Objective:The long-term follow-up results of patients with locally advanced prostate cancer (LAPC) treated with laparoscopic extensive pelvic lymph node dissection combined with radical prostatectomy (ePLND+LRP) are still rare. This study reports 246 LAPC patients treated with ePLND+LRP from 2006 to 2020 in the Third Affiliated Hospital of Sun Yat-sen University.Methods:From October 2006 to October 2020, 246 LAPC patients with ePLND+LRP were enrolled in this study. The operation time, blood loss, duration of hospital stay and complications, oncology results, and adjuvant treatments occurred within 30 days after surgery were collected.Results:The median age was 70(65-74) years; the median PSA was 24(10-60) ng/ml. The median operation time, blood loss, and hospital stay were 217 minutes, 170 ml, and 7 days, respectively. In pathological staging, there were 28 cases (11.4%) in pT2, 117 cases (47.6%) in pT3a, 92 cases (37.4%) in pT3b, and 9 cases (3.7%) in pT4. The median number of lymph nodes dissected was 21(13-27), and the median number of positive lymph nodes was 2(1-3). 48(19.5%) and 31(12.6%) patients had positive lymph nodes and positive surgical margins. Thirty-eight(15.4%) patients experienced complications, of which 17 cases (6.9%) were classified as Clavien I, 19 cases (7.7%) were classified as Clavien II, and 2 cases (0.8%) were classified as Clavien III. The median follow-up time was 127.8 months, during the follow-up period, 23(9.3%), 219(89.0%), 59(24.0%), and 7(2.8%) patients received adjuvant radiotherapy (RT), hormone therapy (HT), and salvage lymph node dissection (sLND), salvage local treatment. The 10-year BCR-free survival and metastasis-free survival (MFS) rates were 58.5%(144/246) and 73.6%(181/246), respectively. Cancer-specific survival (CSS) and overall survival (OS) were 91.6% and 85.3%, respectively. The rate of urinary control at one year after operation was 96.7%.Conclusion:The ePLND+LRP treatment of LAPC has fewer complications and a good tumor control effect. It is safe and effective as the initial treatment of LAPC.

To efficiently remove all recurrent lymph nodes (rLNs) and minimize complications, we developed a combination approach that consisted of 68Gallium prostate-specific membrane antigen (PSMA) ligand positron emission tomography (PET)/computed tomography (CT) and integrated indocyanine green (ICG)-guided salvage lymph node dissection (sLND) for rLNs after radical prostatectomy (RP). Nineteen patients were enrolled to receive such treatment. 68Ga-PSMA ligand PET/CT was used to identify rLNs, and 5 mg of ICG was injected into the space between the rectum and bladder before surgery. Fluorescent laparoscopy was used to perform sLND. While extensive LN dissection was performed at level I, another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal, and laparoscopy was introduced to intensively target stained LNs along levels I and II, specifically around suspicious LNs, with 68Ga-PSMA ligand PET/CT. Next, both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV. In total, pathological analysis confirmed that 42 nodes were rLNs. Among 145 positive LNs stained with ICG, 24 suspicious LNs identified with 68Ga-PSMA ligand PET/CT were included. The sensitivity and specificity of 68Ga-PSMA ligand PET/CT for detecting rLNs were 42.9% and 96.6%, respectively. For ICG, the sensitivity was 92.8% and the specificity was 39.1%. At a median follow-up of 15 (interquartile range [IQR]: 6–31) months, 15 patients experienced complete biochemical remission (BR, prostate-specific antigen [PSA] <0.2 ng ml−1), and 4 patients had a decline in the PSA level, but it remained >0.2 ng ml−1. Therefore, 68Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.

