InVance球部悬吊术治疗男性前列腺术后尿失禁（附5例报告）

目的探讨InVance球部悬吊术治疗男性尿失禁的安全性及有效性。方法2003年3月～2008年1月,应用InVance球部悬吊术治疗5例前列腺手术后尿失禁（经尿道前列腺电切术后4例,前列腺癌根治术后1例）。年龄62～76岁,平均67岁。尿失禁病程2～6年,平均4年。保守治疗无效。术前尿动力学检查平均漏尿点压力25.5cmH2O（20～32.5cmH2O）。截石位,会阴正中皮肤纵行切开3～5cm,显露尿道球部浅面球海绵体肌及双侧耻骨下支。采用InVance器械,电钻将带有1号不吸收合成线的钛螺钉分别在两侧的耻骨联合与耻骨下支连接部和其下约2cm处打钉6个。将聚丙烯筛网材料吊带裁剪成约3cm×4cm,将一侧耻骨下支上的三条合成线穿过吊网两角分别结扎固定,术中增加腹压后（下腹部加压等）咳嗽试验调节吊带的松紧度,或将逆行尿道漏尿点压调整为60cmH2O,留置导尿管。结果手术时间50～85min,平均60min。出血20～50ml,平均30ml。5天拔除气囊导尿管,均能自行排尿。5例随访6～24个月,平均12.6月,4例经尿道前列腺电切术后者尿失禁治愈,1例前列腺癌根治术后者尿失禁改善;尿动力学检查平均漏尿点压力65cmH2O（55～70cmHO）。结论InVance球部悬吊术是一种可治疗前列腺术后轻中度尿失禁的方法。     

螺旋CT和彩色多普勒血流显像检查对胰腺癌可切除性的评估价值

Objective To determine the value of helical computed tomography (HCT) and color doppler flowing imaging (CDPI) in evaluating the resectability of pancreatic cancer. Methods The clinical data of 114 patients with pancreatic cancer who had been admitted to the Affiliated Hospital of North Sichuan Medical College from January 1995 to December 2002 were retrospectively analyzed. The values of HCT and CDPI in assessing the resectability of pancreatic cancer were determined according to the results of operation and pathological examina-tion. All the data were analyzed by chi-square test and Fisher exact probability. Results Of all patients, 109 were examined by HCT, 97 by CDPI and 96 by HCT+CDPI. For patients examined by HCT, the resection rates of pancreatic head cancer, pancreatic body and tail cancer and total pancreatic cancer were 45.3% (39/86), 26.3% (5/19) and 0 (0/9), respectively. The resection rate of pancreatic head cancer was higher than that of pancreatic body and tail cancer (χ2=8.965, P<0.05). With the increase of tumor size, the invasion rate and metastasis rate were increased and the resection rate was decreased (z=6.15, 5.35, 7.18, P<0.01). The sensitivity rate and specificity rate were 77.8% and 82.2% of HCT, 73.3% and 80.6% of CDPI, 90.6% and 92.4% of HCT+CDPI in assessing the resectability of pancreatic cancer. The values of Kappa identity test of HCT, CDPI and HCT+CDPI were 0.58, 0.52 and 0.82, respectively. Conclusions Combined application of HCT and CDPI can further improve the accuracy in assessing the resectability of pancreatic cancer.     

辛伐他汀引起肾移植受者横纹肌溶解症一例

横纹肌溶解症是指横纹肌细胞受损后使细胞膜的完整性发生改变,细胞内物质,如蛋白、离子、酶等释放入血,最后从尿中排出,并可导致急性肾功能衰竭和电解质紊乱等一系列并发症.本例系肾移植后使用辛伐他汀引起横纹肌溶解症,报告如下.     

主动脉肾神经节的局部解剖学

目的:为主动脉肾神经节、肾丛的影像学研究提供形态学基础,为提高对主动脉肾神经节的影像诊断提供参考.方法:对75具成人尸体标本主动脉肾神经节的位置、形状、长度、宽度和厚度进行解剖观测,对6具成人尸体标本的主动脉肾神经节在断面、CT、MRI扫描图像卜进行观察.结果:主动脉肾神经节位于肾静脉的后方,肾动脉表面和附近,其形态可分为椭圆形、长条形、星形、圆形和三角形;主动脉肾神经节横断面观察,组织致密,无管腔横断面;在CT、MRI扫描图像上能分辨其结构.结论:在断面标本中主动脉肾神经节与淋巴结的区别可通过观察其横断面组织是否致密,有无管腔横断面来确定;在尸体标本上主动脉肾神经节与淋巴结的区别可通过手触膜组织的硬度,相连的纤维状结构是否坚韧,是否有内脏小神经相连来确定.     

