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现代泌尿外科杂志

现代泌尿外科杂志

CSTPCD

Journal of Modern Urology
本刊由著名泌尿外科专家吴阶平、郭应禄院士任名誉主编，聘请国内泌尿界知名专家、教授担任顾问及编辑委员会委员。该杂志为泌尿外科专业学术期刊，刊登国内外最新的泌尿外科疾病的诊断及最先进的治疗方法等。
  • 发文量：4966
  • 被引量：2077
  • H指数：1
  • 开始收录时间：1996(1)
  • CNKI综合因子：0.8
  • 维普期刊影响因子： 1.06
  • 万方期刊影响因子：1.27
  • 创刊时间：1996
  • 国内刊号/CN：61-1374/R
    国际刊号/ISSN：1009-8291
  • 发行周期：双月刊
    邮发代号：52-244
  • 主管单位：中华人民共和国教育部
    主办单位：西安交通大学
现代泌尿外科杂志-联系信息
  • 主编：贺大林;王行环
  • 电话：029-82657054
  • 邮箱：xdmnwk@126.com;xdmnwk@163.com
  • 地址：西安市雁塔西路76号
  • 邮编：710061
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现代泌尿外科杂志 >2024年第1期

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  • 摘要：Objective To assess the value of transureteroscopic Holmium laser in the treatment of acute renal failure in-duced by postrenal ureteric stone obstruction. Methods Data of 39 patients with obstructive acute renal failure caused by im-pacted ureteral calculi surgically treated in our hospital during Jul. 2006 to Dec. 2010 were retrospectively analyzed. 36 patients received emergency transureteroscopic Holmium laser lithotripsy within 24 hours and had doubl-J stent placed. 2 cases received a second surgery due to ureteral kink and stricture,and calculi were successfully crushed after ureteral catheter was placed. 1 pa-tient switched to open surgery because of ureteral distortion. During the follow-up of 4～ 6 weeks,ultrasonography and/or plain film radiograph were performed. Results 5 patients had to receive emergency hemodialysis (HD) due to severe sodium and water overload and/or hyperkalemia. 38 patients successfully underwent transureteroscopic Holmium laser lithotripsy. The mean operation time was 45. 3 min,ranging 20～125 min. The success fragmentation rate was 97.2% (70/72),and the overall stone-free rate was 100% (38/38). 36 patients (92. 3%) restored renal function within 10 days. 3 patients (7. 6%) had signifi-cant improvement,but the renal function didn't recover 12 weeks after operation. No intraoperative complications or postoper-ative ureteral stricture occurred. Conclusions Transureteroscopic Holmium laser lithotripsy is effective and safe in treating acute ureteral obstruction and postrenal failure caused by calculi, and the bilateral ureteral calculi and kidney calculi could be fragmented simultaneously.%目的 探讨钬激光输尿管软硬镜治疗输尿管结石致急性梗阻性肾衰竭的应用价值.方法 回顾性分析2006年7月~2010年12月39例输尿管嵌顿性结石梗阻致肾后性急性肾衰竭患者的资料,其中36例患者入院后24 h急诊手术行输尿管镜检查及钬激光碎石取石术(其中5例接受急诊血液透析),术毕安置双"J"管内引流,2例输尿管中段结石因输尿管迂曲、狭窄进镜失败留置输尿管导管后行二次手术成功,1例因输尿管膀胱开口异常而中转开放手术.术后随访泌尿系彩超、腹部X线片(KUB)4~6周.结果 5例患者由于严重水钠潴留、高血钾接受急诊血液透析.38例患者输尿管镜下钬激光碎石获得成功,平均手术时间45.3(20~125)min,碎石成功率97.2% (70/72),患者术后结石清除率100% (38/38).术后36例患者(92.3%)于术后10 d肾功能恢复正常,3例患者(7.6%)肾功能显著恢复,但随访12周仍未恢复至正常范围内.无术中并发症及术后输尿管狭窄等发生.结论 钬激光输尿管软硬镜结合治疗输尿管结石梗阻性急性肾衰竭安全、有效,可同期处理双侧输尿管结石及肾结石,并且可一次性将结石完全清除.
  • 摘要：@@ 本院泌尿外科2011年1月8日收治因腹股沟疝手术缝线缝入膀胱形成结石1例,经行膀胱镜下钬激光碎石术,痊愈出院.现报道如下:rn1 临床资料rn患者,女性,55岁,因尿频、尿急、尿痛及肉眼血尿于2011年1月8日到我院就诊.既往在外院曾行右侧腹股沟疝修补术.
  • 摘要：The incidence of anterior urcthral strictures tends to increase. If improperly treated,anterior urcthral strictures may aggravate urcthral injuries and lead to complex urcthral stricture, which is difficult to deal with. Although progress has been made in the treatment,some urologists still have insufficient knowledge of the cause and treatment of this disease,which, as a result,leads to improper management and postoperative complications. This paper will review the etiology and treatment of anterior urcthral strictures in order to offer urologists help and guidance.%前尿道狭窄的发生率有增高趋势,如治疗不当,会进一步加重尿道损伤而造成复杂性前尿道狭窄,难于处理.近年来在其治疗上取得了很大进步,但多数泌尿外科医师对此病认识不足,治疗上存在差异,可能导致并发症的发生.
  • 摘要：目的 探讨抑制人核小体结合蛋白1(NSBP1)基因后促进非激素依赖性前列腺癌细胞系DU145凋亡的作用机制.方法 通过慢病毒lentivirus-NSBP1转染非激素依赖性前列腺癌细胞系DU145后,MTT法观察细胞活性变化,流式细胞仪检测细胞的凋亡情况,应用Western-blot技术检测NSBP1、Survivin蛋白的变化情况.结果 抑制NSBP1表达水平后非激素依赖性前列腺癌细胞系DU145细胞活性降低,凋亡增加,同时Survivin蛋白的表达也随之降低.结论 通过慢病毒转染抑制NSBP1的表达可以促进非激素依赖性前列腺癌细胞系DU145凋亡,NSBP1可能是通过调控Survivin基因的变化影响细胞的增值凋亡.%Objective To study the effect and mechanism of nucleosome-binding protein KNSBP1) modulating apoptosis on human androgen-independent prostate cancer cell DU145. Methods After DU145 cells were transfected by lentivirus-NSBP1 ,cell viability was measured with MTT assay,apoptosis was observed with flow cytometry,and the changes of NSBP1 and Survivin expressions were detected with Western-blot method. Results The proliferation of DU145 cells decreased and apop-tosis increased. At the same time,the expression of Survivin protein decreased. Conclusions Inhibited expression of NSBP1 transfected by lentivirus decreased cell proliferation and increased apoptosis of DU145. NSBP1 may affect the cell proliferation and apoptosis by regulating the Survivin protein.
