压力性尿失禁是前列腺癌根治术后常见并发症,主要表现为腹压增加的情况下尿液不自主流出,严重影响患者生活质量,往往病情顽固,经保守治疗疗效多欠佳[1].目前临床上保守治疗方法主要有生物反馈、盆底肌锻炼[2]等,而手术治疗的主要选择有男性尿道中段悬吊术[3]及人工尿道括约肌植入术[4].前者手术失败率较高,多导致尿潴留,开展并不普遍[5];后者费用较高,同样存在异物排斥、感染等并发症[6].我们前期临床研究发现,经皮穿刺电针电刺激阴部神经治疗前列腺癌根治术后顽固性压力性尿失禁疗效满意,但穿刺阴部神经是否精准仅凭术者经验和患者的主观感受.本研究采用神经电生理监控下电针电刺激阴部神经,以提高穿刺精确性,取得满意的临床疗效,现报道如下.

目的 评价红景I号方联合西药治疗慢性前列腺炎合并勃起功能障碍的疗效.方法 将符合慢性前列腺炎合并勃起功能障碍患者118例,随机分为观察组(56例)与对照组(62例).对照组予左氧氟沙星片0.5 g,口服,1次/d,连续服用6周,特拉唑嗪片2 mg,口服,1片/晚,连续服用8周.观察组在对照组治疗基础上,同时应用红景I号方,水煎服,2次/d,连续服用8周.比较治疗前后两组患者CPSI评分以及IIEF-5评分,并比较两组治疗效果.结果 治疗后两组患者CPSI评分及IIEF-5评分均比治疗前改善,且观察组比对照组改善更明显(P<0.05).观察组治疗有效率75.0％,对照组为54.8％,两组比较差异有统计学意义(P<0.05).结论 红景I号方治疗慢性前列腺炎合并勃起功能障碍具有较好的疗效,值得临床推广.

目的 探讨电针联合防己黄芪汤治疗TURP术后膀胱过度活动症的临床疗效.方法 选择2012年1月至2016年12月前列腺增生合并OAB行TURP术患者80例,随机将病例分成电针中药组、电针组、中药组及对照组,每组20例.电针中药组给予电针加防己黄芪汤治疗,电针组给予电针治疗,中药组给予防己黄芪汤治疗,对照组给予托特罗定缓释片治疗.在治疗前及治疗后2个月观察OABSS评分、初尿意膀胱容量、最大膀胱容量变化.结果 四组OABSS评分均不同程度低于治疗前(P<0.01,P<0.05),电针中药组明显低于其他三组(P<0.01),电针组低于中药组及对照组(P<0.05);电针中药组、电针组、中药组的初始尿意容量(FDV)、最大膀胱容量(MCC)均不同程度高于手术前(P<0.01,P<0.05),且电针中药组明显高于其他两组(P<0.01),对照组治疗前后比较,差异无统计学意义(P>0.05).结论 电针联合防己黄芪汤治疗TURP术后膀胱过度活动症,能更有效地增加初尿意膀胱容量、最大膀胱容量,改善临床症状.

目的 观察微针刀联合白虎桂枝汤加减治疗急性痛风性关节炎的疗效及其对炎症因子的影响.方法 纳入急性痛风性关节炎患者134例,随机分为治疗组和对照组,每组67例.对照组予口服白虎桂枝汤加减,治疗组在对照组治疗基础上予微针刀治疗.观察两组治疗前后关节疼痛、关节压痛、关节肿胀、关节活动障碍的变化,记录每日疼痛评分、疼痛缓解时间和疼痛消失时间,治疗前后分别检测血尿酸(UA)、C-反应蛋白(CRP)、红细胞沉降率(ESR)、白细胞介素(IL)-1β 、IL-6、IL-8和肿瘤坏死因子(TNF)-α.结果 两组治疗后关节疼痛、关节压痛、关节肿胀、活动障碍评分均较治疗前明显降低(P<0.05),且治疗组治疗后的上述评分均低于对照组(P<0.05).治疗组疼痛缓解时间和疼痛消失时间均短于对照组(P<0.05).两组治疗后血ESR、CRP、UA、IL-1β、IL-6、IL-8和TNF-α 水平均较治疗前降低(P<0.05),且治疗组治疗后血ESR、CRP、UA、IL-1β、IL-6、IL-8和TNF-α 水平均低于对照组(P<0.05).治疗组临床总有效率优于对照组,差异有统计学意义(P<0.05).结论 微针刀联合白虎桂枝汤治疗急性痛风性关节炎可有效改善患者临床症状,缓解和消除疼痛,并抑制相关炎症反应.