全程护理服务模式对鼻咽癌放疗患者的应用效果评价

目的：探讨应用全程护理服务模式和常规护理服务对患者关于鼻咽癌相关健康教育知识的掌握程度以及护理服务满意度的不同影响。方法：对80例初诊的鼻咽癌患者分别采用不同的护理服务模式,出院前进行相关问卷调查。结果：实施全程护理服务模式的患者（实验组）对鼻咽癌6项相关健康教育知识基本了解率高于对照组（P〈0.05）,差异有显著性;实验组患者对护理服务满意率也高于对照组（P〈0.05）,差异有显著性。结论：全程护理服务模式采用多种健康教育形式,可以提高患者对疾病的认识,达到自我照顾、提高生活质量的目的。     

亲属活体供肾切取术式选择探讨

目的 探讨亲属活体供肾切取术式选择的策略及不同术式的临床效果.方法 回顾总结我院2004年1月至2007年6月119例亲属供肾切取的4种术式:(1)经腹部开放手术22例;(2)经腹膜后隙腹腔镜下切肾21例;(3)经腹手助式腹腔镜下切肾13例;(4)经腰部腹膜后隙开放手术切肾63例.比较开放手术与腹腔镜手术手取肾的手术时间、供肾热缺血时间、供肾动静脉长度、供肾移植后3 d内血肌酐的下降速度、供者术后平均住院日及住院费、供者术后并发症.结果 开放手术比腔镜手术组:手术时间短(P=0.0033)、供肾热缺血时间短(P=0.0001);供者术后住院时间长(P=0.0000) 住院费用多(P=0.0000);受者术后3 d血肌酐下降速度快(P=0.0001);供肾血管长(左P=0.0000,右P=0.0001).并发症:腔镜组:皮下气肿1例、DGF2例、术中腰静脉大出血改开放手术2例,开放组术后继发肾上腺大出血再手术1例.两组无移植肾丢失及供者生存意外发生.结论 开放手术与腔镜手术切取活体供肾均是安全的术式.亲属活体供肾切取术式的选择应根据供者肾脏血管的形态、供者体形、术侧、术者对术式的熟练程度综合决定.开放手术取肾稳妥、快捷;腔镜手术取肾损伤小,恢复快,供肾血管短、移植早期血肌苷下降速度慢.     

增加穿刺活检针数提高前列腺癌分级准确性的临床研究

目的 探讨增加穿刺活检针数能否提高前列腺癌穿刺标本Gieason评分准确性.方法 接受根治性前列腺切除的前列腺癌患者86例.平均年龄63(55～72)岁.术前PSA值平均16.8(1.6～57.2)ng/ml,前列腺体积平均39.4(18.1～114.1)ml.患者术前均未接受新辅助内分泌治疗,按经直肠前列腺穿刺针数分为2组.A组46例行标准6针系统穿刺,B组40例行13针系统穿刺.统计学比较分析2组穿刺标本与根治术标本Gleason评分符合情况及影响因素. 结果 A组穿刺标本与根治术标本Gleason评分相符16例(34.8%),B组为26例(65.O%),B组评分符合率明显高于A组(P＜0.05).当穿刺标本Gleason评分≤6时,B组评分相符11例(68.8%),明显高于A组5例(25.0%),差异有统计学意义(P＜0.05).多因素Logistic回归分析结果提示前列腺穿刺活检针数及活检阳性率是影响穿刺标本与根治术标本Gieason评分符合率的主要相关因素(P＜0.05).结论 增加穿刺针数能够提高经直肠前列腺穿刺标本Gleason评分预测前列腺癌分级的准确性.     