  • 摘要：嗜铬细胞瘤/副神节瘤是由神经嵴起源的嗜铬细胞产生的肿瘤,具有分泌儿茶酚胺的功能,而儿茶酚胺作用于血管、心脏,常常引起血液循环系统及代谢的改变.嗜铬细胞瘤手术前后血液中儿茶酚胺浓度的变化会引起相应血液动力学的改变,若没有充分的术前准备和术后监护,心血管意外事件的发生几率很高.因此,了解嗜铬细胞瘤/副神节瘤的病理学特点,术前进行良好的药物准备,术中轻柔的手术操作及与麻醉师的良好配合,术后ICU的严密监护,是嗜铬细胞瘤围手术期处理的关键,也是嗜铬细胞瘤/副神节瘤成功治疗的基本保障.%Pheochromocytoma/paraganglioma is a tumor originated from the neural crest, which can secrete cate-cholamine, while catecholamine can affect the metabolism and blood circulatory system. The changes of catecholamine concentration in blood before and after surgery will affect hemodynamics. Without adequate preoperative preparation and postoperative care, the incidence of cardiovascular events is high. Therefore, good understanding of the pathophysiologcal characteristics of pheochromocytoma/paraganglioma, careful preparation of drugs before operation, gentle surgical operation and good cooperation between surgeons and anesthetists during operation, and intensive care in ICU after operation are the key components of perioperative management and the basis for successful treatment.
  • 摘要：Objective To construct and select the effective siRNA eukaryotic expression plasmid of HIF-la gene which can silence HIF-la gene expression in ACHN cells. Methods ACHN cells were cultured in hypoxia environment, and siR-NA1/2/3/4 were designed according to the HIF-la cDNA sequence in GenBank, which were then inserted into plasmid pU6Hl-GFP. The four recombinant plasmids, pU6Hl-GFP-HIFla-siRNA-l/2/3/4, were identified with sequence analysis, and transferred into ACHN cells. After 24 h, the transfection efficiency was reported with green fluorescence protein expression, and real time-PCR and western blot were used to examine the HIF-la expression on mRNA and protein levels in ACHN cells. Results The correct sequences of the recombinant plasmids were confirmed with DNA sequencing, and green fluorescence observed with fluorescence microscope showed that siRNAs had been transfected into ACHN cells (transfection rate 78%), and HIF-la expression on mRNA and protein levels in ACHN cells in siRNA-1/2 groups was less than that in the control group (P <0. 05), especially in siRNA-1 group. Conclusions The eukaryotic expression plasmids of HIF-la siRNAs was constructed successfully. The pU6Hl-GFP-HIF-la-siRNA-l/2 could down-regulate the expression of HIF-la gene effectively. These results opened a window for research on the gene therapy of carcinoma of the kidney.%目的 采用RNA干扰方法,构建及筛选对肾透明细胞癌ACHN细胞缺氧诱导因子-1α(HIF-1α)基因有干扰沉默作用的真核表达质粒.方法 CoCl2缺氧诱导培养ACHN细胞高表达HIF-1α,设计并化学合成4条针对HIF-1α基因的小干扰RNA(siRNA)序列,构建相应真核表达质粒pU6H1-GFP-HIF1α-siRNA-1/2/3/4,经测序分析,质粒构建成功后,分别转染ACHN细胞后培养24 h,在荧光显微镜下观察绿色荧光蛋白表达,计算转染效率,采用荧光实时定量PCR(real time-PCR)和免疫印记杂交法(Western blot)分别检测HIF-1α的 mRNA与蛋白表达水平.结果 质粒构建后经测序显示与设计完全一致;荧光显微镜下观察到ACHN细胞表达绿色荧光蛋白,证实重组质粒已转入细胞,转染效率约为78%;实时定量PCR与Western blot结果显示,siRNA-1/2组HIF-1α的mRNA与蛋白表达较对照组均明显下降(P<0.05),质粒pU6H1-GFP-HIF1α-siRNA-1/2明显干扰抑制ACHN细胞HIF-1α基因表达,其中以质粒pU6H1-GFP-HIF1α-siRNA-1效果最佳.结论 本实验成功构建靶向HIF-1α基因的真核表达质粒,并筛选出能有效抑制ACHN细胞HIF-1α基因表达的质粒pU6H1-GFP-HIF1α-siRNA-1/2,这为肾癌的基因治疗提供了新的方法和手段.
  • 摘要：目的 探讨膀胱癌患者手术前后机体氧化应激变化及临床意义.方法 173例膀胱癌患者入选研究,其中移行上皮癌163例,腺癌5例,鳞癌4例,肉瘤1例;非肌层浸润性膀胱癌121例,肌层浸润性膀胱癌52例.分别检测手术前后患者血清VitC、VitE、超氧化物歧化酶(SOD)、谷胱苷肽过氧化物酶(GPx)、丙二醛(MDA)、总抗氧化活性(AOA)等.结果 非肌层浸润性膀胱癌患者血清VitC、VitE、SOD、GPx均明显低于肌层浸润性膀胱癌,P＜0.05,MDA含量高于肌层浸润性膀胱癌,P＜0.05.手术后患者血清VitC、VitE、SOD、GPx、AOA均明显高于手术前(P＜0.05),但MDA含量明显低于手术前(P＜0.05).结论 膀胱癌患者机体氧化应激随其恶性程度升高而升高,手术治疗后机体氧化应激水平降低.%Objective To assess the change of oxidative stress before and after operation in patients with bladder carcinoma, and to correlate these changes with the severity of the disease. Methods 173 patients with bladder carcinoma were included in the study, including 163 cases of transitional cell carcinoma, 5 adenocarcinoma, 4 squamous cell carcinoma, and 1 sarcoma. 121 cases were non-muscle invasive bladder tumors, and 52 were muscle invasive bladder tumors. Vitamin C and E, superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA), and total antioxidant activity (AOA) were estimated before and after operation. Results There were significant differences in vitamin C and E, SOD and GPx between the patients with muscle and non-muscle invasive bladder tumors (P<0. 05), and the serum MDA level of non-muscle invasive bladder tumors was higher than that of muscle invasive bladder tumors (P<0. 05). The serum levels of vitamin C and E, SOD, GPx and AOA were significantly higher (P<0. 05) while serum MDA levels were significantly lower (P<0. 05) after operation. Conclusions The oxidative stress of bladder carcinoma increased with the severity of the disease, and the level of oxidative stress reduced after operation.
