目的 比较输尿管镜下U100激光碎石术和气压弹道碎石术治疗输尿管上段结石的疗效及安全性.方法 选取2013年12月-2018年9月柳州市人民医院收治的输尿管上段结石患者100例作为研究对象,按照随机数字表法分为观察组和对照组,各50例.对照组行输尿管镜下气压弹道碎石术,观察组行输尿管镜下U100激光碎石术,比较两组手术时间、单次碎石成功率、结石彻底清除率、手术并发症发生率,并分析单次碎石失败原因.结果 观察组单次碎石成功率及结石清除率为90.00％、86.00％,高于对照组的68.00％、60.00％(P<0.05);观察组手术时间为(35.84±5.34)min,短于对照组的(55.08±9.78)min(P<0.05);观察组并发症发生率为12.00％,低于对照组的30.00％(P<0.05);两组碎石失败的主要原因是碎石过程中结石上移至肾脏,术中未能找到结石所致.结论 输尿管镜下U100激光碎石具有手术时间短、高效、安全及并发症少等优点,是治疗输尿管上段结石的有效手段.

目的:研究腹膜外三孔法腹腔镜前列腺癌根治术(LRP)术后尿控功能与术中保留膀胱颈的关系.方法:选取2017年3月～2021年3月我院收治的行腹膜外三孔法LRP术的局限性前列腺癌患者82例,根据术中膀胱颈保留情况分为保留膀胱颈组42例和未保留膀胱颈组40例.比较两组围术期情况、术后病理分期、切缘阳性率,分析两组尿管拔除后1、3、6个月扩展前列腺癌复合指数(EPIC-UIN)评分、国际尿失禁咨询委员会尿失禁问卷简表(ICIQ-SF)评分、尿控恢复率及1 h尿垫测试结果.结果:两组围术期指标、术后病理分期、切缘阳性率无统计学差异.保留膀胱颈组术后1、3个月时EPIC-UIN评分和尿控恢复率显著高于未保留膀胱颈组,ICIQ-SF评分和1 h尿垫测试显著低于未保留膀胱颈组.结论:腹膜外三孔法LRP术中保留膀胱颈能有效促进患者术后早期尿控功能恢复.

目的 探究血浆纤维蛋白原(FIB)、Ⅰ型胶原氨基末端肽(NTx)及前列腺特异性抗原(PSA)水平在前列腺癌骨转移诊断中的价值.方法 选择202例前列腺癌患者,结合影像学检查结果分为骨转移组(70例)和无骨转移组(132例),以55例体检健康男性为健康对照组.采用ELISA法检测血清总PSA、NTx,采用血液凝固法测定FIB.采用单因素及多因素Logistic回归分析影响前列腺癌骨转移的危险因素.采用受试者工作特征(ROC)曲线分析血浆FIB、NTx、PSA及联合检测对前列腺癌骨转移的诊断价值.结果 前列腺癌骨转移组血浆FIB、NTx、PSA水平高于无骨转移组(P均<0.05),无骨转移组血浆FIB、NTx、PSA水平高于健康对照组(P均<0.05).Logistic回归分析结果显示,FIB升高、NTx升高、PSA升高、Gleason评分≥7分及肿瘤分期Ⅲ、Ⅳ期是影响前列腺癌骨转移的独立危险因素(P均<0.05).血浆FIB、NTx、PSA及联合检测的ROC曲线下面积(AUC)分别为0.628、0.663、0.742及0.815.联合检测诊断前列腺癌骨转移的AUC大于FIB、NTx、PSA单独检测(P均<0.05).结论 血浆FIB、NTx、PSA水平升高与前列腺癌骨转移有关,是前列腺癌骨转移的独立危险因素,三者联合检测对前列腺癌骨转移有较高的诊断价值.