肾上腺皮质髓质混合性病变的诊治研究

目的：提高对肾上腺皮质髓质混合性病变的诊治水平。方法：总结1987-2007年29例肾上腺皮质髓质混合性病变患者的临床资料。临床表现高血压29例,伴头痛16例、心悸10例和肌无力10例。10例血清钾2.4-3.2mmol／L,平均2.87mmol／L。血皮质醇9例增高,节律异常2例。24h尿香草基杏仁酸8例增高。2004年后8例24h尿甲氧基去甲肾上腺素中1例增高;24h尿甲氧基肾上腺素中2例增高。24例中血浆肾素：卧位中9例增高,2例降低。立位中7例增高,6例降低。血管紧张素：卧位中7例增高;2例降低。立位中6例增高,4例降低。醛固酮：卧位中5例增高,立位中3例增高。CT扫描检查：7例。肾上腺增生,14例肾上腺结节状增生,8例腺瘤,平扫CT值2.6-41.0Hu,平均21.0Hu;增强CT值26.0-74.3Hu,平均57.0Hu。结果：开放手术8例,后腹腔镜手术21例,手术时间：开放90-180min,平均110min;后腹腔镜25-70min,平均45min。术中血压变化6例〉50mmHg,23例〈50mmHg。术后7-10天出院。29例中26例随防时间1-5年手术部位未见增生、结节及肿瘤复发。18例患者血压正常,8例仍需服用降压药控制血压,但药物种类和剂量减少。病理诊断：13例肾上腺皮质髓质增生,3例肾上腺皮质髓质增生,皮质增生为主,4例肾上腺皮质髓质增生,髓质增生为主,1例。肾上腺皮质髓质增生伴嗜铬细胞瘤,1例肾上腺皮质结节状增生伴髓质增生,3例肾上腺皮质腺瘤伴皮质髓质增生,4例肾上腺皮质腺瘤伴髓质增生。结论：肾上腺皮质髓质混合性病变临床少见,确诊靠病理诊断。手术是治疗的主要方法,腹腔镜下手术值得推荐。     

腹腔神经丛的应用解剖

目的为提高腹腔神经丛穿刺阻滞的成功率 ,减少并发症提供形态学基础。方法对 4 3具成人尸体标本的腹腔神经丛、腹腔神经节的位置、形态、毗邻、长度、宽度、厚度等进行观测。结果 95 %腹腔神经丛位于第 12胸椎至第 1腰椎体 ,腹腔神经节依据形态可分为长条型、结节型、薄片型、半月型 ;长条型又根据其行程可分为纵行、横行、斜行 3种。结论依据腹腔神经节的位置、形态及行程选择穿刺部位和选择性增加注射点及注射量。     

螺旋CT和彩色多普勒血流显像检查对胰腺癌可切除性的评估价值

Objective To determine the value of helical computed tomography (HCT) and color doppler flowing imaging (CDPI) in evaluating the resectability of pancreatic cancer. Methods The clinical data of 114 patients with pancreatic cancer who had been admitted to the Affiliated Hospital of North Sichuan Medical College from January 1995 to December 2002 were retrospectively analyzed. The values of HCT and CDPI in assessing the resectability of pancreatic cancer were determined according to the results of operation and pathological examina-tion. All the data were analyzed by chi-square test and Fisher exact probability. Results Of all patients, 109 were examined by HCT, 97 by CDPI and 96 by HCT+CDPI. For patients examined by HCT, the resection rates of pancreatic head cancer, pancreatic body and tail cancer and total pancreatic cancer were 45.3% (39/86), 26.3% (5/19) and 0 (0/9), respectively. The resection rate of pancreatic head cancer was higher than that of pancreatic body and tail cancer (χ2=8.965, P<0.05). With the increase of tumor size, the invasion rate and metastasis rate were increased and the resection rate was decreased (z=6.15, 5.35, 7.18, P<0.01). The sensitivity rate and specificity rate were 77.8% and 82.2% of HCT, 73.3% and 80.6% of CDPI, 90.6% and 92.4% of HCT+CDPI in assessing the resectability of pancreatic cancer. The values of Kappa identity test of HCT, CDPI and HCT+CDPI were 0.58, 0.52 and 0.82, respectively. Conclusions Combined application of HCT and CDPI can further improve the accuracy in assessing the resectability of pancreatic cancer.