经腹腔与腹膜后腹腔镜肾癌根治术疗效比较

目的比较经腹腔与经腹膜后入路腹腔镜肾癌根治术的临床效果。方法分析2010年4月至2012年2月间在北京大学第一医院接受腹腔镜肾癌根治术的141例患者资料,其中经腹腔入路组61例、经腹膜后腔入路组80例,比较两种手术入路患者在手术时间、出血量、术后住院日等方面的差异。结果所有141例手术均在腹腔镜下完成。对于经腹腔入路组和经腹膜后腔组,平均手术时间分别为192.1及147.2min（P=0.000）;平均术后住院日分别为5.8d及7.2d（P=0.000）;平均肿瘤长径分别为5.6cm及4.3cm（P=0.001）。在术中出血量、并发症及输血情况等方面无显著性差异。结论经腹腹腔镜和经后腹膜腹腔镜肾癌根治术围手术期均有良好效果,经腹腔入路适合治疗体积较大的肿瘤,术后恢复快,而经腹膜后腔入路具有手术时间短的优势。     

颌骨畸形性骨炎1例报告

畸形性骨炎多发于下肢骨及颅骨,颌骨少见。2001年4月15日,我们收治1例下颌骨畸形性骨炎患者。现报告如下。患者女,26岁。1年前发现右下颌肿胀,抗生素治疗无效,X线摄片拟诊为“右下颌囊肿”,因怀孕未继续治疗,分娩5个月后来我院就诊。口腔颌面部检查:右下颌角膨隆,可扪及2.5cm×3.5cm肿物,质硬、无压痛,牙齿无松动。1年前X线片呈现典型的囊肿表现:右下颌体后部8765区及下颌角囊状透光阴影,约4.7cm×6.1cm,边界清晰,为线样骨质硬化环包绕,相应部位下颌骨明显膨隆,骨皮质形成菲薄的骨壳。8765牙根吸收,8受压移位。1a后X线片示:下颌膨隆略减轻…     

大鼠腹壁浅动脉穿支皮瓣的解剖学

目的探讨大鼠腹壁浅动脉穿支皮瓣的解剖学特点,为该皮瓣切取提供解剖学依据。方法 SD大鼠27只,7只行大体解剖,描述该皮瓣的解剖学特点;20只经颈总动脉行明胶-氧化铅灌注,并通过图片处理技术测量相关数据。结果腹壁浅动脉由股动脉发出后在穿浅筋膜处发出第1个分支,随即分为内外侧支,分别与胸外侧动脉和胸背动脉吻合。其外径在股动脉发出处为(0.46±0.02)mm,在穿经浅筋膜处为(0.46±0.02)mm,其营养面积为(18.37±3.67)cm2,其与胸背动脉的吻合区距离腋下水平线和腹中线分别为(5.34±0.86)cm和(4.38±0.38)cm;与胸外侧动脉的吻合区距离腋下水平线和腹中线分别为(6.28±0.69)cm和(2.04±0.33)cm。结论大鼠腹壁浅动脉解剖位置和外径恒定,是游离皮瓣移植、皮瓣动脉增压、血流动力学研究等的理想模型。     

上尿路微创手术的技术改良

Upper urinary surgery is an important area of urology surgery. Open surgery used to be the gold standard of upper urinary surgery. With the development of medical techniques, minimal invasive surgeries including laparoscopic and robot assisted-laparoscopic surgery have gradually replaced the open surgery. Because of the complexity and diversity of upper urinary diseases, surgeries sometimes are difficult, and minimal invasive surgeries require higher surgical abilities of urologists than open surgeries. In recent years, depending on our surgical experience and international reports, our team from three Chinese medical centers summarizes techniques of upper urinary minimal invasive surgeries. For malignant diseases, such as renal and ureteral carcinomas, it’s important to totally remove the tumor first, and then to avoid the surgical injuries. We summarize surgical experience of retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors. Our team modified minimal invasive techniques for some complex tumors, including ring suture technique for renal hilar tumors, internal suspension technique for renal ventral tumors, and combination retroperitoneal laparoscopic surgery with mini-flank incision for complex renal tumors. While for begin diseases, urologists should focus on the resections and surgical injuries at the same time. We have reported the novel technique of laparoscopic aspiration for central renal angiomyolipoma, making the surgery simple and available. For reconstruction surgeries, operations should be based on several principals. We generalize it as “4TB principals”, which include “tension-free”, “water-tight”, “thin suture”, “no touch of the key area” and “protecting the blood supply”. Depending on the localization, length, and etiology of the strictures, different techniques are required. Our team summarize the pyeloplasty, ureteral reimplantation and ileal ureter replacement based on our surgical experience. For infant upper urinary surgeries, our team has made invasive surgeries that can be used in complex diseases, such as duplex kidney. Based on years of surgical techniques, our modified surgeries achieve a better subjective cosmetic result than the traditional surgeries. In the future, the standardized, practical, simple and individual minimal invasive surgical technique will become the main direction in the future researches.     