目的 探讨前列腺组织学炎症分级对DRE正常、血清PSA>4 ng/ml的前列腺活检患者PSA水平的影响.方法 选取2018年1月至2020年2月本院收治的55例BPD患者和31例前列腺癌患者的组织标本,进行组织病理学分析.活检前,对所有患者进行直肠指诊和血清PSA检测.炎症类型分为腺体、腺体周围、间质和血管周围型,炎症程度为1～3级.结果 BPD患者中,血清总PSA水平与前列腺体积及年龄无相关性.患者穿刺标本组织学分析,BPD患者腺体、腺体周围和间质炎症情况与血清PSA无显著相关性.血管周围炎症则会使PSA水平升高,差异有统计学意义(P<0.05).BPD患者中,腺体、腺体周围、间质和血管周围炎症情况与前列腺体积间无显著相关性.腺体、腺体周围、间质和血管周围炎症情况与年龄间无显著相关性.PCA患者中,血清PSA水平与体积、年龄间无显著相关性.腺体、腺体周围、间质和血管周围炎症情况与患者血清PSA水平、前列腺体积、年龄间均无显著相关性.结论 血管周围炎症使血清PSA水平升高,提示在今后的临床工作中,穿刺标本病理阴性的患者病理报告中,可增加描述出炎症细胞的解剖位置(腺体、腺体周围、间质和血管周围),根据组织学的结果确定随访时间和再活检时间,且PIN患者必须密切随访,必要时再次活检.

目的 研究低分子肝素钠皮下注射联合TP化疗方案治疗经外周静脉穿刺中心静脉(PICC)置管非小细胞肺癌(NSCLC)的效果.方法 选取2018年3月至2019年3月驻马店市中心医院收治的74例PICC置管NSCLC患者为研究对象,按照随机数表法分为对照组与观察组,各37例.对照组接受TP化疗方案治疗,观察组接受低分子肝素钠皮下注射联合TP化疗方案治疗.比较两组疗效、治疗前、治疗2个周期后卡氏评分(KPS评分)及凝血功能[凝血酶原时间(PT)、血小板计数(PLT)、D-二聚体(D-D)]、血清肿瘤标志物[糖类抗原125(CA125)、细胞角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原]及不良反应发生率.结果 观察组治疗总有效率为94.59％,高于对照组的78.38％(P<0.05).治疗2个周期后,观察组KPS评分高于对照组,PT长于对照组,PLT、D-D水平低于对照组(P<0.05).治疗2个周期后,观察组血清CA125、CYFRA21-1、癌胚抗原水平低于对照组(P<0.05).观察组不良反应发生率为5.41％,低于对照组的24.32％(P<0.05).结论 低分子肝素钠皮下注射联合TP化疗方案治疗PICC置管NSCLC效果显著,能改善患者身体状况,提高凝血功能,降低血清肿瘤标志物水平,减少不良反应发生.

目的:探讨URL,SMP,RIRS三种微创治疗复发性输尿管上段结石的效果.方法:通过选取2019年1月—12月期间,我院收治行临床微创手术治疗的复发性输尿管上段结石患者180例,根据所运用的三种URL、SMP、RIRS不同微创手术治疗方法均分为URL组、SMP组、RIRS组各60例.三组分别行不同微创治疗方法,对比分析三组患者的临床治疗效果.结果:URL与RIRS两组手术时间无显著差异(P>0.05),但SMP组手术时间、住院时间较其余两组明显少,差异显著有统计学意义(P<0.05);术后住院时间三组之间差异显著(P<0.05);三组患者术后输尿管狭窄发生率SMP组优于URL组和RIRS组,差异具统计学意义(P<0.05);术后1周三组无显著差异、SMP组在1个月和3个月结石清除率较URL、RIRS组明显高,三组差异显著有统计学意义(P<0.05).结论:URL能够增加患者术后恢复且损伤较小,RIRS对于输尿管结石上移至肾盂、肾盏优势较大,三种微创手术相比之下对复发性输尿管上段结石患者行超微通道经皮肾镜术(SMP)治疗,效果显著且临床治疗安全性较高,在临床中可以应用.