  • 摘要：目的 评价开放手术(OP)、经尿道前列腺切除术(TURP)不同手术方式的远期疗效,为临床治疗方案的选择提供依据.方法 采用前瞻性队列研究,将入组的良性前列腺增生症(BPH)患者随机采用不同手术方式进行治疗,并分别在手术前、手术后3个月、6个月、12个月进行随访观察.采用国际前列腺症状评分(IPSS)、良性前列腺增生症患者的生活质量专用量表(BPHQLS)评价不同时间各组患者的IPSS、生活质量状况.结果 两组IPSS得分呈现曲线下降趋势、生活质量得分呈现曲线上升趋势.OP、TURP组在手术后3、6、12个月时下尿路症状无差别(P＞0.05);术后3个月、12个月时生活质量OP组(278.95±19.68,291.91±59.14)高于TURP组(252.59±18.85,253.49±29.52)(P＜0.05).结论 OP在提高患者的远期生活质量方面优于TURP.%Objective To evaluate the long-term effect of open prostatectomy (OP) and transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia (BPH). Methods A prospective cohort study was conducted. Patients with BPH were treated with OP or TURP. In the 3rd, 6th and 12th month during follow-up, IPSS and BPHQLS were adopted to evaluate IPSS and quality of life of patients. Results The score of IPSS of both groups reduced, while the score of quality of life rose. The lower urinary tract symptoms of both groups had no difference in the 3rd, 6th and 12th month. The quality of life of the OP group (278. 95 + 19. 68, 291. 91 + 59. 14) was higher than that of TURP group (252. 59 + 18. 85, 253. 49 + 29. 52) in the 3rd and 12th month. Conclusions Both OP and TURP can improve the lower urinary tract symptoms, but OP has more strength in improving the long-term quality of life than TURP.
  • 摘要：Objective To evaluate the value of color Doppler ultrasound and computed tomography angiography (CTA) in the diagnosis of nut-cracker syndrome. Methods Data of 50 cases of nut-cracker syndrome and 50 healthy controls were analyzed. Results 31 patients had hematuria,4 had fatigue and poor appetite, 10 had left varicocele, and 5 had proteinuria and waist pains. 13 women patients had pelvic congestion syndrome (PCS). All male patients had left varicocele in varying degrees. Doppler ultrasound showed the angel between superior mesenteric artery (SMA) and aorta was (25.08 + 11.83) vs. (48. 73 + 25. 82) ? The left renal vein (LRV) diameters of the angle segment were (8. 55 + 2. 63) vs. (7. 43 + 2. 03) cm,and the flow velocity was (0. 38 + 0. 16) vs. (0. 48 + 0. 13) m/s. The LRV diameters of the portal segment were (8. 55 + 2. 63) vs. (7.43 + 2.03) cm and the flow velocity was (0. 28 + 0. 21) vs. (0. 94 + 0. 43) m/s. CTA showed that 21 patients had decrescent angle between SMA and aorta, 1 patient had oppressed LRV in the head of pancreas,3 patients had oppressed LRV in the branches of SMA and inferior fibrous structure, and 1 patient had oppressed LRV in the abdominal aorta and the vertebral column. Cystoscopy revealed spouting blood in the left ureteral orifice. Conclusions The color Doppler examination can screen nutcracker syndrome and CTA can accurately measure the spatial structure around LRV.%目的 探讨彩超及CTA对胡桃夹综合征(NCS)的诊断价值.方法 分析50例NCS患者及50例健康人的资料.结果 主诉肉眼及镜下血尿31例;疲乏伴纳差4例;左精索静脉曲张10例;蛋白尿伴左腰不适5例.13例女性有盆底淤血征,男性均有不同程度左精索静脉曲张.彩超肠系膜上动脉(SMA)和腹主动脉(AO)夹角(a)(25.08±11.83)°vs.(48.73±25.82)°;左肾静脉(LRV)受压管径(D1)(2.45±1.28)vs.(3.48±1.02) cm,血流速度(V1)(0.38±0.16)vs.(0.48±0.13) m/s;LRV远端管径(D2)(8.55±2.63)vs.(7.43±2.03) cm,血流速度(V2)(0.28±0.21)vs.(0.94±0.43)m/s.21例CTA 示SMA与AO夹角减小,1例示胰头部压迫,3例SMA分支及下方纤维结构压迫;1例后胡桃夹征(腹主动脉和脊柱之间压迫),15例膀胱镜左输尿管口喷血.结论 彩超初步筛选胡桃夹征,CTA更清晰显示LRV周围结构.
