改良等离子前列腺电切术治疗老年良性前列腺增生的疗效

目的 观察改良等离子前列腺电切术(PKRP)治疗老年良性前列腺增生(BPH)患者疗效，及对术后并发症的影响。方法 回顾性选取2019年1月至2020年1月本院收治的老年BPH患者102例，按手术方式分为两组，改良PKRP组(51例)和常规PKRP组(51例)，常规组采用常规PKRP术治疗，改良组采用改良PKRP术治疗，比较两组围术期指标、术前及术后3个月尿动力指标、国际前列腺症状评分(IPSS)和生活质量(QOL)评分，及术后3个月内并发症发生情况。结果 改良PKRP组手术时间、术中出血量、膀胱冲洗时间、拔管时间及住院时间均短于常规PKRP组(P<0.05)；术后3个月，两组最大尿流率(Qmax)与术前比较明显升高(P<0.05)，但组间比较无明显差异(P>0.05)；两组残余尿量(RUV)与术前比较明显降低(P<0.05)，但组间比较无明显差异(P>0.05)；改良PKRP组IPSS、QOL评分明显降低，且低于常规PKRP组(P<0.05)；术后3个月内，改良PKRP组尿失禁等并发症发生率为5.88%，明显低于常规PKRP组的21.57%(χ...     

腹腔镜辅助完整结肠系膜切除术与传统开腹术后并发症分析

目的:探讨开腹完整结肠系膜切除术与腹腔镜辅助完整结肠系膜切除术两种术式的并发症风险及Clavien-Dindo分级。方法:回顾性分析136例结肠癌患者的临床资料,根据手术方式分为开腹组和腹腔镜组,每组68例患者,比较两组术后并发症的差异。结果:开腹组术后并发症发生率23.5%(16/68),腹腔镜组16.1%(11/68,P 0.05);两组心血管、肺部及腹部并发症均无显著性差异(P 0.05);Ⅰ、Ⅰ、Ⅲ期结肠癌患者术后并发症无显著性差异(P 0.05);左半结肠癌与右半结肠癌术后并发症无显著性差异(P 0.05)。术后并发症Clavien-Dindo分级,开腹组Ⅰ级2例,Ⅰ级10例,Ⅲa级0例,Ⅲb级1例,Ⅳa级1例,Ⅳb级0例,Ⅴ级0例;腹腔镜组Ⅰ级1例,Ⅰ级11例,Ⅲa级0例,Ⅲb级1例,Ⅳa级0例,Ⅳb级0例,Ⅴ级0例,均无显著性差异(P 0.05)。结论:与开腹完整结肠系膜切除术相比,腹腔镜辅助完整结肠系膜切除术术后并发症风险未见明显差异,具有安全性。     

创伤性脾破裂患者术后发生Clavien-Dindo Ⅱ～Ⅴ级并发症的危险因素分析

目的根据术后并发症Clavien-Dindo分级方法,对创伤性脾破裂手术患者出现并发症及其危险因素进行分析研究。方法回顾性分析芜湖市第二人民医院急诊外科2 0 1 6年1月至2019年8月收治的64例创伤性脾破裂手术患者的统计资料,使用Clavien-Dindo分级法对术后并发症进行等级分析并筛选出其危险因素。结果 Clavien-Dindo分级Ⅰ级有31例(48.4%),Ⅱ级19例(29.7%),Ⅲa级1例(1.6%),Ⅲb级6例(9.4%),Ⅳa级3例(4.7%),Ⅳb级1例(1.6%),Ⅴ级3例(4.7%)。术后出现Clavien-DindoⅡ～Ⅴ级并发症与患者年龄、出血量以及是否合并空腔脏器损伤有关(P0.05)。其中年龄超过65岁是发生Ⅱ～Ⅴ级并发症的独立危险因素。结论参照Clavien-Dindo并发症分级法,为降低创伤性脾破裂患者手术后并发症,需注重围手术期的监管,尤其是对于年龄超过65岁、合并有空腔脏器损伤、术中出血量大的患者。     

