重组红细胞生成素治疗肾性贫血的新进展

当今,在美国接受透析治疗的慢性肾衰(CRF)病人逾10万,世界范围约30万。另外,尚未严重到非透析不可的CRF病人更是一组庞大的数字。肾功能降至正常的30%以下,即可导致贫血,维持性透析病人约90%合并贫血,通常程度较重(红细胞压积<25%)。约25%的病人需反复输血以缓解贫血症状,但输血可带来诸多麻烦,如价格贵、传染病及反复输血造成铁负荷过重继而引起器官功能障碍等。肾性贫血的原因包括红细胞生存期缩短,血液循环中尿毒抑制物(如甲状旁腺素、聚胺),伴骨髓纤维化的严重甲状旁腺功能亢进,铝中毒,铁、叶酸盐或维生素B_(12)缺乏,反复失血;还有人认为与谷胱甘肽氧化状况     

首剂利福平致急性肾功能衰竭1例

患者女,53岁,因恶心、呕吐伴少尿4天由他院转入我院。患者于4天前一次顿服利福平胶囊3粒(150mg×3)后6h,出现剧烈恶心、呕吐,伴双侧腰痛,继而少尿,尿呈酱油色,在他院实验室检查:血红蛋白65g/L,红细胞2.8×10~(12)/L,尿常规:蛋白(++),尿比重1.006,尿血红蛋白阳性,酸溶血试验阴性,血尿素氮     

后灌洗;移植肾早期无功能的一种简单补救法

移植肾早期无功能(PNF)经常发生,据报道,发病率为76%,而且PNF继发排斥与其他原因导致的移植肾功能减退很难鉴别,作者通过冷藏前及移植时二次肾灌洗排除肾活性复合物,降低PNF的发生。作者从1986、6～1988、1前瞻性研究145例肾移植病人。1986、、6～1987、6原位肾灌洗后冰块冷藏并直接移植给病人(106例,Ⅰ组);1987、6～1988、1上述方法处理后,移植前用冰冷的Travenol灌洗液500毫升再次灌洗(“后灌洗”)(39例,Ⅱ组)。除Ⅰ组中13例病人外,均采用环孢素负荷量15mg/kg,术后减少到10mg/kg,其后环孢素血浓度保持在200～400ng/ml;强的松龙25mg/日口服;急性排斥用甲基强的松龙500mg,连续三日静点。未用环孢素的13例应用硫唑嘌呤和强的松龙。PNF定义为:移植术后头7天需透析治疗。     

环孢素A肾副作用的最新认识

环孢素A的“肾毒性”机理已讨论了几年,目前尚无定论,由于笼统概括“肾毒性”,无论在实验研究还是临床应用中常常引起概念混淆,甚至得出错误结论,本文重点就“肾毒性”一词提法的更改以及肾副作用机理的最新研究和认识作以综述。     

早期排斥对首次尸肾移植受者移植物的影响

导致肾移植术后第1年移植物丧失的最常见原因是急性排斥。然而,很少有人研究急性排斥对移植物后果及功能的影响。为此,他们从1987.6～1990.3对110例首次尸肾移植受者(年龄>10岁)随机分为三联组(Ⅰ组,53例)和四联组(Ⅱ组,57例)进行前瞻性分析。Ⅰ组免疫抑制方案:根据术后尿量,CsA3～4mg/kg.d青点,5天后按5mg/kg.db.i.d口服,头3个月保持CsA全血谷值浓度300～450ng/ml(RIA法),尔后保持100～250ng/ml。Ⅱ组起始应用ALG10mg/kg.d,当SCr<300μmol/L时按如上所     

空军飞行员与地勤人员慢性前列腺炎流行病学调查

目的：调查空军飞行员和地勤人员慢性前列腺炎的发病情况,探讨有效的预防治疗措施。方法向空军飞行场站男性飞行员及地勤人员发放慢性前列腺炎流行病学调查问卷及美国国立卫生研究院慢性前列腺炎症状指数（ NIH?CPSI）评分表,初步筛查慢性前列腺炎患者,之后采用“两杯法”尿常规检查、前列腺液检查和前列腺液培养确诊Ⅲ型前列腺炎患者。比较两组人员Ⅲ型前列腺炎发病率,分析发病因素。对确诊患者行健康宣教和药物治疗,4周后重新评价患者的NIH?CPSI评分。结果调查384例飞行员和378例地勤人员。确诊为Ⅲ型前列腺炎飞行员38例,地勤人员41例。两组人员发病率无统计学差异（ P＞0．05）;21～29岁年龄组的飞行员和地勤人员的患病率均高于其他年龄组（ P＜0．05）;飞行机种与飞行时间对飞行员Ⅲ型前列腺炎发病率无影响。飞行时间与症状严重程度具有相关性（ P＜0．05）。确诊患者中,有20例飞行员和22例地勤人员接受药物治疗。经过4周的治疗患者NIH?CPSI 评分较治疗前有显著改善（ P＜0．05）。结论空军飞行员与地勤人员慢性前列腺炎发病率无显著差异。对确诊慢性前列腺炎患者,实施健康教育和药物治疗,能使症状得到显著改善。     

良性前列腺增生症的病因及治疗进展

良性前列腺增生(BPH)简称前列腺增生,亦称前列腺良性肥大,是老年男性常见病,由于它在泌尿系所造成的梗阻,影响排尿,直接威胁肾功能,对患的生活与健康带来严重的危害,故本病在老年医学中是重要课题之一。     