Objective:To explore the efficacy of fluorescent retroperitoneal lymph node dissection in the comprehensive treatment of lymph node recurrence after radical prostatectomy (RP).Methods:From January 2017 to December 2020, 25 patients with lymph node recurrence diagnosed by 68Ga-PSMA PET/CT after RP in our hospital were enrolled in this study. The patients were 67 (59-77) years old. The median PSA was 7.7 (0.5-12.6) ng/ml at lymph node recurrence, and was treated with androgen deprivation therapy (ADT), suggesting hormone-sensitive prostate cancer. Before recurrence, 4 cases were in T 2 stage, 17 cases in T 3, 4 cases in T 4, 10 cases in N 0, and 15 cases in N 1stage, 25 cases in M 0stage. 2 cases diagnosed as ISUP grade group <3, 9 cases in group 4, and 14 cases in group 5. The median time from radical resection to recurrence was 43 (27-56) months. All 25 cases were diagnosed as lymph node recurrence by 68Ga-PSMA PET/CT examination. Fluorescence retroperitoneal lymph node dissection was performed. Pelvic lymph nodes were detected in the dark field under the fluorescence mode, and positive lymph nodes were found. The white light mode was switched, and the lymph nodes were cleaned, and recorded. For metastatic lymph nodes indicated by preoperative PSMA PET/CT, routine dissection was performed regardless of whether the lymph nodes were fluorescently positive or not. The only routine examination was performed if there were no lymph nodes with fluorescently positive staining in other sites. Perioperative data, biochemical recurrence (BCR) rate, radiological recurrence (RAR) rate, and follow-up data were collected and analyzed. Results:25 patients were pathologically diagnosed with lymph node metastasis. The median lymph node dissection time was 21(15-28) min, estimated blood loss was 30(20-50) ml, hospital days was 4(3-5)d without any severe complications (

Objective:To compare the pathological results and complications of limited and extended pelvic lymph node dissection among high-risk prostate cancer patients, and to explore the risk factors that affect the rate of lymph node metastasis in high-risk prostate cancer patients.Methods:The data of 800 high-risk prostate cancer patients who underwent radical prostatectomy and pelvic lymph node dissection from January 2016 to December 2020 in three affiliated hospital of Sun Yat-sen University were analyzed retrospectively. According to the scope of pelvic lymph node dissection, they were divided into limited pelvic lymph node dissection (LPLND) group and extended pelvic lymph node dissection (EPLND) group. There were 172 patients underwent LPLND, and 628 patients underwent EPLND.The age of the patients in the LPLND group was 67 (62, 72) years old, diagnosed PSA 20.7 (10.9, 54.8) ng/ml. The biopsy Gleason score 6 in 22 cases, 7 in 59 cases, 8 in 56 cases and 9-10 in 35 cases.The clinical T stage: T 1 in 29 cases, T 2 in 102 cases, T 3 in 37 cases, T 4 in 4 cases; N 0 in 160 cases and N 1 in 12 cases. 50 patients received neoadjuvant hormonal therapy. The age of patients in the EPLND group was 67 (63, 72) years old, diagnosed PSA was 23.9 (14.0, 46.8) ng/ml. Biopsy Gleason Score 6 in 51 cases, 7 in 194 cases, 8 in 218 cases and 9-10 in 165 cases. Clinical T stage: T 1 in 114 cases, T 2 in 341 cases, T 3 in 144 cases, T 4 in 29 cases; N 0 in 526 cases and N 1 in 102 cases.158 patients received neoadjuvant hormonal therapy. There were no significant differences in the age, PSA, puncture Gleason score, clinical T stage, and whether or not to receive neoadjuvant hormonal therapy between the two groups of patients ( P>0.05). The difference in clinical N staging was statistically significant ( P=0.002). The number of postoperative lymph nodes, positive pelvic lymph nodes and postoperative complications and other related clinical and pathological data of the two groups were analyzed. Multivariate logistic regression was used to analyze the risk factors of patients with positive lymph nodes. Results:The median number of lymph nodes harvested [13(8, 19)vs. 6(4, 13), P<0.001] and the rate of positive lymph node cases[31.2%(196/628) vs. 10.5%(18/172), P<0.001] in the EPLND group was significantly higher than those in the LPLND group. Preoperative PSA, clinical N staging, Gleason score, and way of lymph node dissection were independent risk factors for postoperative positive pelvic lymph node in high-risk prostate cancer patients. Compared with the LPLND group, the ELPND group had a higher postoperative complication rate [19.9%(125/628) vs. 11.0%(11/172), P=0.007]. Conclusions:Compared with the LPLND, EPLND in high-risk prostate cancer patients can harvest more lymph nodes and increase the detection rate of positive lymph nodes. The complications of EPLND were higher than those of LPLND. Preoperative PSA, clinical N stage, Gleason score, and the way of lymph node dissection are independent risk factors for positive pelvic lymph node dissection.