我国自《黄帝内经》便有尿石症的记载,称"石淋"或"沙石淋",有众多药物方剂传承至今广为应用,对于其中医诊治我们不断求证循证医学论据.《石淋病中医临床诊疗指南》[1]2009年由国家中医药管理局立项,初稿于2012年发布.其初稿以专家共识为主,存在采用意见方法不够规范、征求意见不够广泛、审查不够严格等问题,故2015年浙江中医药大学附属第二医院接受中华中医药学会外科分会委托,对原有指南进行修订,强化循证依据,制订符合中医学术特点的循证性实践指南.德尔菲(Delphi)法采用匿名方式针对某一问题广泛征求专家的意见,经过数轮信息交流和反馈修正,使专家意见逐步趋向一致,得到较为一致和可靠的结论[2].该方法具有较强的科学性和可操作性.我们采用Delphi法,在文献研究的基础上制定专家问卷调查,从而筛选石淋病中医诊疗指南的指标框架及诊治意见,为制修订有循证依据的诊疗指南奠定基础.

压力性尿失禁为一种常见的泌尿系统疾病,多见于女性,目前临床治疗较为棘手,方法单一且疗效不满意.近年来,在获取与培养自体干细胞技术方面取得的进展促进了其在治疗 SUI领域的研究.本文综合相关基础研究与临床研究,就不同干细胞类型作为 SUI潜在疗法的研究进展作一回顾.

目的 探讨金银花水煎液膀胱灌注治疗老年女性反复膀胱炎后OAB的临床疗效.方法 选取我院2013年4月～2017年10月反复膀胱炎后OAB老年女性患者45例,平均年龄(65.5±4.5)岁,随机分为金银花组、辣椒素组、对照组,各15例.金银花组和辣椒素组在常规治疗的基础上予以金银花水煎液或辣椒素溶液膀胱灌注,对照组患者行常规治疗.在治疗前及治疗3个月时,评估患者OABSS评分,检测患者初始尿意膀胱容量、最大膀胱测压容量及残余尿量.结果 金银花组、辣椒素组、对照组OABSS评分均明显低于治疗前(P＜0.05),而金银花组明显低于其他两组(P＜0.05),辣椒素组则明显低于对照组(P＜0.05).初始尿意膀胱容量、最大膀胱测压容量方面,金银花组、辣椒素组明显高于治疗前(P＜0.05),治疗后明显高于对照组(P＜0.05);金银花组、辣椒素组比较无统计学差异(P＞0.05).残余尿量方面,三组与治疗前相比无统计学差异(P＞0.05),三组治疗后比较同样无明显差异(P＞0.05).结论 金银花水煎液膀胱灌注能一定程度缓解反复膀胱炎后OAB老年女性患者的临床症状,提高初始尿意膀胱容量、最大膀胱测压容量,值得进一步研究.

The giant prostatic utricular cyst is a rare abnormality in the ejaculatory duct area. We report a 29-year-old male patient who had multiple semen examinations suggesting azoospermia. Transrectal ultrasonography (TRUS) showed a midline cyst of the prostate, about 6.0 cm in diameter. Pelvic magnetic resonance imaging (MRI) showed an approximately 7.0 cm diameter cyst between the seminal vesicles with high signal intensity on T1 and T2 weighted images. Urine sediment collected via prostate massage immediately after patient ejaculation contained a large amount of sperm. We performed a laparoscopic surgery for the prostatic utricular cyst, and successfully found sperm in semen postoperatively. The patient's symptoms, TRUS, MRI, and surgical results confirmed a diagnosis of giant prostatic utricular cyst with retrograde ejaculation. We review this case as well as previously reported cases and associated literature.

