腹腔镜肾部分切除术式与肾癌根治术式对老年肾癌（T1期）患者的疗效及康复作用比较

目的 比较腹腔镜肾部分切除术式(PN)与肾癌根治术式(RN)对老年肾癌(T1期)患者的疗效及康复作用。方法 回顾分析2018年1月～2020年12月解放军总医院第三医学中心收治的肾癌(T1期)老年患者104例,以随机数表法进行分组,对照组(n=52),行腹腔镜RN,研究组(n=52),行腹腔镜PN,对两组患者的手术情况与术后康复情况。结果 研究组手术时间低于对照组,拔管时间、住院时间高于对照组,差异有统计学意义(t=4.558、4.149、2.683,P <0.05);2组术中出血量、术后进食时间对比无明显差异(P> 0.05);研究组手术后肾小球滤过率(GFR)高于对照组,而肌酐(Cr)、血尿素氮(BUN)低于对照组,差异有统计学意义(t=3.383、5.451、2.248,P <0.05);研究组术后并发症发生率高于对照组,差异有统计学意义(χ²=5.282,P <0.05)。结论 腹腔镜肾脏部分切除术式与肾癌根治术式用于肾癌(T1期)老年患者治疗各有优劣,PN的肾功能改善效果更优,但RN并发症更少,术后康复更快。     

腹腔镜缝合引导器辅助缝合作用的实验研究

目的:利用3支杆的末端在同一圆心圆弧上的原理设计腹腔镜缝合引导器,并在离体人肾进行缝合实验,探讨该器械的设计合理性和实用效果。方法:⑴制作腹腔镜缝合引导器。该器械的三支杆按顺序排列装于固定轴上。功能结构上包括限制方向装置和出针定位装置。限制方向装置包括第二、三支杆的"U"形末端、弧形圆筒。出针定位装置为第一支杆的"Y"...     

15例气囊导尿管致医源性尿道损伤的原因及预防

探讨气囊导尿管所致医源性尿道损伤的原因及预防。操作规范、气囊完全置入膀胱腔内及完全排空气囊后再拔管等,可有效预防尿道损伤的发生。     

前列腺肉瘤的诊断与治疗

目的初步探讨前列腺肉瘤的诊断与治疗方法。方法回顾11例前列腺肉瘤患者的临床资料,并对所有患者进行随访。结果11例患者中,10例术前确诊前列腺肉瘤,1例手术后确诊。其中4例行根治性前列腺膀胱切除及回肠膀胱术,3例行前列腺切除术。2例行膀胱造瘘术,1例行放疗,1例仅行前列腺穿刺活检。病理结果:平滑肌肉瘤5例,横纹肌肉瘤4例,纤维肉瘤2例。1例失访,1例存活5年至今,1例术后8个月,尚未发现复发或转移,余8例均在确诊1年内死亡。结论前列腺肉瘤发展快,恶性度高,预后不良,应早期诊断,采用综合手段治疗。     

老年活体供肾移植术后供者安全性及受者移植效果的分析

Objective To investigate the safety for donors and the effectiveness for recipients of living-related donor (LRD) kidney transplantation from elder donors. Methods 251 cases of LRD kidney transplantation were reviewed. According to the age of LRDs, the patients were divided into 2 groups:≥55 years group (group A) and <55 years (group B). The parameters studied included serum creatinine (Cr), glomerular filtration rate (GFR), creatinine clearance (Ccr), perioperative complications, average hospital stay, and acute rejection rate of LRDs and recipients were compared. Results (1)There was no significant difference in serum Cr between groups A and B at different time points (P>0.05). (2)There was no significant difference in Ccr between two groups pre-donation (P = 0.45). But at the 10th day after the donor nephrectomy, Ccr level in group A was significant lower than in group B (P<0.01). (3)Total GFR pre-donation, remaining renal GFR, and remaining renal GFR on the day 10 after donation had no significant difference in both groups A and B (P>0.05). Remaining renal GFR on the day 10 before and after donation had no significant difference in group A (P>0.05), but on the day 10 after donation that was significantly increased in group B as compared with that pre-donation (P<0.01). (4) The serum Cr of recipients at different time points after transplantation had no significant difference between two groups (P>0.05). (5) The mean hospital stay after donation of LRDs and recipients had no significant difference between two groups. (6) The incidence of recipients" acute rejection was 6.50 % (5/77) in group A, and 5.75%(10/174) in group B within 6 months after operation (P = 0.95). Conclusion Transplantations performed from the elderly donors will yield similar results from younger donors if the eider donors are evaluated or assessed as the standards.     

老年活体供肾移植术后供者安全性及受者移植效果的分析

Objective To investigate the safety for donors and the effectiveness for recipients of living-related donor (LRD) kidney transplantation from elder donors. Methods 251 cases of LRD kidney transplantation were reviewed. According to the age of LRDs, the patients were divided into 2 groups:≥55 years group (group A) and <55 years (group B). The parameters studied included serum creatinine (Cr), glomerular filtration rate (GFR), creatinine clearance (Ccr), perioperative complications, average hospital stay, and acute rejection rate of LRDs and recipients were compared. Results (1)There was no significant difference in serum Cr between groups A and B at different time points (P>0.05). (2)There was no significant difference in Ccr between two groups pre-donation (P = 0.45). But at the 10th day after the donor nephrectomy, Ccr level in group A was significant lower than in group B (P<0.01). (3)Total GFR pre-donation, remaining renal GFR, and remaining renal GFR on the day 10 after donation had no significant difference in both groups A and B (P>0.05). Remaining renal GFR on the day 10 before and after donation had no significant difference in group A (P>0.05), but on the day 10 after donation that was significantly increased in group B as compared with that pre-donation (P<0.01). (4) The serum Cr of recipients at different time points after transplantation had no significant difference between two groups (P>0.05). (5) The mean hospital stay after donation of LRDs and recipients had no significant difference between two groups. (6) The incidence of recipients" acute rejection was 6.50 % (5/77) in group A, and 5.75%(10/174) in group B within 6 months after operation (P = 0.95). Conclusion Transplantations performed from the elderly donors will yield similar results from younger donors if the eider donors are evaluated or assessed as the standards.     