目的 回顾一例多囊肾并精道动力梗阻性无精症的诊疗经过,探讨该类型无精症的治疗要点.方法 29岁男性无精症患者,彩超资料显示精囊囊性扩张、输精管阴囊段及盆腔段扩张,精液量0.2 ml,初诊射精管梗阻性无精症,予行双侧输精管探查并经尿道射精管切开术治疗.结果 术中发现输精管及附睾管道通畅,左侧输精管往远睾端推注美蓝阻力大,予以行射精管切开,患者术后持续发热,再次行精囊镜检查冲洗控制感染.术后1年精液随访:精液量4.2 ml,无精子.结论 多囊肾并发的无精症,往往为精道动力梗阻性无精症,原因是多囊肾伴随引起的精囊囊性改变、输精管长期扩张,导致精道动力缺乏,这种类型的无精症发病原因往往并不是射精管梗阻,采取射精管切开手术治疗,术后无法恢复精道正常蠕动能力,往往治疗无效.

目的 探讨1470 nm激光剜除治疗高危前列腺增生的手术技巧及临床效果.方法 回顾分析2018年6月至2018年9月中山大学附属第三医院泌尿外科采用1470 nm激光治疗共89例高危前列腺增生患者的临床资料,年龄平均(68±3)岁,前列腺体积(57.4±2.6)ml.所有患者均采用"寻找层面,先易后难,剜切结合"的层面递进法思路行激光腔内前列腺剜除术,比较患者术中及术后情况.结果 89例均顺利完成手术,与术前相比,术后3个月患者最大尿流率明显增加,[(6.9±2.1)ml/s vs(19.8±3.6)ml/s].国际前列腺症状评分显著好转,[(24.6±1.7)vs(8.0±1.2)].术中无输血、无电切综合征、无直肠和膀胱穿孔病例,无输尿管损伤、大出血、心脑血管意外等严重并发症发生.结论 层面递进法激光剜除技术构想对于高危前列腺增生外科包膜层面的寻找、减少术后并发症有独到优势,且易于掌握,或可为业界同行提供一个新的思路.

目的 晚期肾盂输尿管移行细胞癌常并发转移和输尿管壁间段肿瘤侵犯.本文报告4例肾盂输尿管移行细胞癌合并肺或输尿管旁淋巴结转移及患侧输尿管壁间段肿瘤侵犯,术前组织多学科讨论,按照多学科治疗模式联合微创手术治疗.方法 收治本院晚期上尿路移行细胞癌4例,男性3例,女性1例;平均年龄73岁;平均血尿病史10个月;3例肾盂输尿管全程侵犯,4例均有患侧输尿管壁间段肿瘤侵犯,3例肾盂输尿管周围淋巴结侵犯,1例肺转移.4例患者均行多学科联合治疗,所有患者接受新辅助治疗后均接受微创手术治疗(3例机器人辅助、1例腹腔镜辅助).选择1例肺转移和肾盂及输尿管周围淋巴结侵犯做多学科病例分析汇报.结果 4例手术均顺利完成,术后予辅助治疗,中位随访时间为33个月,4位患者健侧肾功能正常,且无肿瘤复发.结论 晚期上尿路移行细胞癌多学科治疗模式中,选择合适病例切除病灶(包括输尿管壁间段肿瘤)能有效延长患者肿瘤特异性生存率.

目的 探讨腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)中膀胱尿道吻合及重建技术对降低吻合口并发症的作用.方法 回顾性分析27例行LRP的前列腺癌患者临床资料,术中行膀胱颈及前列腺尖部精准游离,经筋膜内分离保留前列腺尖部"帽状"结构,膀胱颈及尿道精细吻合,分期高患者行膀胱颈前后壁重建,观察患者术中情况及术后吻合口尿漏、吻合口狭窄及排尿情况.结果 27例患者手术时间114～189 min(平均142.2 min),出血量200～650 mL(平均420 mL),无直肠损伤,术后无引流液48 h内拔除引流管,7～10 d拔除尿管.术后随访3～24个月,无吻合口尿漏,吻合口狭窄1例(3.7％),无肿瘤复发,术后病理分期:pT2期19例,pT3期8例;切缘阳性0例.术后拔除尿管即刻控尿15例(55.56％),术后1个月恢复控尿8例(29.63％),术后3个月恢复控尿3例(11.11％),术后6个月恢复控尿1例(3.7％),无永久性尿失禁.结论 腹腔镜前列腺癌根治术中行膀胱颈及尿道精准吻合及膀胱颈重建可有效降低术后尿漏、吻合口狭窄及尿失禁等并发症,值得临床推广.