肝移植术后胆道并发症的Clavien分级及高危因素分析

目的 探讨肝移植术后胆道并发症(biliary complication,BC)发生高危因素及Clavien 分级在BC分类中的意义.方法 逐步回归法筛选BC发生的高危因素;对BC进行Clavien分级,筛选ClavienⅢb级以上BC发生的高危因素.结果 14.4％ (26/181)的肝移植患者发生BC,其中ClavienⅢb级以上BC占84.6％ (22/26).BC组的回归分析表明:T管留置(P=0.0090,OR=31.177),术后1d肝动脉阻力指数(RI1d)(P=0.0094,OR＜0.001),术后1周肝动脉阻力指数(RI1w)(P=0.0013,OR＞999.999)的差异有统计学意义,且对该疾病的发生作用显著.ClavienⅢb 以上BC组的回归分析表明:RI1d(P=0.0065,OR＜0.001)、RIlw(P=0.0022,OR＞999.999)的差异有统计学意义,且对该疾病的发生作用显著.结论 Clavien分级系统对胆道并发症的分类具有重要指导意义.T管的放置增加了BC发生的风险,但并不会增加ClavienⅢb以上BC的发生.术后肝动脉血流异常的存在是BC尤其是ClavienⅢb以上BC发生的独立危险因素.     

活体肝移植供体安全性的研究(单中心356例临床分析)

目的评估活体肝移植术供体的安全性。方法回顾性分析2001年1月至2015年9月期间在我中心行活体肝移植供肝切取术的356例供体,按时间顺序以2008年1月为界分为前期组(n=129)与后期组(n=227),从术后并发症、肝功能和生活质量3个方面评估其安全性。结果 1总共356例活体肝移植供肝切取术中无一供体死亡。2发生并发症83例,总体并发症发生率为23.3%(83/356)。其中ClavienⅠ级并发症42例(50.6%),ClavienⅡ级并发症22例(26.5%),ClavienⅢ级并发症18例(21.7%),ClavienⅣ级并发症1例(1.2%)。在全部供体中,ClavienⅠ、Ⅱ、Ⅲ、Ⅳ级并发症的发生率分别为11.8%(42/356)、6.2%(22/356)、5.1%(18/356)、0.3%(1/356)。后期组的总并发症率较前期组明显降低〔18.1%(41/227)比32.6%(42/129),P0.01〕,严重程度亦有所减轻。并发症中最常见者为胆管并发症,发生率为8.4%(30/356)。3供体术后的肝功能变化均为一过性,一般在1周内恢复正常。4使用SF-36量表对供体过去1年的生活质量进行评价,均呈良好状态,且94.8%(239/252)的受访者表示若有必要愿意再次捐献。结论不断改善的手术和麻醉技术,结合严格的供体筛选和规范的围手术期管理,可以确保活体肝移植供体较低的并发症发生率和较好的远期效果。     