  • 摘要：目的 了解月见草油在草酸钙结石形成中的作用,为临床治疗提供新的方法与思路.方法 雄性SD大鼠60只,随机分为4组,各组15只.C组和D组以月见草油(含γ-亚麻酸9.2%)或葵花籽油(含亚油酸70%)10 g/kg灌胃4周后,用诱石剂1%乙二醇(EG)加2%氯化氨喂饮,同时继续以月见草油或葵花籽油灌胃4周,8周后检测各组大鼠肾功能、24 h血尿生化指标和肾草酸钙结晶情况;仅饲普通饲料(A组,空白组)和普通饲料加1%乙二醇(EG)加2%氯化氨喂饮(B组,成石组)大鼠作为对照.结果 月见草油组肾组织水肿较轻,肾内草酸钙结晶数及肾成石率低于成石组(P<0.05),尿枸橼酸较成石组高(P<0.01),24 h尿钙、尿草酸排泄均低于成石组(P<0.01),血尿素氮(P<0.01)、血肌酐(P<0.05)低于成石组.结论 γ-亚麻酸能有效改善肾功能,减少尿钙及草酸的排泄,抑制实验鼠肾草酸钙结晶形成,在尿石症防治方面可能有一定应用价值.%Objective To compare the role of y-linolenic acid (y-LNA) in the prevention of stone-forming with that of linoleic acid (LNA). Methods 60 male adult SD rats were divided into 4 groups, group A (normal control), group B (stone forming), group C (evening primrose oil, 9. 2% y-LNA), and group D (sunflower seed oil, 70% LN). Rats in group C were fed with evening primrose oil and rats in group D with sunflower seed oil for 4 weeks. Renal stone formation was induced by 1% ethylene glycol (EG) plus 2% muriate. Meanwhile, gavage was continued with evening primrose oil and sunflower seeds oil. After 8 weeks, all rats were sacrificed and the renal function, 24 h blood and urine biochemical indexes, renal calcium oxalate crystallization and urinary oxalate were detected. Results The parenchymal edema in group C were milder compared with that in group B. Calcium oxalate crystallization, urinary calcium excretion (P<0. 01), urinary oxalate(P<0. 01), blood urea nitrogen (P<0. 01) and creatinine (P<0. 05) were lower in group C than in group B, but urinary citrate was higher in group C than in group B (P<0. 01). Conclusions It is suggested that y-linolenic acid can protect and improve renal function, decrease urinary calcium and urinary oxalate excretion, and prevent calcium oxalate crystal formation. It may be valuable for the prevention and treatment of urolithiasis.
  • 摘要：Objective To evaluate the safety and efficacy of holmium laser lithotripsy under ureterscope for mid-upper ureteral calculi. Methods Clinical data of 1 200 patients with mid-upper ureteral calculi treated with holmium laser lithotripsy under ureteroscope during Jan. 2005 to Dec. 2010 were retrospectively analyzed. Results The overall stone-free rate was 95.4% (1145/1200). The stone-free rate was respectively 75.7% (28/37), 92.6% (486/525) and 98.9% (631/638) for stones located upon the third lumbar vertebra, between the third lumbar vertebra and the sacroiliac joint, and within the sacro-iliac joint. 3. 6% (43/1 200) patients switched to extracorporeal shock wave lithotripsy due to translocation of broken stones. 9 patients developed ureteral perforation, 2 of which received open surgery, and 7 had double-pigtail stent placed and were cured with another holmium laser lithotripsy 3 months later. The operation time was 20?0 minutes (mean 45. 6 + 17. 4). No complications such as hemorrhea, ureteral avulsion or ureteral rupture were found. 4 cases developed ureteral mucosa tearing and 8 false passage, but no urinary cyst or ureteral stricture formed after placement of double-pigtail stent. 57 cases had nephric colic, 24 had belly distending pain, and 28 had fever. All such cases recovered with anti-infectious and ant-symptomatic treatment. Catheters were removed after 2?3 days. Hospital stay after operation was 3? days (mean 4. 3 + 1. 2). Conclusion Holmium laser lithotripsy under ureteroscope is highly effective and minimally invasive with few complications and quick recovery.%目的 评估输尿管镜钬激光碎石治疗输尿管中上段结石的安全性和有效性.方法 对2005年1月~2010年12月输尿管镜下钬激光碎石治疗的1200例输尿管中上段结石患者的临床资料进行回顾性分析.结果 一次性结石清除率95.4%(1145/1200),其中,第三腰椎下缘以上结石为75.7%(28/37),第三腰椎下缘至骶髂关节上缘结石为92.6%(486/525),骶髂关节段结石为98.9%(631/638).3.6% (43/1200)患者因碎石移位改行ESWL术.9例出现输尿管穿孔,除2例改开放手术外,7例成功留置双"J" 管3月后再次行输尿管镜钬激光碎石获成功.本组手术时间20~90 min,平均(45.6±17.4)min,术中未发生大出血、输尿管撕脱、断裂等,术中输尿管黏膜撕裂4例,黏膜下假道形成8例,均顺利留置双"J" 管,随访1~6月无尿囊肿和输尿管狭窄形成.术后患侧肾绞痛57例、腹部胀痛24例、发热28例,予以抗感染、对症治疗后好转.术后2～3 d拔除导尿管,术后住院天数3～7 d,平均(4.3±1.2)d.结论 输尿管镜钬激光碎石术,具有微创、高效、并发症少、恢复快等优点,在掌握一定输尿管镜技巧的基础上处理中上段输尿管结石可取得比较好的疗效.但对L3水平以上且直径大于1.0 cm的结石不建议使用输尿管镜处理.
  • 摘要：盆底器官功能障碍是中老年女性常见病、多发病。依据累及的组织结构不同,可表现为排尿困难、尿失禁、排便困难、粪失禁、性功能障碍和子宫阴道脱垂。美国一项流行病学调查显示,50岁以上女性,约半数其生活质量受到该病的影响,
  • 摘要：目的 探讨腹腔镜联合软镜(胆道镜)在上尿路结石中的应用价值.方法 分析2010年10月至2011年6月我科收治肾结石、输尿管上段结石患者中的28例应用纤维胆道镜辅助取石的临床资料.结果 本组28例均顺利完成手术,手术时间45~130 min,术中出血30~100 mL,术后住院5~10 d.结论 腹腔镜联合胆道镜取石方法适用肾结石及并发输尿管上段结石患者,对肾内多发小结石取石效果好,具有创伤轻、恢复快、出血少、结石清除率高等优点,是一种安全有效的治疗方法,值得临床推广应用.