目的 分析腹腔镜前列腺癌根治术(LRP)术后自动结扎夹(Hem-o-lok)移位导致膀胱结石的原因,探讨预防LRP术后膀胱结石发生及其治疗的方法.方法 回顾性分析2014年1月至2019年12月中山大学附属第三医院收治的12例LRP术后发生Hem-o-lok移位致膀胱结石病例资料,包括手术方案、术中情况、Hem-o-lok放置部位及数量、吻合口张力、膀胱碎石术中所见等,分析Hem-o-lok移位致膀胱结石的可能因素.结果 12例患者病理分期T1a-T2cN0M0,均行经腹腔/腹膜外LRP,术中在吻合口附近使用Hem-o-lok 1～2枚,在前列腺侧韧带附近使用Hem-o-lok 4～8枚,术后6～15个月出现膀胱结石1～2颗,结石核心为Hem-o-lok,其中2例合并吻合口狭窄,1例合并吻合口Hem-o-lok嵌顿.采用经尿道狭窄环冷刀切开及瘢痕电切术处理膀胱颈狭窄,气压弹道碎石及取出Hem-o-lok,术后痊愈出院.结论 在LRP术中,合理使用Hem-o-lok以及熟练的吻合技术,是预防术后吻合口狭窄及减少其移位形成膀胱结石的关键.

The latest perspective indicates that apoptotic dysregulation is an important mechanism in male infertility induced by varicocele. To elucidate the molecular mechanism of apoptosis caused by varicocele, we used proteomics (2D-MALDI-TOF MS) to identify the altered proteins in the testes of experimental varicocele rats compared with the control. Here, 21 significantly different protein spots were detected by proteomics technology. 14-3-3 epsilon (14-3-3ε) was our subsequent research target because of its function in apoptosis. The expression of 14-3-3ε in rat testes was confirmed by Western blot and immunohistochemistry, and the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) method was used to analyse the apoptosis of germ cells. GC-1 spg cells transfected with small interfering RNA were used to confirm the function of 14-3-3ε in vitro. 14-3-3ε protein expression decreased, accompanied by a higher apoptosis index in rat testes of the varicocele group. Furthermore, 14-3-3ε siRNA-treated GC-1 spg cells caused the upregulation of the apoptotic rate detected by flow cytometry. The expression of Bax and Bcl-2 was found to be regulated by 14-3-3ε in vitro. Our investigation demonstrated the pro-apoptotic function of the downregulation of 14-3-3ε, which may play an important role in germ cell apoptosis induced by varicocele.

Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND)and oncological outcome by fluorescence laparoscopic radical prostatectomy (FLRP) versus high-definition laparoscopic radical prostatectomy (HD-LRP) for men with locally advanced prostate cancer (LAPCa).Methods In a prospective trial,we recruited 51 patients with T3a-bNxM0 prostate cancer from July 2015 to April 2018.Patients were assigned to study group or control group according to random number method,and were underwent either FLRP + ePLND or HD-LRP + ePLND.21 in the study group were injected with 5 mg of indocyanine green (ICG) into the bilateral lobes of the prostate transperineally guiled by transrectal ultrasound 30 min before surgery for lymphography.During the surgical procedure a fluorescence laparoscope,optimized for detection in the near infrared range,was used to visualize the lymph nodes (green fluorescent) in the dissection region in the study group while a common laparoscopy introduced in control one.Lymph nodes were removed in the external iliac vessiles,internal iliac artery,obturator fossa regions,common iliac regions and presacral regions in both groups.Radical prostatectomy was completed in the both groups by similar steps.The operation time,blood loss,number of removed lymph nodes and positive lymph nodes,complication rate,biochemical recurrence (BCR) and metastasis free survival rates in 2 years were recorded and compared in the two groups.Results 51 eligible patients were selected,including 21 in the study group and 30 in the control group.The mean age of biopsy of study group and control one were (66.4 ± 7.7) and (66.8 ± 7.4),the mean age PSA (23.5 ± 16.8) ng/ml and (26.0 ± 20.1) ng/ml,the mean Gleason score of biopsy (8.1 ± 1.0) and (7.9 ± 0.9) respectively,and there was no statistical significant difference between two groups.The mean operation time of study group and control one were (45.9 ± 4.6) min and (56.4 ± 3.2) min,the mean removed lymph nodes were (27.7 ± 5.6) and (22.1 ±5.6) respectively,and there was statistical significant difference between two groups (all P ＜ 0.05).Lymph nodes invasion in pathology were reported in 8 cases(38.1％)in the study groups while 9 (30.0 ％) in the control one;the proportion of positive lymph node (metastasis) were 3.2％ (19/583) and 3.4％ (23/663) in the two groups respectively and no statistically significant difference was noted between the two groups.Lymphorrhagia occurred in 4 cases in the control group,and there was no serious complications in both groups.The median follow-up time was 20 (7-33) month and during this time,BCR observed of 1 (4.7％) in the study group and 8 (26.7％) in the control;meanwhile,the MFSR was recorded of 100.0％ (0)in the study group and 86.7％ (4)in the control one,showing a statistically significant difference between the two groups(P =0.04).Conclusions Comparing with LRP,FLRP achieved better results of LN dissection,which will improve oncological outcomes.