顺逆结合围肝门外科入路与传统手术入路治疗侵犯肝门胆囊癌对比研究

目的评价顺逆结合围肝门外科入路治疗侵犯肝门部胆囊癌的疗效。方法收集2007年1月至2017年12月上海交通大学医学院附属仁济医院普外科与胆胰外科收治的侵犯肝门部胆囊癌手术共39例病人的临床资料,比较顺逆结合围肝门外科入路(围肝门入路组,20例)与传统手术入路(传统手术入路组,19例)两种手术入路术后R0切除率、术中出血量、并发症发生率和总体生存时间等。结果传统手术入路组采用CT和(或)MRI进行术前评估,围肝门入路组采用CT+MRI+三维重建评估。传统手术入路组可切除评估准确率为57.9%(11/19),围肝门入路组可切除评估准确率为90.0%(18/20),两者差异有统计学意义(P=0.031)。传统手术入路组和围肝门入路组比较,两组R0切除率分别为26.3%(5/19)和85.0%(17/20)(P=0.000)。两组行S4b,5+肝外胆管切除、S4b,5,6,7,8+肝外胆管切除、S4a,4b,5,6,7,8+肝外胆管切除、联合脏器切除术、胆囊切除+T管架桥胆肠内引流术或剖腹探查术分别为7例vs.8例、3例vs.6例、0 vs.1例、1例vs.3例、8例vs.2例(P=0.156)。两组术后30 d死亡例数为4例vs.0(P=0.047)。在肝切除病人中,传统手术入路组病人出血量显著大于围肝门入路组[(660.0±219.1)mL vs.(358.8±184.8)mL,P=0.006],传统手术入路组Clavien Ⅲ级以上并发症发生率显著高于围肝门入路组,其中Clavien Ⅲ级病人所占比例分别为72.7%vs. 27.8%(P=0.027),Clavien Ⅳ级病人所占比例分别为45.5%vs. 0(P=0.004),Clavien Ⅴ级27.3%vs. 0(P=0.045)。传统手术入路组与围肝门入路组1年存活率分别为21.1%(4/19)vs.61.1%(11/18)(P=0.020),总体生存时间围肝门入路组显著优于传统手术入路组(16.0个月vs 8.4个月,P=0.0005)。结论顺逆结合围肝门外科入路能提高R0切除率,减少术中出血量,降低围手术期病死率与严重并发症发生率,提高总体生存时间;CT+MRI+三维重建评估能提高术前可切除评估准确性,减少盲目手术探查。     

根治性肾切除术及下腔静脉癌栓取出术治疗Mayo Ⅳ级下腔静脉癌栓的手术技术及临床经验

目的探讨根治性肾切除术及下腔静脉癌栓取出术治疗MayoⅣ级下腔静脉癌栓(IVCTT)的有效性和安全性。方法回顾性分析2015年4月至2018年1月北京大学第三医院泌尿外科收治的10例肾癌合并MayoⅣ级IVCTT患者的临床资料。10例患者中行不开胸取膈上癌栓手术者4例,采用"Milking"技术行开胸非体外循环取膈上癌栓手术者3例,行体外循环下根治性肾切除术加下腔静脉癌栓取出术者3例。结果 10例患者手术均顺利完成。平均手术时间(495.7±109.0)min。术中平均出血量(4 430.0±2 755.2)mL。10例患者中有8例发生术后早期并发症,其中3例为ClavienⅤ级严重并发症,于围手术期死亡,其余5例中有1例ClavienⅣa级、3例为ClavienⅡ级、1例ClavienⅠ级并发症。度过围术期的7例患者术后平均住院时间(12.4±6.3)d;7例皆获随访,随访时间3～27个月,平均(13.6±8.8)个月。除1例患者非肿瘤性死亡外,6例存活,其中1例出现肺转移。结论根治性肾切除术及下腔静脉癌栓取出术治疗MayoⅣ级下腔静脉癌栓较为有效、安全。Ⅳ级癌栓延伸范围广,手术技术难度较大,充分的术前准备、丰富的解剖学知识和手术操作经验可提高手术安全性。     

经尿道等离子双极前列腺切除术与前列腺电切术的疗效比较

目的比较经尿道等离子体双极电切术(PKRP)与经尿道前列腺汽化电切术(TURP)治疗良性前列腺增生症(BPH)的临床疗效。方法将300例有症状的前列腺增生症(BPH)患者随机分成两组,各150例,分别行PKRP和TURP术,记录患者围手术期和术后3个月复查的有关指标(手术时间、术中出血量、冲洗时间、留管时间、住院时间,国际前列腺症状评分(IPSS),尿流率峰值(Qmax)和生活质量评分(QOL)),并发症(TURS、术中输血、继发出血、尿失禁、膀胱痉挛、尿道狭窄)发生率,对两组数据进行统计学分析。结果 PKRP组出血量、冲洗时间、留管时间和住院时间少于TURP组,两组相比差异有显著性(P0.05),术后3个月,两组患者症状评分、生活质量分析、最大尿流率均比术前明显改善(P0.05),PKRP组并发症发生率为3.3%,低于TURP组的13.3%,两组比较差异有统计学意义(P0.05),所有并发症对症处理恢复正常,两组均无死亡病例。结论 PKRP与TURP均是治疗BPH的有效术式,但PKRP较TURP并发症少,安全性高,是治疗BPH较理想的微创术式。     