目的 探讨三孔法与五孔法经腹膜外入路腹腔镜前列腺癌根治术(ELRP)的临床效果.方法 回顾分析柳州市人民医院泌尿外科2013年6月至2019年3月收治的90例行ELRP的患者资料,其中观察组行三孔法ELRP 48例,对照组行五孔法ELRP 42例.比较两组患者的一般资料、围手术期结果、并发症、尿控恢复情况和肿瘤结局指标.结果 全部90例前列腺癌患者均在腹腔镜下顺利完成手术,无中转开放手术.两组患者在年龄、体质量指数、Gleason评分、术前PSA、临床分期方面差异无统计学意义(P＞0.05).观察组手术时间、术中出血量、前列腺体积均少于对照组,差异均有统计学意义(P＜0.05);两组术后留置引流管时间、留置导尿时间、住院时间和术后漏尿、尿道狭窄、尿失禁发生率比较,差异均无统计学意义(P＞0.05);两组术后尿控率相似,差异无统计学意义(P＞0.05);两组术后切缘阳性分别为2例和8例,差异有统计学意义(P＜0.05);观察组术后随访6～36个月,平均12个月,对照组术后随访6～48个月,平均17个月,两组生化复发分别为1例和2例,差异无统计学意义(P＞0.05).结论 与五孔法ELRP相比,三孔法ELRP治疗前列腺癌创伤小、具有相似疗效,且未增加并发症,值得临床推广.

Objective To evaluate the clinical efficacy of intracavitary drainage using two ipsilateral double pigtail stents in the treatment of ureteral stricture secondary to ureteral calculi. Methods Eighty patients with ureteral stricture secondary to ureteral calculi who enrolled in our hospital from January 2012 to June 2017 were randomly divided into study group and control group, 40 cases in each group. The single double pigtail stent was used in the control group, while ipsilateral two double pigtail stents in the study group. Postoperatively double pigtail stents were placed in ureters for 4 to 12 weeks with a median of 8 weeks. The indexes including serum creatinine, stone clearance rate and hydronephrosis were compared. Results The decrease of serum creatinine and stone clearance rates 4 weeks after stents removal in the two groups had no statistical difference (P>0.05). However, the hydronephrosis in the study group was improved better than that in the control group [(23.5±7.0) mm vs (20.1±7.3) mm, P<0.05)]. Conclusions Placement of two indwelling double pigtail stents appears to achieve a better drainage compared with single pigtail stent for the management of ureteral stricture secondary to ureteral calculi, long-term efficacy and the exact mechanism need further investigations. Key words: Ureteral calculi; Ureteral stricture; Double J stents; Randomized controlled study

目的:探讨超声刀及Ligasure在腹腔镜根治性肾根治术处理肾蒂血管中的应用及安全性.方法:选取选取柳州市人民医院2010年1月～2017年12月期间治疗的局限性肾癌(T1N0M0～T2N0M0)患者60例,随机数字表法分为两组,各30例,均采用腹腔镜下均腹膜后入路进行手术,术中处理肾蒂血管时观察组采用Hem-o-Lok夹闭后用超声刀及Ligasure切断,对照组采用采用Hem-o-Lok夹闭后用冷刀切断.统计对比两组手术时间、术中失血量、术后肾窝引流量、住院时间以及手术相关并发症等指标.结果观察组手术时间、住院时间均短于对照组,且术中失血量、术后肾窝引流量均少于对照组,差异有统计学意义(P＜0.05).观察组并发症发生率与对照组比较差异无统计学意义(P＞0.05).结论:证明超声刀及Ligasure对肾脏血管止血满意,治疗效果好,安全性高,费用低廉,值得推广.

Double J stents have good effects on support and the internal drainage, they can drainage urine,and can play an important role in drainage urine, improving renal function and preventing ureteral stricture. The retention of two double J tubes in the lumen of the ipsilateral urinary tract is better than the retention of single double J tube in some cases.

核医学实习教学具有专业特性强的特点,在对实习学生进行带教的过程中,带教人员需掌握相应的技巧来增加教学的趣味性,将相关知识进行直观展示,从而促进学习对理论知识的掌握和领会,同时使学生的学习积极性得以激发,进而使核医学实习教学的质量得以提高.