  • 摘要：移行细胞癌是泌尿系统肿瘤常见的病理类型,其中膀胱上皮移行细胞癌约占90%～95%,上尿路移行细胞癌（肾盂癌、输尿管癌）约占5%。双侧上尿路、膀胱全程出现移行细胞癌则较为少见,而肾结核同时合并双侧全程尿路移行细胞癌则更是罕见报道。我院于2011年收治1例,报告如下。
  • 摘要：目的 研究临床路径在输尿管结石治疗中的实施情况并评价其效果.方法 将2010年11月至2011年10月期间我科室收治的285例第一诊断为输尿管结石(单侧)并适合行输尿管镜碎石取石术的患者利用简单随机分组的方法分为临床路径组和对照组.其中入临床路径组151例,对照组134例,对比分析两组患者平均住院时间、住院费用、临床疗效、患者认知度和满意度以及医护人员对临床路径实施效果调查.结果 临床路径组在疗效上与对照组无显著差异,而在平均住院天数及住院费用显著低于对照组(P<0.05);临床路径组患者对疾病的认识程度和满意度调查亦显著高于对照组(P<0.05);多数医护人员认为临床路径可有效增进医患沟通、提高医疗质量.结论 临床路径可有效规范输尿管结石的手术治疗,提高效率,值得深入实施和推广.%Objective To evaluate the impact of clinical pathway for ureteroscopic lithotripsy. Methods 285 patients with primary diagnosis of unilateral ureteral calculus who needed ureteroscopic operation were randomly divided into clinical pathway group (151 cases) and control group (134 cases). Average hospital stay, hospital costs, clinical efficacy, patients' satisfaction and awareness of disease were comparative analyzed. Furthermore, clinical workers' assessment assay was conducted. Results Patients who received clinical pathway treatment had shorter mean hospital stay, lower mean hospital costs than non-pathway patients (P<0.05), but there were no significant differences in therapeutic efficacy (P>0. 05). Most patients and health care workers agreed clinical pathway improved communication, efficacy and satisfaction. Conclusion Clinical pathway was associated with improved medical quality for patients with ureteral calculi.
  • 摘要：1病例报告 患者,男性,74岁。因＂进行性排尿困难2年＂主诉以＂前列腺增生症＂诊断收住入院。既往有高血压病史。入院查体脉搏64次/min,血压145/85mmHg（1mmHg=0.133kPa）,心律不齐,腹部检查无阳性体征。B超报告：前列腺肥大症。颅脑CT提示：脑萎缩。心脏彩色超声检查提示：
  • 摘要：目的 从人膀胱移行细胞癌(BTCC)组织中分离培养肿瘤干细胞样细胞(CSLC),鉴定其生物学特性,并研究PIWIL2在 CSLC中的表达和意义.方法 收集12例不同临床分期BTCC患者组织标本,通过酶消化和原代培养相结合等方法处理,采用无血清悬浮培养法分离培养获得含CSLC的悬浮细胞球,流式细胞仪检测细胞表面分子标志CD133和CD44的表达,免疫磁珠分选系统分离CD133+CD44+细胞;采用半定量逆转录聚合酶链反应检测PIWIL2 mRNA在CSLC中的表达;裸鼠皮下接种CSLC,观察其成瘤能力.结果 成功地从人膀胱癌组织分离培养获得可悬浮生长、稳定传代的CSLC,CSLC高表达CD133和CD44,裸鼠皮下接种1×104、1×105个CSLC均可全部成瘤,PIWIL2 mRNA在CSLC的表达显著高于正常膀胱组织细胞.结论 采用无血清悬浮培养法成功从人膀胱癌组织中分离获得CSLC,具有肿瘤干细胞特性,能高度表达PIWIL2,为靶向肿瘤干细胞的治疗提供了实验依据.%Objective To isolate and cultivate cancer stem-like cells (CSLC) from human bladder transitional cell carcinoma (BTCC) and identify their biological characteristics, and to investigate the expression and significance of PIWIL2 in CSLC. Methods Tumor samples were obtained from 12 patients with T3-T4BTCC. The method of suspension culture in specific serum free medium was employed to isolate and obtain CSLC spheres by using enzymatic digestion combined with primary culture. The expressions of cell surface markers CD133 and CD44 were detected with flow cytometry. CD133 + CD44+cells were separated with magnetic activated cell sorting system. PIWIL2 mRNA expression in CSLC was detected with semi-quantitative reverse transcription polymerase chain reaction. The tumor formation ability was evaluated with subcutaneous injection of CSLC into nude mice. Results CSLCs were obtained from BTCC and floating cell spheres were formed under the suspension culture method with serum-free medium, which could propagate stably. The CSLCs highly expressed CD133 and CD44 of CSC markers. PIWIL2 mRNA expression was significantly higherin CSLC than in normal bladder tissues. Tumor formed in all mice after subcutaneous injection of 1×104 and 1×105 CSLCs and exhibited a high degree of similarity with the primary tumor in BTCC. Conclusion CSLC can be isolated from the suspension culture method combined with serum-free medium, which possess the potentials of CSC and highly expresses PIWIL2.
  • 摘要：Objective To investigate the expressions of signal transducers and activators of transcription 3 (STAT3), vascular endothelial growth factor (VEGF) and microvessel density (MVD) in adrenal cortical carcinoma (ACC) and to discuss their clinical significance. Methods 37 adrenal cortical neoplasm specimens were divided into two groups, 20 in the benign group and 17 in the malignant group (adrenal cortical carcinoma, ACC group). The expressions of STAT3, VEGF and MVD were detected with immunohistochemical staining. Results STAT3 was highly expressed in the ACC group (11/17, 64. 71%), while lowly expressed in the benign group (4/20, 20. 00%), with significant difference (P<0. 05). VEGF staining was seen in 70. 59% (12/17) of the malignant cases versus 25.00% (5/20) of the benign cases, with significant difference (P< 0. 01). MVD was highly expressed in the ACC group than in the benign group (76. 40+15. 64 vs. 21. 05 + 8. 07), with significant difference (P<0. 05). In both benign and malignant adrenal neoplasm, STAT3 expression was positively correlated with VEGF expression, which was positively correlated with MVD. Conclusion The high expression of STAT3 and VEGF in ACC contributes to tumor angiogenesis.%目的 探讨信号转导和转录活化因子3(signal transducers and activators of transcription 3,STAT3)、血管内皮生长因子(vascular endothelial growth factor,VEGF)和微血管密度(microvessel density,MVD)在肾上腺皮质癌(ACC)中的表达及其临床意义.方法 选取经手术治疗且具有完整的临床、病理资料的肾上腺皮质肿瘤存档石蜡标本37例,其中良性组20例,恶性组(ACC组)17例.采用免疫组化技术,检测良、恶性肾上腺皮质肿瘤中STAT3、VEGF和MVD的表达情况.结果 STAT3在ACC组中呈高表达(11/17,64.71%),在良性组中表达较低(4/20,20%),ACC组与良性组之间STAT3的表达有显著性差异(P<0.05);VEGF在ACC组中呈高表达(12/17,70.59%),在良性组中表达较低(5/20,25%),VEGF在ACC组中的表达与在良性组中的表达有显著性差异(P<0.05);MVD在ACC组中的表达为76.40±15.64,良性组中为21.05±8.07,两者之间有显著性差异(P<0.05).无论是在良性组中还是在ACC组中,STAT3与VEGF的表达、VEGF与MVD的表达均呈正相关.结论 STAT3和VEGF在ACC中的高表达为抗肿瘤血管生成治疗在ACC中的应用,提供了一定的理论依据.