改良尿道括约肌的保护技术在双极等离子前列腺剜除术中的应用

目的:探讨等离子前列腺电切术(PKRP)和改良尿道括约肌保护的双极等离子前列腺剜除术(PKEP)治疗良性前列腺增生(BPH)的疗效及对尿控功能的保护作用。方法:选取2020年6月—2021年3月我院泌尿外科诊断为BPH并行手术治疗的100例患者为研究对象并回顾性分析其临床数据。改良剜除组50例患者实施改良尿道括约肌保护的PKEP(颈部环切+顶部保留),等离子电切组50例患者实施PKRP。结果:两组患者术前一般资料比较,差异均无统计学意义(P0.05)。围术期相关资料行单因素分析发现改良剜除组手术时间长于等离子电切组[(120.4±34.9) min vs.(94.1±40.8) min,P0.01],而术中出血量少于等离子电切组[(86.2±44.6) mL vs.(166.1±152.1) mL,P0.01],差异有统计学意义。改良剜除组的术后QOL、术后Q_(max)及术后残余尿改善程度均优于等离子电切组,且差异有统计学意义(P0.01)。两组间术中并发症(P=0.22)、持续膀胱冲洗时间(P=0.15)、住院时间(P=0.39)、术后IPSS(P=1.00)、术后尿失禁发生率(P=0.24)的差异无统计学意义。结论:PKEP与PKRP相比具有更好的出血控制能力,更好的术后Q_(max)及残余尿改善程度,术后不增加尿失禁等并发症发生率,对于术后尿控功能具有一定的优势。     

经尿道前列腺等离子双极电切与TURP治疗BPH的疗效比较

目的:比较经尿道前列腺等离子双极电切术(PKRP)与经尿道前列腺电切术(TURP)治疗BPH的临床疗效及安全性。方法:将164例BPH患者随机均分成PKRP组和TURP组,比较两组术后最大尿流率(Qmax)、剩余尿量(PVR)、国际前列腺症状评分(IPSS)、生活质量评分(QOL)等指标。结果:PKRP组72例、TURP组76例获得随访,随访时间3个月。PKRP组尿道外口狭窄2例,膀胱颈挛缩1例,TURP组尿道外口狭窄6例,膀胱颈挛缩4例;PKRP组Qmax为(22.6±4.6)ml/s,PVR为(8.6±4.4)ml,IPSS为(4.6±1.2)分,QOL为(1.2±0.6)分;TURP组分别为(24.2±4.2)ml/s、(9.6±3.6)ml、(4.4±1.0)分、(1.4±0.8)分,两组比较差异有统计学意义(P<0.05)。结论:PKRP与TURP治疗BPH疗效相近,但PKRP平均手术时间、术中出血量、围手术期及术后并发症较TURP明显减少,手术安全性高,有良好的应用前景。     

Anatomy of the prostate: An historical survey of divergent views

Historically, the study of the prostate anatomy has been characterized by a proliferation of contradictory findings. The major divergent views of prostate anatomy are here reviewed and compared in order to facilitate further study and the ultimate selection of the best anatomical model. The details of Lowsley's original concept of the prostate lobes and the subsequent evolution of this concept into several contradictory hypotheses are traced. Discrepancies between the findings of Lowsley, Franks, and McNeal are explained. Conclusions are drawn which may facilitate the further study of anatomy and disease in both the human animal prostate.     