目的 女性膀胱过度活动症发病率逐年升高,但该病治疗手段单一,疗效一般,而本研究旨在积极探讨经皮穿刺阴部神经电刺激疗法治疗女性膀胱过度活动症的临床疗效,摸索该病治疗的新方法,造福更多患者.方法 选取浙江中医药大学附属第二医院2015年1月-2017年2月收治的膀胱过度活动症女性患者60例,按随机数字表法随机分为观察组和对照组,每组各30例.在常规治疗的基础上,对照组给予口服酒石酸托特罗定缓释片治疗;观察组在对照组的基础上,继续给予经皮穿刺阴部神经电刺激治疗.3个月后观察患者平均24h排尿次数、平均24h尿失禁次数、膀胱过度活动症评分问卷表(overactive bladder symptom score,OABSS)评分、焦虑自评量表(self-rating anxiety scale,SAS)评分、生活指数评分.应用SPSS 22.0统计软件对数据进行分析.结果 2组各疗效指标较治疗前均有改善,且观察组平均24h尿失禁次数,OABSS、SAS及生活指数评分的改善程度明显优于对照组(均P＜0.05),2组平均24h排尿次数差异无统计学意义(P＞0.05).结论 经皮穿刺阴部神经电刺激疗法能有效减少膀胱过度活动症患者平均24h尿失禁次数,改善患者OABSS、SAS及生活指数评分,缓和患者焦虑状态,提高患者生活质量,疗效确切,且无明显不良反应,具有较高的安全性,值得临床推广,造福更多该病患者.

目的 探讨白拟阳举1号汤联合安特尔对中老年男性迟发性性腺功能减退症的临床疗效.方法 选取我院2013年6月～2014年6月门诊中老年男性迟发性性腺功能减退症患者93例,平均年龄(59.5±4.5)岁,随机分为对照组(n=22)、安特尔组(n=24)、中药组(n=21)和研究组(n=26).对照组不予治疗,安特尔组和中药组分别予以口服安特尔及阳举1号方,研究组同时口服安特尔和阳举1号汤.3个月后评估患者AMS症状评分并检测睾酮水平.结果 安特尔组、中药组、研究组AMS症状评分均不同程度低于治疗前(P＜0.05或P＜0.01);研究组明显低于其他三组(P＜0.05);安特尔组和中药组明显低于对照组(P＜0.05),安特尔组和中药组比较无统计学差异(P＞0.05).安特尔组、研究组睾酮水平均明显高于治疗前(P＜0.05),且治疗后明显高于中药组和对照组(P＜0.01);安特尔组和研究组比较差异无统计学意义(P＞0.05);中药组和对照组比较差异无统计学意义(P＞0.05).结论 自拟阳举1号汤联合安特尔能有效改善中老年男性迟发性性腺功能减退症的临床症状,增加睾酮含量,值得进一步研究.

In our experience patients undergoing circumcision are mostly concerned about pain and penile appearances. We conducted a prospective randomized trial to assess the benefits of a new disposable circumcision suture device (DCSD). A total of 942 patients were equally divided into three groups (conventional circumcision, Shang ring and disposable suture device group). Patients in the DCSD group were anesthetized with compound 5% lidocaine cream, the others with a 2% lidocaine penile block. Operation time, intra-operative blood loss, incision healing time, intra-operative and post-operative pain, the penile appearance and overall satisfaction degree were measured. Operation time and intra-operative blood loss were significantly lower in the Shang ring and suture device groups compared to the conventional group (P < 0.001). Intra-operative pain was less in the suture device group compared with the other two groups (P < 0.001); whereas post-operative pain was higher in the conventional group compared to the other two groups (P < 0.001). Patients in the suture device (80.57%) and Shang ring (73.57%) groups were more satisfied with penile appearances compared with the conventional circumcision group (20.06%, P < 0.05). Patients in suture device group also healed markedly faster than the conventional group (P < 0.01). The overall satisfaction rate was better in the suture device group (78.66%) compared with the conventional (47.13%) and Shang ring (50.00%) groups (P < 0.05). The combination of DCSD and lidocaine cream resulted in shorter operation and incision healing times, reduced intra-operative and post-operative pain and improved patient satisfaction with the cosmetic appearances.