  • 摘要：Objective To investigate whether melamine has long-term damage on infants' liver and kidney function. Methods 37 cases diagnosed as melamine-related urinary calculus were followed up. The results of routine urine test, liver and kidney function, and B-ultrasonographic imaging of the urinary system before treatment and one year after treatment were compared and analyzed. Results Of all 37 patients suffered from kidney stones before treatment, 3 had remaining stones after treatment (P<0. 05), indicating most patients recovered. 17 patients had positive results of urinary occult blood test before treatment, and 3 had positive test results after treatment; 10 patients had positive results of urinary white blood cell test, and all patients had negative resultsafter treatment. These comparisons had statistical difference (P<0.05), showing urine routine improved significantly. The serum creatinine (Cr) was (38. 47 + 9. 60)μmol/L and (33. 38 + 5. 24)μmol/L before and after treatment; the serum uric acid (UA) was (296 + 104)μmol/L and (227 + 60)μmol/L before and after treatment, with statistical significance (P<0. 05), which meant the kidney function improved. The glutamic pyruvic transaminase (GPT) was (21. 45 + 15. 70)U/L and (15. 16 + 6. 35)U/L before and after treatment (P<0. 05). Conclusion Melamine has no obvious long-term damage on infants' liver and kidney function.%目的 初步了解三聚氰胺对婴幼儿肝肾功能有无长期的损害.方法 随访已确诊的三聚氰胺结石患者,通过对比治疗前后的尿常规、肝肾功能和泌尿系B超变化,根据结果初步判断三聚氰胺对婴幼儿的肝肾脏是否有长期的损害.结果 治疗前37例患者全部有肾结石,治疗后只有3例仍有结石,两者相比有统计学差异(P<0.05),大部分患者肾结石消失;治疗前有17例患者尿潜血试验阳性,治疗后尿潜血试验阳性者只有3例,治疗前有10例患者尿白细胞(WBC)阳性,治疗后全部患者尿白细胞为阴性;两者前后比较提示尿液常规明显改善(P<0.05);治疗前血清肌酐(Cr)为(38.47±9.60)μmol/L、治疗后为(33.38±5.24)μmol/L,血清尿酸(UA)在治疗前为(296±104)μmol/L,治疗后为(227±60)μmol/L,两者治疗前后比较提示肾功能有所改善(P<0.05);治疗前后血清谷丙转氨酶(GPT)分别为(21.45±15.70) U/L和(15.16±6.35) U/L,治疗后GPT较治疗前明显降低(P<0.05).结论 三聚氰胺对婴幼儿的肝肾功能无明显的长期损害.
  • 摘要：Objective To explore the effects of Celebrex on the cell growth and the expression of vascular endothelial growth factor (VEGF) in PCI2 cells in vitro. Methods The inhibition effects during proliferation of PCI2 cells treated with Celebrex were evaluated with MTT assay. The cell morphology was observed with Wright-Giemsa staining. The apoptosis rate of PCI2 cells was determined with flow cytometry. The expression of VEGF-165 was detected with Western blot. Results Celebrex significantly inhibited the growth of PC12 cells in vitro in a dose-dependent manner with an IC50 value of 100μmol/L, with a significant difference in cell apoptosis rates among the groups. Celebrex inhibited the expression of VEGF-165 and had a positive correlation with time. Conclusion Celebrex inhibits PC12 cell proliferation, induces cell apoptosis and inhibits the expression of VEGF.%目的 体外探讨COX-2抑制剂塞来昔布对PC12细胞的生长影响及血管内皮生长因子VEGF的表达的调控.方法 应用噻唑蓝(MTT)比色法观察塞来昔布对大鼠嗜铬细胞瘤细胞系PC12细胞的生长抑制作用;Wrights-Giemsa染色法观察细胞形态学;流式细胞技术观察细胞在各时间点的凋亡率;Western blot检测VEGF-165蛋白的表达变化.结果 塞来昔布呈时间、剂量依赖性抑制PC12细胞,24 h半数抑制浓度(IC50)为100 μmol/L;各点凋亡率均高于空白对照组;塞来昔布能抑制PC12细胞的VEGF-165蛋白表达,且跟时间正相关.结论 COX-2抑制剂塞来昔布能抑制PC12细胞增殖,诱导细胞凋亡,抑制VEGF蛋白表达.