Course of localized adenocarcinoma of the prostate treated by radical prostatectomy

Among 562 patients with histologic stage B-1, B-2, or C adenocarcinoma of the prostate treated by radical prostatectomy and pelvic lymphadenectomy, analysis revealed that increasing histologic stage, tumor size, degree of capsular invasion, seminal vesicle involvement, and histologic grade all were highly correlated with both local and systemic progression (log-rank two-sided P less than or equal to 0.0001). No variable correlated with survival--a result that may reflect appropriate adjuvant therapy given at the time of progression. The death rate from prostatic cancer did appear to rise progressively with increase of stage. Overall, the projected 10-year survival was 76%.     

Impact of the static prostatic urethral angle on men with lower urinary tract symptoms

ObjectiveThe purpose of this study was to investigate the relationship between the prostatic urethral angle (PUA) and the peak urinary flow rate (Q_max), as well as the severity of lower urinary tract symptoms (LUTS) in men with benign prostate hyperplasia.Materials and methodsThe records of first-visit male patients with LUTS in the outpatient department of our institution were obtained. A transrectal ultrasound was performed on these patients after a detailed physical examination and medical history taking were performed. The International Prostate Symptom Score (IPSS) of the patients, the prostate size, the length of intravesical prostatic protrusion (IPP), and the PUA were evaluated. The patients also underwent uroflowmetry and bladder scan for residual urine.ResultsA total of 227 patients were included in this study. The mean PUA was 44.58 ± 12.87°. The mean prostate volume was 39.39 ± 19.79 mL, and the mean IPP was 4.82 ± 6.82 mm. After utilizing multivariate linear regression analysis, PUA was independently associated with IPSS (p < 0.001) and Q_max (p < 0.001). However, prostate volume and IPP were not associated with the above clinical items. None of the prostatic parameters were associated with the amount of postvoiding residual urine.ConclusionPUA has a remarkable correlation with Q_max and IPSS in men with LUTS. As PUA increased, IPSS also increased, and urinary flow rate decreased, exhibiting an inverse relationship.     

Androgen Interaction with the Polyamine System of the Rat Prostate

The ventral and dorsal lobes of the rat prostate contain larger quantities of the aliphatic amines putrescine, spermidine and spermine and higher activities of the enzyme ornithine decarboxylase (ODC; EC 4.1.1.17) than other accessory sex glands. In contrast, the coagulating glands and the seminal vesicles contain only small quantities of the amines but the highest activities of the arginase (ARG; EC 3.5.3.1). Lineweaver-Burk plots indicated that the Km-values for ARG in the coagulating gland and ODC in the ventral prostate lobe were 20 mM and 0.2 mM, respectively. Castration decreased ODC and ARG activities to 3 and 50% of control levels, respectively, after 3 days, whilst the Km-values were unaffected. Daily administration of 3 mg dihydrotestosterone (DHT) prevented these castrational changes. Oestrogen treatment alone had no effect on the activities of the enzymes, but appeared to exert a synergistic effect with androgen on the ODC. Administration of androgen to intact rats for 7 days caused a dose-related alteration in the ratios of the various amines, particularly the spermine: putrescine ratio. A minor but significant decrease was also recorded in the activity of the ODC, which was mirrored by an increase in the levels of putrescine in the tissue. The data suggest that androgen control of the polyamine pathway is biphasic, first stimulatory and later inhibitory with lesions occurring at the ODC, possibly via short loop feedback of its product putrescine, but also at subsequent enzymic steps in spermidine and spermine biosynthesis.     

Tissue type plasminogen activator as a marker for functional zones, within the human prostate gland

The cellular distribution of tissue plasminogen activator in the prostate central zone, prostate peripheral zone, and seminal vesicle was studied by using immunohistochemistry. Samples of these three regions were taken from 20 radical prostatectomy specimens. Sixteen of 18 central zone samples showed positive staining of 20-90% of the epithelial cells. All 15 peripheral zone samples were negative, and only three of 14 seminal vesicles showed positive staining, which was present in less than 5% of cells. The distribution of tissue plasminogen activator within the prostate was the same as that previously reported for pepsinogen II. This suggests that the central zone of the prostate may be the selective site of origin for proteolytic enzymes in seminal fluid.     