经尿道2μm激光前列腺剜除术治疗良性前列腺增生的疗效分析

目的 探讨2μm激光剜除技术治疗BPH的疗效.方法 BPH患者107例,年龄52～85岁,平均(67±9)岁.其中伴尿潴留者10例.超声检查测量前列腺体积45～158 ml,平均(72.5±17.6)ml.行RevoLix 2 μm 激光前列腺剜除术治疗.硬膜外阻滞麻醉或全麻.术中首先从膀胱颈5、7点位置至精阜两侧各纵行切成一条状槽沟,深达包膜,并沿精阜两侧弧形向上继续切开尿道黏膜及黏膜下层至尿道外括约肌内弧线.自精阜前缘开始,切开尿道黏膜,分离找到外科包膜平面,以电切镜鞘前端沿包膜平面钝性剥离,并摆动镜鞘扩大包膜平面,中叶增生明显者采用分割切除.同样在12点的位置纵行切开,深达包膜,以逆行方式自精阜两侧的前列腺尖部组织沿包膜用镜鞘剜除侧叶,至1点和11点处,与12点沟槽汇合并保留条索状蒂,使剜除的腺体固定并悬挂在腺窝内.前列腺体积≤60 ml者直接汽化切除增生腺体为小块组织;体积＞60 ml者改用普通电切手件,4%甘露醇持续冲洗,将剜除组织切成小块,用冲洗塑料瓶经镜鞘冲出.观察术中出血情况、手术时间、术后尿管留置时间、排尿情况、最大尿流率及住院时间.结果 107例患者均顺利完成手术.手术时间45～150 min,平均(74±12)min.输血5例.未发生尿道狭窄.1例一过性尿失禁者1个月后恢复.术后随访2～6个月,平均3个月,术后留置尿管4～6 d,手术前后血电解质及血红蛋白浓度差异无统计学意义(P＞0.05).最大尿流率由术前(6.3±0.6)ml/s升至(17.5±1.5)ml/s,国际前列腺症状评分及生活质量评分分别从26.4±5.5和4.6±0.5降至9.3±2.1和2.8±0.3,手术前后比较差异均有统计学意义(P＜0.01).结论 经尿道2 μm激光前列腺剜除术治疗BPH安全、有效,彻底性甚至优于TURP.

Abstract：

Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in the treatment of benign prostatic hyperplasia (BPH). Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm laser under continuous epidural anesthesia or laryngeal mask anesthesia. The patient′s, average age was 67±9 yrs (52 to 85 yrs). Of whom, 10 patients had a history of urinary retention. The mean prostate volume was 72.5±17.6 ml (45 to 158 ml). Two deep trenches were cut at the 5 and 7 o, clock position from the bladder neck to the verumontanum. The incision continued to the urethral mucosa and submucosa along with the verumontanum bilaterally in an arc-shape and ended at the internal arc of urethral sphincter. Then the urethral mucosa at the level of the verumontanum was cut and the surgical capsule plane was identified. A retrograde blunt dissection was made along the surgical capsule plane with the resectoscope sheath front-end, and the sheath was swung from side to side to extend the capsule plane. The significantly enlarged middle lobe was treated with laser vaporization resection. In the same way, a trench was made at the 12 o, clock position, and the lateral lobe were removed by the sheath from the verumontanum level, finally only two cord-like pedicles were kept at the 1 and 11 o, clock position at the bladder neck, so that the removed gland tissue was fixed and hung in the gland fossa. For prostate volume less than 60 ml, the laser vaporization resection was carried out directly. If the prostate volume was greater than 60ml, transurethral resection would be performed instead of laser vaporization resection. With 4% mannitol irrigation, the enucleated prostate tissue was then cut into small pieces and washed out by a Braun plastic bottle through the resectoscope sheath. Intraoperative bleeding, operative time, catheterization time, postoperative voiding status, maximum urinary flow rate (Qmax) and length of hospital stay were recorded and analyzed. Results All patients successfully completed the transurethral prostate enucleation. The average operative time was 74±12 min (45-150 min). Five cases required blood transfusion. There was no recorded urethral stricture and no urinary incontinence except for one patient who recovered 1 mon after the operation. The follow-up time was 2-6 mon. The average Qmax was 6.3±0.6 ml/s before and increased to 17.5±1.5 ml/s after the operation. The international prostate symptom score (IPSS) and quality of life (QOL) were reduced from 26.4±5.5 and 4.6±0.5 to 9.3±2.1 and 2.8±0.3 after the operation, respectively, P<0.01. Postoperative secondary bleeding was not observed. Conclusions Transurethral prostate enucleation with 2 μm laser for BPH is a safe and effective minimally invasive treatment. Its efficacy is superior to open surgery, and even better than TURP.     

输尿管镜下NTrap网篮配合钬激光碎石术治疗输尿管结石

目的：探讨输尿管镜下NTrap网篮配合钬激光碎石术治疗输尿管结石的疗效及其安全性。方法：2005年1月～2009年12月应用NTrap网篮输尿管镜下配合钬激光碎石术治疗输尿管结石206例,并对临床资料进行分析。结果：一次手术碎石成功195例,成功率94．7％（195／206）;10例在碎石过程中结石被冲入肾盏内形成结石残留,术后行ESWL治愈;1例双侧输尿管结石因输尿管狭窄中转开放手术取出结石并切除狭窄段输尿管。所有患者术后无严重并发症发生。结论：输尿管镜下NTrap网篮配合钬激光碎石可以有效防止碎石逆行移位,避免术后结石残留于肾盏,是一种安全、有效的工具。