  • 摘要：目的 探讨姜黄素(CUR)对大鼠睾丸受X线辐射损伤的保护作用.方法 选取雄性SD大鼠60只,体重160~180 g,随机分为4组.B组(单纯辐射组)、C组(辐射+溶剂对照组)及D组(辐射+CUR组)大鼠进行剂量为2.0 Gy X射线一次性全身照射,对照组(A组)不进行照射.C组大鼠于辐射开始1 h后给予腹腔注射二甲基亚砜;D组于辐射开始1 h后给予腹腔注射姜黄素溶液.照射1周后将所有大鼠处死.采用TUNEL 法检测生殖细胞凋亡;检测睾丸组织中超氧化物歧化酶( SOD)、谷胱甘肽过氧化酶(GSHPx)活性及丙二醛(MDA) 含量.结果 B组及C组SOD和GSHPx活性明显降低,MDA含量明显升高,与对照组相比,差异有统计学意义(P<0.01).而CUR能有效升高SOD和GSHPx活性并降低MDA含量(P<0.01).B组及C组睾丸脏器系数明显低于正常对照组,差异有统计学意义(P<0.01).CUR能有效增加睾丸脏器系数(P<0.01).B组及C组凋亡指数明显高于A组(P<0.01),而CUR可以使凋亡指数显著下降(P<0.01).结论 本实验为CUR作为治疗睾丸辐射损伤的有效物质提供了组织学及生化依据,为临床预防和治疗睾丸辐射损伤提供了理论依据.%Objective To examine the effectiveness of curcumin on X-ray radiation damage of testis tissue in male rats. Methods Male Sprague-Dawley rats (n = 60, 160-180 g) were divided randomly into 4 groups. Rats in group A served as controls. Rats in group B (radiation group) underwent whole-body X-ray exposure at the dose of 2. 0 Gy. Rats in group C and D received DMSO and curcumin respectively 1 hour after 2. 0 Gy irradiation. Testicular tissues were prepared 1 week after irradiation. Superoxide dismutase (SOD) activities, glutathione peroxidase (GSHPx) activities, and concentration of malondialde-hyde (MDA) were detected. Moreover, the spermatogenic cell apoptosis was visualized with TUNEL. Results SOD activities and GSHPx activities in group B and C decreased as compared with those of the controls (P<0. 01). Curcumin treatment significantly increased SOD activities and GSHPx activities (P<0. 05). The MDA concentration in group B and C increased as compared with that of the controls (P<0. 01). Curcumin treatment significantly reduced the MDA concentration (P<0. 01). Irradiation significantly decreased the testis weight (P<0. 01). Curcumin treatment significantly restrained the decrease in testis weight (P<0. 01). Apoptosis indexes in group B and C significantly increased compared with those in the controls (P< 0. 01). Curcumin treatment significantly reduced the apoptosis index. Conclusions The results provide a biochemical and his-topathological basis to indicate that curcumin acts as a therapeutic agent for the testicular damage induced by X-ray exposure.
  • 摘要：Objective To investigate the distribution of ICC and nNOS positive neurons in the corpus cavernosum of guinea pig and the histological association. Methods Using c-kitNOS immunofluorescence double staining of frozen sections of adult guinea pig corpus cavernosum, we observed the morphology and distribution of corpus cavernosum ICC and nNOS-posi-tive neurons under laser scanning confocal microscope(LSCM). Using c-kitNOS immunofluorescence double staining of cultured ICC by enzyme digestion, we observed the morphology and the expression of c-kit and nNOS under laser scanning confocal microscope. Results ICC were located near the boundaries of smooth muscle meshwork and interstice of smooth muscle, spindle-shaped, with long processes, round or oval-shaped cell body and expressed nNOS. ICC and nNOS-positive neurons were located on the boundaries of the smooth muscle meshwork and interstice of smooth muscle, and abundant ICC could be seen a-round nNOS-positive nerve trunk. Conclusions ICC are closely associated with nNOS-positive neurons in the corpus cavernosum of guinea pig, indicating that ICC may participate in the transduction of NO signal from nerves to smooth muscle cells.%目的 初步探讨豚鼠阴茎海绵体组织中cajal间质细胞 (ICC)和神经型一氧化氮合成酶(nNOS)阳性神经元的分布及两者的组织学关系.方法 ①制作成年豚鼠阴茎海绵体组织冰冻切片,利用c-kitNOS免疫荧光双染技术,激光共聚焦扫描显微镜(LSCM)下观察阴茎海绵体ICC及nNOS阳性神经元的形态及分布情况.②酶消化法体外培养阴茎海绵体ICC,c-kitNOS免疫荧光双染,LSCM下观察细胞形态及c-kit和nNOS的表达情况.结果 ICC分布在阴茎海绵体平滑肌小梁边缘及平滑肌肌间,纺锤形,具有长的突起,胞体呈圆形或椭圆形,并且表达nNOS;阴茎海绵体平滑肌小梁边缘及平滑肌肌间同时分布有ICC和nNOS阳性神经元,局部nNOS阳性神经主干附近可见较多ICC分布.结论 豚鼠阴茎海绵体ICC与nNOS阳性神经元组织联系紧密,ICC可能参与阴茎海绵体内NO神经信号的传递.
  • 摘要：Objective To observe the Aquaporin-KAQP1) protein changes of prostatic carcinoma cells by RNA interference of AQP1 gene. Methods Small interference RNA targeting AQP1 was designed and synthesized, and was transfected into PC-3 cells by lipofectamine method. The expression of protein was detected with Western blot. Results AQP1 expressed in prostate carcinoma cells PC-3. The expressions of AQP1 protein could be effectively contained by express carriers (transfection groups: 0.54 + 0.04, normal control group: 0. 82 + 0. 08,P<0. 01). Conclusions Transfection of siRNA-expressing vectors, which target against specific sequences of AQP1 in the PC-3 cells, can result in a significant reduction in the corresponding AQP1 protein, and induce apoptosis of PC-3 cells.%目的 探讨RNA干扰技术沉默AQP1基因对前列腺癌PC-3细胞AQP1蛋白表达影响.方法 设计合成针对前列腺癌PC-3细胞AQP1基因的小干扰RNA并构建高效表达载体,脂质体法转染PC-3细胞,Western Blot检测AQP1蛋白表达的变化.结果 AQP1在前列腺癌PC-3细胞表达,针对AQP1基因siRNA高效表达载体能够抑制AQP1蛋白在PC-3细胞的表达,AQP1蛋白相对表达量为:转染组0.54±0.04,正常对照组0.82±0.08,差异有显著性(P<0.01).结论 通过抑制AQP1基因的表达,有效抑制了前列腺癌PC-3细胞AQP1蛋白表达.