前列腺体积及前列腺穿刺针数对前列腺癌诊断的影响

目的探讨前列腺体积及前列腺穿刺针数对前列腺癌诊断情况的影响并分析其原因。方法回顾性总结2002∽2009年间于我院行超声引导下经直肠前列腺系统12针穿刺292例患者的临床资料。患者PSA在o～20ng／mL之间。经直肠超声计算前列腺体积。将患者按照前列腺体积分为：〈30mL,30∽60mL,60∽90mL,〉90mL四组,比较各组前列腺穿刺6针、8针、10针、12针时前列腺癌诊断率。统计学Fisher’S检验比较各组间差异性。结果总体前列腺癌诊断率为25％（73／292）,在〈30mL组：6针、8针、10针、12针的前列腺癌诊断率相同,均为39．13％（21／54）;在30～60mL组：6针、8针、10针、12针的诊断率分别为：21．3％（23／108）、23．1％（25／108）、23．1％（25／108）、24．1％（26／108）,诊断率无显著差异（P〉0．05）。在60～90mL组：6针的诊断率为12．9％（12／93）,显著低于8针（19．4％（18／93）3、10针[20．4％（19／93）]、12针（20．4％（19／93）]的诊断率（Pd0．05）。在〉90mL组：6针、8针的诊断率均为8．1％（3／37）,显著低于10针、12针的诊断率C18．9％（7／37）,P〈0．053。黠论前列腺体积是选择前列腺穿刺针数时的一个重要的参考因素,在前列腺体积较大的情况下,可适当的增加前列腺穿刺针数,在前列腺体积较小的情况下,增加前列腺穿刺针数并不能提高前列腺癌的诊断率。     

Expression of prostatic TRH-like peptides differs between species and between malignant and nonmalignant tissues

Thyrotropin-releasing hormone-immunoreactive peptides (iTRH) were analyzed in normal rat and rabbit prostates and in human benign prostatic hyperplasia (BPH) and prostate cancer. Peptides were extracted from tissues, fractionated by anion and cation exchange chromatography, and analyzed by TRH radioimmunoassay. pGlu-Glu-Pro-NH₂ predominated in rabbit, but accounted for only 10–15% of iTRH in rat and human BPH. Uncharged peptides predominated in rat and human prostate. Authentic TRH (pGlu-His-Pro-NH₂) is not present in rabbit prostate, but may account for up to 25% of iTRH in rat and human prostate. iTRH was virtually absent in prostate cancer. These results demonstrate considerable heterogeneity in the expression of TRH-like peptides in the prostates of various animal species, and suggest decreased expression of these peptides in prostate cancer. © 1993 Wiley-Liss Inc.

1 This article is a US Government work and, as such, is in the public domain in the United States of America

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超声引导下前列腺12针系统穿刺活检增加前列腺癌检出率的研究

目的:探讨不同年龄及前列腺特异性抗原(PSA)分组对12针穿刺活检前列腺癌检出率及肿瘤特征的影响。方法:临床表现怀疑前列腺癌患者210例,按照患者的年龄分为≤59岁组、60～69岁组、70～79岁组、≥80岁组,按照PSA水平分为0～4μg/L组、4.1～10μg/L组、10.1～20μg/L组、20.1～50μg/L组、>50μg/L组,记录患者临床资料及活检结果。提出不同的穿刺方案并计算其检出率。结果:210例怀疑为前列腺癌患者,检出前列腺癌91例,总的前列腺癌检出率为43.3%,随着年龄的增长,PSA水平的提高,检出率逐渐提高。年龄的增长、PSA水平的提高与体积较大、分级较高的肿瘤密切相关。外周带穿刺与旁正中矢状尖部穿刺有较高的前列腺癌检出率。当患者年龄<60岁,PSA水平<20μg/L时,12针穿刺活检为较佳方案。结论:12针穿刺活检可以弥补6针穿刺活检的缺陷,随着患者年龄的增长,PSA水平的提高,肿瘤的体积增大、病理分级较差。传统6针穿刺法与12针相比,受患者年龄、PSA水平的影响较大。