目的 探讨学习曲线内1 470 nm激光层面递进前列腺剜除法的临床应用体会.方法 回顾分析2018年6月至2018年10月初学者采用层面递进法剜除治疗共93例前列腺增生患者的临床资料,主要观察的内容有:移交高年资熟练医师的中转发生率与手术例数的关系、移交高级熟练医师的中转发生率与前列腺体积的关系、剜除效率与手术例数的关系、国际前列腺症状评分、最大尿流率等,并予评估初学者的学习曲线.结果 学习曲线中的93例前列腺汽化剜除全部顺利完成,没有中转开放及输血病例.术前与术后相比,最大尿流率、术后国际前列腺症状评分均有明显改善.在学习曲线中,前列腺体积对初学者手术病例的选择较有参考性,前列腺体积在50～70 mL时外科包膜层面较容易显露,中转熟练医师的发生率最低,剜除效率也较高.随着手术例数及手术经验的累加,20余例后中转熟练医师的发生率明显下降,手术剜除效率也有明显的改善,40余例后逐渐进入稳定期.结论 学习曲线内的术者可优先选择前列腺大小在50～70 mL的病例,20余例后初学者可独立完成大部分的剜除手术,40余例后剜除技术成熟并进入稳定期.1 470 nm激光层面递进剜除法术后并发症较少,术后尿控良好,可较安全、有效的应用在前列腺增生的治疗中.

一、前列腺癌多参数磁共振成像的现状 近年来国际、国内掀起了精准医学、无创诊断的多参数磁共振成像(multiparametric MRI,mpMRI)浪潮,利用影像图像,提取影片中的病灶影像特征,结合患者的临床数据,分析影像学潜在的基因组学、蛋白组学及其他病理生理学特征.在大数据的潮流当中,从大量影像检查的数据中可提取病变特征并进行量化分析,挖掘病变的结构特征数据(例如:体积、形态、内部强化等),提取纹理特征数据(例如:边界梯度、维度、傅立叶描述、共生矩阵、小波分析特征等),可反映疾病的亚型及微环境特点,进行异质性分析,并且将这些数据整合、分析,构建数据库,建立医学诊疗平台,可指导疾病的诊断,特别是肿瘤的分期和精准诊断,监测患者的治疗效果及预测治疗反应,对判断患者的预后有极其重要的作用.

