病例1,男,92岁,于2015年6月因无痛性肉眼血尿收治人院,术中即见膀胱内多发肿块,膀胱颈及部分前列腺累及,诊断为膀胱恶性肿瘤,予以行经尿道膀胱肿瘤电切术(TU RBT),术后3个月患者仍有反复肉眼血尿,给予行DSA栓塞术后,效果不佳,仍有间断出血.病例2,男,78岁,于2016年1月因膀胱恶性肿瘤晚期收治入院,该患者2013年检查发现膀胱恶性肿瘤,于外院行TURBT,术后出现复发,患者一般条件较差,无全膀胱切除手术条件,予以积极保守治疗.病例3,男,70岁,于2016年10月因膀胱恶性肿瘤晚期收治入院,该患者于2011年发现膀胱恶性肿瘤后于外院行多次TURBT,此次入院相关检查提示膀胱内布满肿瘤性病灶,考虑患者高龄,基础疾病较多,家属无全膀胱切除手术意愿,予以积极保守治疗.

：Objective To investigatetranscriptional expression and promoter CpG methylation status of A-kinase anchoringprotein 12 (AKAP12) gene and analyze their correlation with clinical pathological stage inbladder transitional cell carcinoma. Methods AKAP12 mRNA expression level and promoter CpGmetbylation status was measured by fluorescent quantitative RT-PCR (FQ-RT-PCR) andmethylation specific PCR (MSP) in 30 bladder transitional cell carcinoma and adjacentnormal tissues. The products of PCR were cloned and bisulfite sequenced. Results DecreasedAKAP12 mRNA expression was demonstrated in 22 carcinomas (73. 3% ) and was significantlyassociated with turnout grade (P =0. 02).The frequency of promoter methylation of AKAP12gene was 53. 3 % (16/30) and correlated with the tumor stage(r =0.52,Pn =0.03)and grade(r=0.61,Pn =0.01). Conclusion Aberrant promoter methylation of AKAP12 can result in the lossof gene expression and may association with bladder transitional cell carcinoma.

Objective To investigate the expression of pigment epitheliumderived factor(PEDF) mRNA and its clinical significance in bladder cancer. Methods mRNA of PEDF in 30 bladder tumors and 10 normal tissues were detected by polymerase chain reaction(PCR).The microvessel density was accessed by immunostaining of CD34. Results PEDF was under regulated in 23 of 30 carcinomas(76.6%) and 1 of 10 normal tissues(10.0%).No significant relationship was revealed between PEDF expression and age,tumor size,tumor amount and tumor grade.The loss of PEDF correlated with the malignant stage of tumor and microvessel density. Conclusions This is the first report on PEDF expression in bladder cancer.The loss of this gene might be related with progress of bladder cancer.

目的探讨双J管在ESWL治疗输尿管结石中的应用价值.方法选取2000年2月至2002年12月所有经单纯ESWL治疗2次无效的输尿管结石患者46例,向其患侧输尿管逆行置入双J管后,继续行ESWL治疗.结果置管后1次碎石率为69.6%,2次碎石率为93.5%,3次碎石率100%.拔管后1周内结石排净率73.9%(34/46);2周内排净率84.8%(39/46);3月内排净率93.5%(43/46).3例手术治疗.结论应用双J管可以提高ESWL的成功率.

Objective To study the improvements in transurethral resection of prostate. Methods 170 cases with BHP underwent transurethral resection of prostate with improved techniques. The mainly improved techniques included ingressing the resectoscope under direct vision, the bladder fistulization by puncture, the stronger electrocoagulation followed by weaker electrosection, electro-vaporization, and keeping the 11～12～1 prostate tissues. Results Average resection speed of the improved techniques was 0.65(0.13-0.67) g/min with a significant difference ( P 0.05) compared to the traditional TURP. 98.8% (168/170) had a smooth emiction when the catheter was removed 3～5 days after operations. Conclusions The improved techniques can widen indications, increase efficiency, reduce bleeding and complications.

目的评价经尿道前列腺汽化(Transurethral vaporization of prostate,TVP)联合电切(Transurethral resction of prostate,TURP)治疗前列腺增生症的疗效. 方法采用TVP联合TURP治疗137例前列增生症,年龄58岁～77岁,平均60岁. 结果术后获得随访125例,平均20月.疗效达优103例、良17例,优良率95.8%. 结论经尿道汽化联合电切治疗以中叶增生为主的前列腺增生症,是一种安全、可靠、有效的治疗方法.

1999年2月～2001年2月，我们对34例输尿管结石长期梗阻致肾功能严重受损患者，行双J管内引流后进行（ESWL）治疗。现报告如下。 一般资料：本组男25例，女9例；年龄29～43岁，平均32岁。结石直径1～1.8cm，平均1.6cm。16例输尿管下段结石，梗阻2个月～1年，平均5个月；11例输尿管中段结石，梗阻3～7个月，平均4.5个月；7例输尿管上段结石，梗阻2～5个月，平均3个月。行大剂量静脉肾盂造影（IVU）检查，34例患肾功能明显受损，其中29例显影延迟2～5小时；5例不显影。本组患者行IVU检查后，经膀胱向肾盂内置入双J管内引流，术后常规应用抗生素，同时行ESWL。待结石粉碎、肾功能基本恢复后，拔除双J管。