肾输尿管全长切除术两种不同术式的双中心疗效对比

目的:比较经腹完全腹腔镜肾输尿管全长切除术(complete transperitoneal laparoscopic nephroureterectomy, CTNU)和传统后腹腔镜肾输尿管全长切除术(traditional retroperitoneoscopic nephroureterectomy, TRNU)治疗上尿路尿路上皮癌(upper urinary tract urothelial carcinoma, UTUC)的手术安全性和疗效。方法:收集2011年1月至2018年12月期间在北京大学第一医院泌尿外科和福建省立医院泌尿外科接受CTNU和TRNU手术治疗的UTUC病例,比较两种手术方式患者在临床资料、围术期参数、术后随访结果等方面的差异。结果:最终共纳入病例266例,其中CTNU组94例,TRNU组172例。与CTNU组相比,TRNU组左侧病变比例更大(P<0.05)。两组患者年龄、性别分布、体重指数(body mass index,BMI)、美国麻醉医师学会评分(American society of anesthesiologists score, ASA score)、肿瘤所在侧别等方面均差异无统计学意义(P>0.05)。所有病例均完成手术,TRNU中有1例因左肾动脉损伤加行开放血管修补术。CTNU组手术时间为(202.9±76.7) min、术中出血量(68.4±73.3) mL、术后引流管留置天数(3.9±1.5) d、引流液总量(181.7±251.5) mL、术后住院天数(7.8±4.1) d;TRNU组手术时间为(203.5±68.7) min、术中出血量(130.2±252.1) mL、术后引流管留置天数(4.3±1.6) d、引流液总量(179.1±167.5) mL、术后住院天数(8.2±3.7) d。CTNU组术中出血量少于TRNU组,且差异有统计学意义(P=0.005)。中位随访时间39个月(1~88个月),TRNU组的5年总体生存率(overall survival, OS)、肿瘤特异性生存率(cancer specific survival, CSS)、无膀胱复发生存率(intra-vesical recurrence free survival, IvRFS)、无病生存率(disease free survival, DFS)分别为75.6%、86.9%、73.8%、57.5%;CTNU组的5年OS、CSS、IvRFS、DFS分别为66.3%、83.5%、75.9%、58.6%,两组间差异均无统计学意义。结论:CTNU手术是一种安全有效的手术治疗方式,但尚需更进一步的前瞻性随机对照研究加以证实。     

脱细胞异体真皮在泌尿生殖疾病手术治疗中的应用

Humanacellular dermal matrix (HADM) is widely used in the field of burn wound repair and tissue engineering plastic surgery. HADM is manufactored by physical and chemical decellular process to remove the antigenic components that might cause immune rejection in dermis.The extracellular matrix of three-dimensional cell scaffold structure with collagen fibers had been used for wound repair and tissue regeneration, while HADM characterized with low absorption rate after implantation and strong ability to induce angiogenesis in host tissue. Studies reported that after the HADM was implanted into the patient, the host cells, such as fibroblasts and myofibroblasts, as well as lymphocytes, macrophages, granulocytes and mast cells, rapidly infiltrated the graft. The connective tissue and neovascularization were then formed within the HADM three-dimensional cell scaffold, the lymphatic system also appears after vascular reconstruction. Traditional urethral reconstruction using autologous skin flaps has some defects, such as complexity of the technology, risk of necrosis of the skin flaps after transplantation, and failure to achieve functional repair of the urethral epithelium. It has been reported that using HADM to reconstruct the urethra in patients with urethral stricture, hypospadias and bladder-vaginal fistula, showed promising results. Others have reported the experience of using HADM to repair and reconstruct congenital classic bladder exstrophy. HADM has also been used for tissue repair in patients with penile skin defect caused by Fonier’s gangrene and hidradenitis suppurativa, and implanted under Bucks’ fascia to enlarge the penis. The report of HADM implantation for treating premature ejaculation also deserves attention. Researchers found that HADM implantation can form a tissue barrier between the skin and corpus cavernosum, which can effectively reduce penile sensitivity and treat premature ejaculation. The safety and effectiveness of HADM implantation in the treatment of premature ejaculation need to be further standardized by data from multi-center, large-sample clinical studies. In summary, HADM is the extracellular matrix and three-dimensional cell scaffold of human dermis. As a new type of tissue repair material, new blood vessels are formed actively after implantation, which shows good histocompatibility. HADM has shown increasingly broad application prospects in treatment of genitourinary diseases including penis, urethra and bladder diseases. HADM has also been used in the treatment of premature ejaculation in recent clinical studies, and its long-term safety and efficacy need to be further investigated.     