Objective To explore the surgical techniques and clinical efficacy of adrenalectomy through the extraperitoneal approach of perirenal fat. Methods Clinical data of 136 patients with adrenal tumors undergoing adrenalectomy in the Third Affiliated Hospital of Sun Yat-sen University and Southern University of Science & Technology School of Medicine from January 2018 to December 2018 were retrospectively analyzed. Among them, 97 cases were treated via the extraperitoneal approach of perirenal fat and 39 patients via the retroperitoneal approach. The intraoperative and postoperative conditions of the patients were compared between two groups. Results All 136 patients successfully completed the surgery. In the extraperitoneal approach of perirenal fat group, the average operation time was (47±13) min and the average intraoperative blood loss was (32±9) ml, and (66±19) min and (35±11) ml in the other group. Three patients were switched to open surgery, 1 case of intraoperative blood transfusion, and 1 case of postoperative hypertensive crisis. During adrenalectomy through the extraperitoneal approach of perirenal fat, the operation time and blood loss were better compared with those in the retroperitoneal group. The trans-abdominal technique was advantageous to the retroperitoneal approach for patients with large diameter of adrenal tumors and obesity. No statistical difference was observed in surgical complications and postoperative recovery between two groups. Conclusion Laparoscopic adrenalectomy through the trans-abdominal and retroperitoneal approach of perirenal fat can achieve safe and satisfactory clinical efficacy. Key words: Adrenalectomy; Anatomical plane; Laparoscopy

Acid sphingomyelinase (ASM) is a membrane lipid hydrolase, acting to generate ceramide and regulate cell functions and inflammatory responses.The roles of ASM in mediating T cell functions are postulated whereas its function in regulation of macrophages remains uncertain. The study was performed to explore ASM activity in control of macrophage functions. RAW 264.7 cells were pretreated with desipramine, an ASM inhibitor, prior to LPS challenge in vitro. LPS initiated ASM activity in RAW 264.7 cells. Conversely, inhibition of ASM activity by desipramine diminished LPS induced ASM activities and TNF production of RAW 264.7 cells. The DSS colitis in mice was induced, and desipramine was administered to the mice two days post induction of colitis. Murine colitis was characterized by elevation of ASM activities in colon tissues. Desipramine administration overrode ASM activities in colon, and ameliorated DSS-induced colitis evidenced with the reduced disease activities and the decreased cytokine levels. Together, our data show a crucial role of ASM activity in regulation of macrophage functions and responses, and suggest that ASM represents a novel therapeutic approach for the management of immune diseases.

Objective To investigate curative effects and adverse reactions by Sapylin and mitomycin in bladder irrigation for prevention of postoperative recurrent muscle non invasive bladder cancer. Methods A total of 63 patients with primary bladder cancer were divided by different bladder irrigation drugs into Sapylin group (35 cases, Sapylin in bladder irrigation) and mitomycin group (28 cases, mitomycin in bladder irrigation). Follow-up was made to observe recurrence and adverse reactions in both groups. Results There was no statistically significant difference of recurrent rates (5.71% VS 3.57%, 8.57% VS 7.14%, 14.29% VS 21.43%) in 0.5, 1 and 2 years after operation between the two groups (P>0.05). The Sapylin group had lower incidences of frequent micturition, urgent urination and odynuria as 14.29%, 8.57% and 8.57% than 46.43%, 32.14% and 28.57% in the mitomycin group, and the difference had statistical significance (P<0.05). The difference of incidences of gross hematuria and fever (5.71% VS 10.71%, 11.43% VS 7.14%) had no statistical significance between the two groups (P>0.05). Conclusion Both Sapylin and mitomycin can provide satisfactory prevention to recurrent tumor, and Sapylin causes fewer adverse reactions of lower urinary tract symptoms.

目的 探讨超声辅助的腹腔镜下肾实质切开取石术的临床应用价值.方法 分析2008年1月至2016年1月我院行腹腔镜下肾实质切开取石术8例患者的临床资料,其中男5例,女3例,中位年龄43岁.既往有肾盂输尿管切开取石术史和经皮肾镜碎石取石术(PCNL)史例,PCNL取石失败史2例,多囊肾合并肾结石3例,右肾上盏结石并肾盏重度扩张2例.患者均在气管内麻下行腹腔镜下肾实质切开取石术,同时处理合并疾病.观察术中和术后出血量、结石清除率、术后并发症等指标来评估手术的安全性及治疗效果.结果 8例手术均顺利完成,无中转开放手术,术中均未行肾动脉阻断.1例同时行近端输尿管瘢痕粘连松解,3例多囊肾者同时行该侧肾囊肿去顶减压术.1例肾上极巨大囊性扩张者同时行肾实质囊壁部分切除.手术时间100～180 min,中位数为116 min;术中出血量50～260 ml,中位数为80 ml;术后平均3d拔除肾周引流管,6～9 d拔除尿管,无尿漏发生.术后随访6～36个月,无结石残留及其他并发症发生.结论 选择合适病例行腹腔镜肾实质切开取石术具有安全、高效,创伤小,可同时处理肾脏多种合并病变的优势,是PCNL术的重要补充.术中超声使用有助于结石准确定位和减少肾实质损伤.