经尿道汽化电切联合膀胱灌注治疗腺性膀胱炎的临床观察

目的探讨经尿道汽化电切术联合膀胱灌注治疗腺性膀胱炎的有效性及安全性。方法将腺性膀胱炎患者38例,选用硬膜外麻醉,行经尿道电切术(TUR)切除膀胱内病灶至浅肌层;术后行羟基喜树碱或吡柔比星化疗药物膀胱灌注治疗,出院后门诊随访临床疗效。结果 38例均获随访6～36个月。30例治愈,6例好转,2例无效,其中3例术后5～16个月复发,38例均无恶变。结论经尿道电切术联合膀胱化疗药物灌注治疗腺性膀胱炎临床疗效满意,手术安全性高且易于开展,是一种有效可行的治疗方法。     

老年活体亲属供肾移植的安全性分析

目的 探讨老年活体亲属供肾移植供体、受体的围手术期并发症、疗效及安全性.方法 亲属活体供肾移植132例,分为老年供体组(≥55岁,43例)和中青年供体组(＜55岁,89例);对供受体的住院时间、手术前后血肌酐(SCr)、内生肌酐清除率(CCr)、肾小球滤过率(GFR)、并发症以及受体的急性排斥反应率、人/肾存活率等进行比较分析.结果 2组供者术前SCr分别为(77.67±15.21)、(83.09±15.98)μmol/L,术后7 d分别为(109.54±22.32)、(106.56±23.46)μmol/L,均在正常范围内,2组间各时间点比较差异均无统计学意义(P值均＞0.05).术后3个月2组供者SCr分别为(112.57±20.87)、(104.29±19.43)μmol/L,与术前比较分别上升44.93%和25.51%,老年供体组比中青年供体组供者scr升高更明显.差异有统计学意义(P=0.0268).2组术前CCr分别为(1.63±0.34)、(1.56±0.25)ml/s,术后10 d分别为(0.83±0.29)、(1.11±0.27)ml/s.老年供体组术后3个月CCr为(0.97±0.10)ml/s,中青年供体组为(1.16±0.17)ml/s.2组手术前后CCr变化差异无统计学意义(P＞0.05).老年供体组术后10 d的留存肾GFR为(36.58±13.26)ml/min,术后3个月增加至(52.31±12.74)ml/min,达到原双肾GFR[(73.01±20.96)ml/min]的71.65%.中青年供体组术后10 d GFR为(38.32±10.79)ml/min,术后3个月增至(56.31±12.95)m1/min,达到原双肾GFR[(78.34±20.98)ml/min]的71.88%.手术前后GFR变化差异均无统计学意义,P值均＞0.05.供者手术并发症包括术中脾脏包膜下血肿1例、降结肠破裂1例和切口脂肪液化5例.术前和术后各时间点2组受者SCr水平差异无统计学意义(P值均＞0.05).2组供者平均住院时间分别为(13.2±3.4)和(12.8±2.6)d,P=0.4563.2组受者平均住院时间分别为(23.1±11.9)和(22.3士11.4)d,P=0.6991.老年供体组受者6个月内急性排斥反应发生率为4.7%(2/43),中青年供体组为7.9%(7/89).术后1年内2组各死亡1例,中青年供体组因急性排斥反应移植肾失功1例.结论 老年活体亲属供肾可能存在一定危险性,应予以重视,但供体年龄并非独立风险因素.在严格控制老年供者的纳入标准、对供者进行全面系统评估的情况下,老年供体活体肾移植的供体和受体围手术期并发症/疗效及安全性与中青年供体比较无明显差异.     

肾移植排斥反应中细胞毒性T淋巴细胞相关抗原4的作用

背景：细胞毒性T淋巴细胞相关抗原4是新近发现的共刺激分子,在肿瘤及自身免疫性疾病中研究较多,在肾移植领域缺少研究。 目的：探讨细胞毒性T淋巴细胞相关抗原4在肾移植排斥反应中的作用。方法：纳入肾移植患者50例,根据移植后肾功能分为2组,急性排斥组20例,移植肾功能稳定组30例。同时选择30例健康查体者作为健康对照组。分别抽取外周静脉血,采用ELISA法及流式细胞术检测观察对象血清及外周血淋巴细胞中的细胞毒性T淋巴细胞相关抗原4水平。 结果与结论：细胞毒性T淋巴细胞相关抗原4在肾移植后急性排斥组、肾功能稳定组及健康对照组血清中的表达水平差异有显著性意义（F=70.0081,P=0.0000）。肾功能稳定组显著低于健康对照组（P=0.0000）,急性排斥组显著低于健康对照组（P=0.0000）,急性排斥组显著低于肾功能稳定组（P=0.0000）。细胞毒性T淋巴细胞相关抗原4在肾移植后急性排斥组、肾功能稳定组及健康对照组淋巴细胞中的表达水平差异无显著性意义（F=1.8656,P=0.1617）。提示细胞毒性T淋巴细胞相关抗原4在肾移植患者发生排斥反应时血清中表达减低,具有一定的相关性,可能参与了排斥反应的发生。