直接数字曲面体层摄影在涎腺造影中的临床价值

目的评价直接数字曲面体层摄影在涎腺造影中的临床价值。方法选择表现正常的腮腺造影数字化曲面体层影像(58侧)及传统曲面体层照片(44侧),评价主导管、腮腺腺泡及分支导管的显影情况。结果在显示腮腺主导管、第一级分支导管及腮腺腺泡方面,直接数字曲面体层与传统曲面体层胶片摄影无明显差异;数字成像显示细微解剖结构(第二、三级分支导管)的质量则明显优于胶片方式(P<0.01)。结论直接数字曲面体层摄影在涎腺造影中具有重要的临床价值。     

探讨高低场强多参数MRI对PI-RADS（第2版）定性诊断前列腺临床显著癌的价值

【摘要】目的：对比1.5T和3.0T多参数MRI（mpMRI）结合前列腺影像报告和数据系统（PI-RADS v2）对临床显著前列腺癌的诊断准确性。方法：从2010年12月至2013年12月行前列腺mpMRI检查的患者中,筛选出以定性诊断前列腺癌为目的、且在检查后3个月内取得经直肠超声引导下活检病理结果的447例患者纳入分析,年龄（68.7±9.0）岁,PSA（15.4±14）ng/mL。其中75例使用1.5T MR仪,372例使用3.0T MR仪。检查序列包括常规T2WI、DWI（b=0、800s/mm2）和动态增强扫描。以病理结果作为金标准,Gleason评分≥7认为是临床显著癌。由两位放射科医师对入组病例使用PI-RADS v2进行独立阅片分析,将1.5和3.0T mpMRI的诊断结果进行诊断效能分析和一致性检验。结果：447例中经病理证实的临床显著前列腺癌195例（43.6%）。1.5T和3.0T两组的受试者工作特征（ROC）曲线下面积（AUC）分别为0.94和0.89,诊断敏感度分别为95.0%和85.8%,特异度分别为91.4%和80.7%,阳性预测值为92.7%和76.1%,阴性预测值为94.1%和88.8%;两组间诊断准确性的差异无统计学意义（P＞0.05）。结论：不同场强多参数MRI对PI-RADS v2定性诊断前列腺临床显著癌的影响不显著。     

曲美他嗪对稳定型心绞痛治疗效果的Meta分析

目的：系统评价曲美他嗪对稳定型心绞痛（SAP）患者的治疗效果。方法检索Cochrane Central Register of Contronlled Trials、MEDLINE、EMbase、Pubmed、中国知网、万方数据库中关于曲美他嗪对稳定型心绞痛患者干预治疗的随机对照试验（RCT）,同时追溯纳入文献的参考文献,检索时限均为从建库到2012年12月。对纳入研究的质量进行严格评价和资料提取,对符合质量标准的RCT进行Meta分析。统计学分析采用RevMan5.2软件。结果共纳入11个RCT,共收集了1683例SAP患者的资料。Meta分析显示：加用曲美他嗪对SAP患者的疗效与单纯常规抗心绞痛治疗的比较,每周心绞痛发作次数（WMD=-1.65,95%CI：-2.27～-1.03）、每周硝酸甘油消耗量（WMD=-0.90,95%CI：-1.14～-0.66）、心电图改善（WMD=1.33,95%CI：1.16～1.52）、运动试验中使ST段压低1 mm的阈值（WMD=58.67,95%CI：45.38～71.96）、ST段最大压低幅度（WMD=-0.29,95%CI：-0.40～-0.19）、运动持续时间（WMD=62.04,95%CI：42.87～81.21）6方面,其差异均有统计学意义。结论对于SAP患者,在常规治疗心绞痛药物的基础上,加用曲美他嗪可进一步提高治疗的效果疗效。     

改良经腹途径腹腔镜下单一体位肾输尿管全长切除术的临床应用

目的:探讨完全经腹腹腔镜一体位肾输尿管全长切除以及输尿管末端使用定制的防滑哈巴狗钳切除的手术方法和临床价值.方法:回顾性分析2018年2月-2021年3月在汉中市中心医院接受经腹腹腔镜一体位肾输尿管全长切除术的16例上尿路尿路上皮癌患者的临床资料.改良腹腔镜手术方式,术中患者无须改换体位,改良手术器械,用特制防滑哈巴狗...