Objective To explore the efficacy of single versus double J ureteral stent placement in the treatment of recurrent benign ureteral stricture.Methods From January 2012 to December 2016,26 patients with recurrent benign ureteral stricture in the Department of Urology,Liuzhou General Hospital,Guangxi Zhuang Autonomous Region were selected as the research objects and divided into the single J ureteral stent group and the double J ureteral stent group by random number table.The clinical efficacy was compared between the two groups after stent placement.Before and after 3 months of stent placement,the levels of serum creatinine and hydronephrosis were compared between the two groups.Results After stent placement,the total effective rate in double J ureteral stent group was higher than that in single J ureteral stent group,but with no statistically significant difference (P ＞ 0.05).Before and after stent placement,there were no statistically significant differences in the levels of serum creatinine between the two groups and within groups (P ＞ 0.05).In the single J ureteral stent group,there was no statistically significant difference in hydronephrosis before and after stent placement (P ＞ 0.05),but after stent placement,that in the double J ureteral stent group was lower than that of before stent placement and that in the single J ureteral stents group,with statistically significant differences (P ＜ 0.05).Conclusion The efficacy and the drainage of double J ureteral stent placement in the treatment of recurrent benign ureteral stricture are better than those of single J ureteral stent placement.However,the long-term effects and mechanisms need to be further studied and verified by large samples.

目的:观察输尿管硬镜扩张后留置两根双J管治疗良性输尿管狭窄中远期疗效.方法:对2012年1月-2016年7月在我院就诊的17例良性输尿管狭窄患者,采用输尿管硬镜扩张后留置两根双J管引流,3～4个月后根据患者病情决定拔除或者继续更换双J管,随访12～48个月,平均随访22.5个月,观察患者的疗效.结果:14例患者拔除双J管后均无腰胀、发热、血尿等症状,B超示患者肾积水改善,2例患者拔管后发热腰痛,改定期更换双J管,1例肾积水加重,肾功能差,最后切除患肾,总有效率82.4％.结论:输尿管硬镜扩张后留置两根双J管治疗良性输尿管狭窄安全可靠,中远期疗效好,可有效预防输尿管再发狭窄.

目的:对比前列腺增生并急性尿潴留急诊导尿失败后耻骨上膀胱穿刺造瘘和输尿管镜辅助下留置尿管两种治疗方法的临床疗效.方法:对50例老年前列腺增生并急性尿潴留急诊导尿失败的患者,随机均分两组,一组采用传统的耻骨上膀胱穿刺造瘘(膀胱穿刺造瘘组),另一组采用在输尿管镜辅助下留置导尿管(输尿管镜导尿组),比较两组手术时间,手术并发症发生率,术后疼痛视觉模拟评分(VAS),膀胱刺激征,尿路感染率等指标.结果:膀胱穿刺造瘘组在手术时间上要短于输尿管镜导尿组,两组比较有显著差异(P＜0.05);但输尿管镜导尿组在手术并发症发生率和术后疼痛VAS评分方面要少于膀胱穿刺造瘘组,两组比较有显著差异(P＜0.05);膀胱刺激征和尿路感染率,在短期内(7 d)两组比较差异不明显(P＞0.05).结论:输尿管镜辅助下留置导尿管虽然在手术时间上稍长,但操作简单安全,患者痛苦小,手术并发症少,较传统耻骨上膀胱穿刺造瘘术的临床疗效好.

Objectives To evaluate the safety and efficacy in the treatment of benign ureteral stricture by placing two ipsilateral ureteral stents simultaneously.Methods Between 2012 and 2016, seven male and four female patients who had benign ureteral stricture underwent single stent treatment to relieve obstruction.After failure of such management, two 4.7 F double-J ureteral stents were placed.Kidney, ureter and bladder X-ray was conducted to identify the location of double-J ureteral stents three months after the operation.B-mode ultrasound or CT was used to determine the clinical efficacy one month after stent removal.Results Insertion of two 4.7 F double-J ureteral stents in a single ureter was successful in all cases.During the mean follow-up of 6 months (range 3~12 months), no flank abdomen pain,fever,hematuria,displacement of double-J catheters occurred in all patients.The hydronephrosis was markedly improved in patients.Conclusions Simultaneous placement of two double J ureteral stents for the treatment of benign ureteral stricture is safe and effective.Long-term efficacy and the exact mechanism need further investigations.