目的:探讨尿路净1号预防腹腔镜术后双J管附壁结石形成的作用。方法:选取输尿管上段结石(湿热蕴结型)患者54例,随机分为研究组和对照组,均行腹腔镜下输尿管切开取石术中留置双J管,术后研究组在对照组治疗的基础上口服尿路净1号。结果:研究组双J管附壁结石的例数及重量均明显少于对照组(P<0.05)。结论:尿路净1号能有效预防腹腔镜术后患者双J管附壁结石形成。

<正>胃癌的常用诊断有消化道造影及胃镜检查,一般用于病变的检出和定性,但无法了解肿瘤是否侵犯周围组织器官以及有无淋巴结、远处器官的转移,不能满足临床分期的要求。胃肠道螺旋CT检查,可以显示肿瘤的存在和胃外脏器的侵及,对肿瘤分期

Objective To investigate the effect of Shenhuang Powder on intestinal motility disorder after abdominal surgery in mice. Methods Ninety healthy male ICR rats were randomly divided into the model group,Shenhuang powder group and the sham operation group. The model group and Shenhuang powder group were prepared into the intestinal motility disorder models. In the sham operation group only exploratory laparotomy was applied. The above-mentioned groups were then randomly divided into 2 h、4 h and 6 h groups. Thirty minutes after the model was successfully established, in the Shenhuang powder group Shenhuang powder oblatum was applied on bellybutton while equal volume of fine sandbag were used in the sham operation group and the model group. At the end of 2 h、4 h and 6 h after treatment, the serum levels of motilin and somatostatin and carbon-ink transit rate were detected. Results The carbon-ink transit rate in Shenhuang powder group was significantly higher than that in model group at 6 hours after operation. The serum levels of motilin and somatostatin were significantly higher than those in sham operation group and model control group at 2 and 4 hours after operation (P 0.05). Conclusion Shenhuang powder can promote the recuperation of enterokinesia in mice after abdominal surgery.

<正>胃癌是较为常见的恶性肿瘤,其发病率居消化系统首位[1-3],外科手术是目前主要治疗手段,其临床治疗方案的选择及预后的判断与肿瘤浸润胃壁深度(T分期)、周围淋巴结转移情况(N分期)密切相关[1-2],因此,术前胃癌准确的分期评估,对于手术可行性评估及判断预后有重要的意义。

目的:探讨数字化X线钼靶摄影及彩色超声检查在乳腺癌诊断中的应用价值.方法:回顾性分析经病理证实的23例乳腺癌,钼靶摄影及彩色超声图像.结果:钼靶摄影检查乳腺癌的检出率为82.6%,彩色超声检查乳腺癌的检出率82.6%,钼靶摄影与超声联合检查检出率为 95.6%.结论:乳腺钼靶摄影检查和彩色超声检查相结合明显提高乳腺癌的诊断率.

Objective To investigate the inhibition of hedyotic diffusa extract on the proliferation of human gastric cancer cell line SGC-7901 in vitro.Methods The human gastric cancer cell line SGC-7901 was subcultivated aseptically in vitro.Hedyotic diffusa extract acted on such cell at four different concentrations,0.05 mg/mL,0.1 mg/mL,0.15 mg/mL and 0.2 mg/mL successively.24 h later,MTT assay was adopted to determine the activity and numbers of cells.Results The absorbance in drug groups of 0.05 mg/mL and 0.1 mg/mL concentration holes had no apparent difference compared with that in control group(P0.05),that at 0.15 mg/mL and 0.2 mg/mL concentration holes was significantly lower than that in control group(P0.05).Conclusion Hedyotic diffusa extract has a certain inhibition in vitro on the proliferation of human gastric cancer cell line SGC-7901.Moreover,the strength of its inhibition is relevant probably with drug concentration,which deserves a further research.

急性胰腺炎(acute pancreatitis,AP)是一种发病急、进展快,易导致多脏器损伤,且病死率较高的常见急腹症[1,2].近年来临床研究发现,AP并发肝损伤的发生率为40.1%～56.6%,而重症急性胰腺炎(severe acute pancreatitis,SAP)并发肝损伤者高达88.9%[3].