Extracellular purinergic products, particularly ATP, have recently been implicated to regulate immune cell functions and contribute to aberrant inflammatory responses of immune diseases. However, regulation of immune responses of colitis by extracellular ATP and its main receptor, P2 × 7, remains to be elucidated. In the study, we induced murine colitis by feeding mice with 4% dextran sulfate sodium (DSS), and noted dramatically heightened extracellular ATP levels in colon tissues during the progression of experimental colitis. Blockade of ATP release by carbenoxolone (CBX) treatment, or promoting ATP degradation by ATP diphosphohydrolase (apyrase), decreased extracellular ATP levels in colon tissues, attenuated DSS-induced colitis, whereas inhibition of extracellular ATP degradation by sodium metatungstate (POM-1) exacerbated tissue damage in the mice with colitis. Moreover, treatment with inhibitor of P2 × 7 receptor, A438079, decreased NFκB activation and active caspase-1 expression in lamina propria immune cells, downregulated proinflammatory cytokine production in colon tissues, and attenuated murine colitis. Collectively, these data suggest extracellular ATP participates in regulation of inflammatory responses of experimental colitis, through P2 × 7 receptor and inflammasome and NFκB signaling, which provides potential alternatives to the current clinical approaches to suppress extracellular ATP-mediated immune responsiveness.

目的:观察结石封堵器在输尿管上段结石治疗中的临床效果及安全性.方法:回顾分析2010年11月～2015年8月期间应用国产输尿管封堵器治疗输尿管上段结石患者50例的临床资料,其中男34例,女16例.所有患者结石均位于第4腰椎横突以上,结石长径为0.7～2.8 cm,平均1.4 cm;结石病史3周～28个月,合并有不同程度肾积水.均采用国产输尿管封堵器下行钬激光碎石术,具体方法为应用Storz或Olympus F9.8输尿管硬镜,在其下方侧孔放置结石封堵器通过结石位置,另一孔置入钬激光光纤碎石.结果:除1例0.7cm结石位置较高滑人肾盂内,采用改变体位后结石重新滑回肾盂出口处碎石成功外,其他均一次性放置结石封堵器成功碎石.所有患者术中无输尿管穿孔、假道等并发症发生,术后无发热和低血压等并发症.所有患者术后复查KUB无结石残留,随访2～3个月复查发现结石清除效果好,肾盂肾盏内无残留结石,患侧肾积水消退或减轻.结论:应用输尿管结石封堵器能显著提高输尿管上段结石碎石成功率,减少手术并发症和预防术后不良反应发生,值得临床应用和推广.

As the second most common gynecologic malignant tumors with a high mortality rate, cervical cancer jeopardizes women's life worldwide. The low cure rate in cervical cancer patients is mainly attributed to the lack of effective therapies. One feasible novel strategy is to develop immune-based approaches such as adoptive cell immunotherapy of DCCIKs which represents a promising nontoxic antineoplastic immunotherapy preferred in clinic practice. However, the therapeutic effect is not as efficient as anticipated. Possible explanations are tumors exploit immunoregulatory check-points such as programmed death 1(PD1)/PDL1 which provides tumor cells an escape strategy of circumventing immunologic rejection from immune surveillance by hampering activated tumor-specific T cell activities and rendering them functionally exhausted. With reduced transformation activity and enhanced antigenicity, a modified HPV16 E7 (HPV16mE7) was used to load DCs with silenced SOCS1 mediated by a recombinant adenovirus to improve the targetability and efficiency against cervical cancer. Combined with anti-PDL1 antibody MPDL3280A therapy, the co-cultured DCCIKs were transfused into murine models bearing tumor of HPV16 E6/E7 expressing CaSki cells for in vitro/in vivo antitumor activity assay. Although all of the animals succumbed to CaSki tumors even after adoptive DCCIKs transfer or MPDL3280A immunotherapy, the infusion of PDL1 blocking monoclonal antibody with activated T cells cured 40% of animals. These data support PDL1 blockade improves the efficacy of adoptive DCCIKs therapy, providing a new approach of immunotherapy against cervical cancer.