It shows that research hospital is a necessity for the development of the hospital by analyzing 5 stages of hospital development and standardization management is the inherent requirement of research hospitals with quality content-building.General Hospital of PLA surrounded the theme of quantity,safety,efficiency,effectiveness,followed the quality control PDCA cycle by implementing standardization management and got good effectiveness.

前列腺增生(BPH)并急性尿潴留(AUR)是老年人的常见病,前列腺增生并急性尿潴留的患者导尿失败后哪一种治疗方法更好还没有明确的结论.耻骨上膀胱穿刺造瘘是否比输尿管镜辅助下留置尿管有更多的优点呢？本文就两种治疗方法的研究进展做一简要综述.

目的 比较经直肠超声(TRUS)引导下经会阴与经直肠前列腺穿刺活检术后并发症的发生率,探讨发生原因及处理方法.方法 2013年1月～ 2015年7月我院泌尿外科收治的111例直肠指捡异常和(或)PSA＞4ng/mL和(或)TRUS、CT或MRI检查发现异常的患者随机分成经会阴组(n=56)与经直肠组(n=55),分别予经会阴和经直肠系统性穿刺活检,每例8～9针,随访并发症发生情况并比较两组并发症的发生率.结果 经会阴组与经直肠组前列腺癌穿刺阳性率分别为42.86％及38.74％,两组差异有统计学意义(P＜0.05).经会阴组与经直肠组的总并发症发生率分别为12.50％及60.00％,两组差异有统计学意义(P＜0.01).经会阴组与经直肠组血尿发生率分别为5.36％及25.45％,两组差异有统计学意义(P＜0.01).经会阴组与经直肠组感染发生率分别为1.79％及14.55％,两组差异有统计学意义(P＜0.05).结论 TRUS引导下经会阴前列腺穿刺活检精确、安全.

Objective :To explore the early diagnosis and effective treatment of Fournier syndrome .Methods :A total of 16 cases of Fournier syndrome from January 2009 to December 2015 were retrospectively analyzed .16 patients under‐went surgical treatment including incisions ,aggressive debridement ,and antibiotic therapy ;of them ,7 patients received vacuum sealing drainage(VSD) therapy .Results:13 cases were cured ,3 cases died of multi‐organ failure .The average hospital stay in 7 cases without VSD was(34 .8 ± 6 .5)days;the average hospital stay in 6 cases with VSD was(26 .8 ± 5 .3)days .The average hospital stay of the two groups were significant differences (P<0 .05) .Conclusion:The early di‐agnosis of Fournier syndrome and timely aggressive surgical debridement are critical for improving survival .In combina‐tion with a series of comprehensive treatments ,the prognosis is generally good .If available ,VSD may be used to pro‐mote the healing of tissue wound and shorten average hospitalization .

Objective?To observe the curative effect of the treatment for prostatic hyperplasia (BPH) by transurethral bipolar vaporization (TURP) . Methods?Choosing 120 BPH patients in our hospital from March 2012 to March 2014 ,TURP resection treatment. After the operation for three months , comparing the patient's maximum urinary lfow rate (Qmax) and I - PSS average score with the preoperative, observation curative effect.Results?The?patients?with preoperative 3 h measured average Qmax of mL/s (5.4±2.3), postoperative march the average Qmax was (21.3±3.8) mL/s, increased signiifcantly (P<0.05),?and?I-PSS?score?decreased?from?preoperative?(23.7±2.5)?points?to?(4.5±1.3)?and?significant?difference?(P<0.05).?Conclusion?TURP surgery resection?of?the?prostate?gland?has?the?characteristics?of?little?blood?loss?,?safe?and?effective,?it?is?one?of?the?best?treatment?of?BPH,?broad?application?prospect.