  • 摘要：盆底手术由妇科医生做或由泌尿科医生做的争论其实由来已久，在压力性尿失禁的手术治疗方面，上世纪存在逾百种方法，妇科医生倾向阴道前壁修补术，泌尿科医生喜爱sling手术，并在由谁来做更好方面存在争执。在妇科医生为手术的发展做出贡献的同时，此间由泌尿医生主导的尿动力检查更为压力性尿失禁的发病提供了坚实的理论基础。
  • 摘要：目的 探讨经尿道选择性120 W绿激光前列腺汽化术(PVP)治疗高龄高危良性前列腺增生症(BPH)的临床疗效及安全性.方法 分析2010年7月至2011年7月,本院行PVP手术治疗的高龄高危BPH 57例患者的临床资料.结果 57例患者手术均顺利,其中5例行TURP辅助PVP手术治疗,所有患者均未出现电切综合征,无死亡病例.单纯行PVP手术者52例,术后输血1例,泌尿系感染4例,手术时间平均(38.3±11.3)min,平均出血量(25.5±16.5)mL,术后均留置导尿管行膀胱冲洗6~26 h,平均(9.3±5.1)h,留置尿管时间平均(1.9±0.7)d,术后平均住院时间(2.9±0.9)d.行TURP辅助PVP手术患者手术时间(47.2±8.6)min,平均出血量(32.6±17.8)mL,术后均留置导尿管行膀胱冲洗9~26 h,平均(13.4±7.1)h,留置尿管时间平均(2.5±0.6)d,术后平均住院时间(4.5±1.3)d.术后国际前列腺症状评分、生活质量评分、最大尿流率和残余尿量与术前比较均明显改善.结论 经尿道选择性120 W绿激光前列腺汽化术治疗BPH具有操作安全、术中出血少、手术时间短、近期疗效显著,尤其适合于高龄高危患者.
  • 摘要：综述国际最近20年关于肾癌生长速度的研究,发现大部分临床上偶然发现的早期肾癌生长缓慢,且发生转移的几率也低.这对部分不适合手术的肾癌进行保守治疗提供了临床指导及理论依据.
  • 摘要：Objective To investigate the diagnosis and management of primary hyperparathyroidism with repeated bilateral renal stones. Methods Clinical data of 5 patients diagnosed with primary hyperparathyroidism with repeated bilateral renal stones during Feb. 2009 to March 2011 were analyzed retrospectively. Results The 5 patients included 2 men and 3 women, pathologically diagnosed as with parathyroid adenoma, mean age (35. 6 + 9. 6) years(18-56), stone history (2. 4 + 0.3) years(0. 5-3. 0). Their serum calcium and PTH level elevated obviously, while serum phosphate reduced. After resection of the parathyroid adenoma, the patients' serum calcium, phosphate and PTH returned to normal. Conclusions Parathyroid-ectomy is effective to treat the disease, which can reduce recurrence of kidney stones remarkably. Early diagnosis and treatment of primary hyperparathyroidism is helpful to reduce stone recurrence and preserve renal function. Patients should be followed up closely in case they need appropriate treatment.%目的 探讨反复双肾结石患者中原发性甲状旁腺机能亢进的诊断和治疗,提高对本病的认识.方法 回顾性分析2009年2月~2011年3月因反复双肾结石就诊,临床诊断原发甲旁亢5例的资料.结果 5例病理证实为甲状旁腺腺瘤,男2例,女3例,年龄18~56岁,平均年龄(35.6±9.6)岁,结石病史0.5~3.0年,平均时间(2.4±0.3)年.血钙和甲状旁腺激素明显升高,血磷降低.切除腺瘤后,患者血钙、血磷和甲状旁腺激素恢复正常.结论 手术是治疗原发甲旁亢的有效方法.甲状旁腺手术可以明显降低结石复发,甲旁亢的早期诊治有益于减少结石复发和保护肾功能.术后应密切随访尿路结石,必要时予相应治疗.
  • 摘要：结石形成是肠代膀胱术后的晚期并发症,尤其是当缝合材料长期暴露于尿液中时更易形成结石。本文报道1例,去带盲结肠可控膀胱术后8年,在储尿囊中以偶然脱落的金属钉为核心形成结石。
  • 摘要：As the laparoscopic technology developed and experience accumulated, laparoscopic radical nephrectomy has become the standard treatment of localized or partial locally advanced renal cell carcinoma. Classic or early ligature of renal artery violates Robson principle in varying degrees, but the technique of direct access to the renal artery, which is achieved at the level of the Treitz ligament on the left and interaortocaval space on the right, not only follows Robson principle best, but also has incomparable advantages on high-complexity and high risk renal cell carcinoma like large tumor, lymph node metastasis, prior surgery or infection of ipsilateral kidney, renal artery variation and renal vein thrombus. This technique also can be used in other renal disease like local advanced renal pelvic carcinoma, renal metastatic carcinoma, huge benign tumor, non-functioning kidney caused by nephrophthisis or renal infection. The technique should be popularized because it follows Robson principle and by which laparoscopic nephrectomy for high-complexity becomes easier.%随着腹腔镜技术的成熟和经验的积累,腹腔镜肾癌根治术已经成为局限性肾癌和部分局部进展性肾癌治疗的"金标准".经腹腹腔镜肾癌根治术中采用经典或早期肾动脉阻断方法是不符合无瘤原则的,而采用超早肾动脉阻断方法(左侧经屈氏韧带从左肾动脉根部阻断、右侧经主动脉-下腔静脉间隙从右肾动脉根部阻断)能在尽少触碰瘤体的情况下完成肾动脉阻断,不仅最大程度地遵循了无瘤原则,而且在处理一些复杂性肾癌(如大肾癌、伴淋巴结转移、伴肾静脉癌栓、既往同侧肾手术史、外伤史、感染史、肾动脉变异等)也体现出明显优势.同时该方法还能扩展应用于其他比较复杂的肾(根治)切除手术中,如肾周严重侵犯的肾盂癌、巨大肾良性肿瘤、肾结核、感染性无功能肾等.超早期肾动脉阻断方法既遵循无瘤原则,又降低了复杂性腹腔镜肾脏手术的难度,值得临床推广.
  • 摘要：慢性前列腺炎（chronicprostatitis,CP）是影响男性健康的重要因素之一,其疗效不确切与众多因素有关,其中心理因素对疾病转归的影响已引起广泛关注。2008年1月～2010年7月年我科收治120例慢性前列腺炎患者,给予分组治疗,现报告如下。

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