3B1基因1245位点突变在去势抵抗型前列腺癌(castration-resistant prostate cancer,CRPC)发生中的作用。方法:回顾性分析2004年1月~2011年1月在我院行睾丸切除术的103例前列腺癌患者临床资料,其中HSD3B1基因1245位点突变18例。依据位点突变结果,将103例患者分为突变组及正常对照组,分别比较两组的PSA下降一半时间、CRPC形成率、CRPC形成时间、死亡率及生存时间等。结果:两组术前指标无异质性。突变组在CRPC形成率方面较对照组高,差异有统计学意义;但在PSA下降一半时间、CRPC形成时间、死亡率及生存时间等方面差异无统计学意义。结论:HSD3B1基因1245位点突变可提高CRPC形成率,但并没有缩短患者的生存时间及增加患者的死亡风险。HSD3B1基因1245位点突变是否会对CRPC将来的治疗带来改变,尚需进一步研究。     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

应用阴囊皮瓣矫治小儿隐匿阴茎

目的 探讨利用阴囊皮瓣矫治小儿隐匿阴茎的疗效.方法 于阴茎腹侧纵行切开狭窄环,距冠状沟约0.5 cm环状切开包皮内板,将包皮脱套至阴茎根部.完全切除异常附着筋膜,裁剪包皮包绕冠状沟.于阴茎阴囊交界处向阴囊两侧切开,将两侧阴囊皮瓣上移覆盖阴茎根部.缝合包皮,重建阴茎阴囊角,阴囊成形.结果 2009年3月至2011年7月采用阴囊皮瓣矫治隐匿阴茎患儿24例,术后尿道外口粘连2例,经尿道扩张后排尿正常;包皮远端轻度坏死1例,经门诊换药2周后好转,余21例手术效果良好.随访6个月至2年,所有患儿均未发现阴茎回缩,阴茎外观塑形良好,勃起时无侧弯、旋转.结论 应用阴囊皮瓣矫治小儿隐匿阴茎可最大程度地显露阴茎,塑形效果良好,并发症较少,是一种较为理想的手术方法.     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

急性肾梗塞的诊断与治疗

急性肾梗塞(acute renal infarction,ATI)主要指肾组织因肾动脉主干和/或其分支栓塞或血栓形成而缺血坏死,致使肾功能急性受损的一种疾病.此病临床少见,缺乏特异性症状和体征,少部分病例可无任何临床表现,因此漏诊率高.     

特发性阴囊钙沉积症1例

1病例报告 患者，男，42岁。因阴囊皮肤多发无痛性结节，伴瘙痒10余年入院。患者18年前阴囊皮肤无明显诱因出现米粒样小结节，无临床症状，未予重视。后结节增多，并逐渐增大，部分融合，布满阴囊大部分皮肤。性交时伴早泻、勃起功能障碍等症状，有夜间或清晨阴茎勃起。近年来阴囊出现痒感，搔抓后有白色乳酪样物质排出，外用“派瑞松”软膏无明显好转。既往无阴囊外伤及代谢病史，无家族遗传史。查体：满阴囊皮肤有多量大小不等、半球状结节，部分相互叠加，直径约0．2-2．5cm，外表呈黄白色，无破溃。     

肾上腺节细胞神经瘤伴发肾血管平滑肌脂肪瘤一例报告

肾上腺节细胞神经瘤是起源于交感神经节的罕见良性肿瘤,伴发肾血管平滑肌脂肪瘤者更罕见.2007年12月我院收治1例,现报告如下.