目的 比较5种不同前列腺穿刺活检方式的前列腺癌检出率和并发症情况.方法 收集2001年至2012年间前列腺穿刺活检的住院病例239例,分别采用经会阴6点、手指引导6点、经直肠超声引导6点、5区13针(13点)和6+4(10点)5种不同穿刺活检方式分组.比较5种前列腺穿刺活检方式的阳性率及并发症情况;同时对比按年龄、直肠指检(DRE)结果、前列腺特异性抗原(PSA)和直肠超声(TRUS)情况分组后的相关结果.结果 5种不同穿刺方式组的前列腺癌检出阳性率差异无统计学意义(x2=6.530,P＞0.05);5组血尿阳性率的差异有统计学意义(x2=9.947,P＜0.05),其中5区13针组的血尿阳性率分别高于6+4组和超声6点组(P＜0.005),手指6点组血尿阳性率高于6+4组(P=0.005).按不同年龄和PSA水平分组后,PSA＞ 20 μg/L组的前列腺癌检出阳性率高于＜10 μg/L和10～ 20 μg/L组(P＜0.012 5);＞80岁组的前列腺癌检出阳性率也高于＜70岁组(P＜0.025);同时DRE阳性和TRUS可疑组的前列腺癌检出阳性率也均高于阴性组(均P＜0.05).而各分层分组并发症发生情况均无统计学差异(均P ＞0.05).结论 对国内临床就诊人群,初次穿刺活检者采用10点的前列腺扩充穿刺即可,部分临床局部进展或前列腺体积较小者,采用6点穿刺足够诊断需要.对未细分穿刺人群简单的统一采用12点以上的穿刺方式不应是最佳选择.

OBJECTIVE:To explore the long-term survival and prognosis of prostate cancer patients after treated by androgen deprivation therapy.METHODS:We conducted a follow-up study of 124 patients with prostate cancer treated by androgen deprivation therapy, and compared the survival times of the patients with different pathological grades and clinical characteristics using Kaplan-Meiers survival curves.RESULTS:The mean survival time of the 124 patients after androgen deprivation therapy was 5. 912 years, with the median survival time of 7.81 years. The patients with bone metastases showed a shorter survival time than those with non-bone metastasis (P = 0.04). Pathological grades and PSA levels were not prognostic factors. No significant differences were found in the mean survival time between those died of prostate cancer (n = 35) and those from other factors (n = 23) (P = 0.50).CONCLUSION:Bone metastasis is an important prognostic factor in advanced prostate cancer following androgen deprivation therapy, which is more significantly correlated with the survival time of the patients than tumor grades and clinical classification.

为了解前列腺特异性抗原(prostate-specific antigen,PSA)筛查对我国高龄男性前列腺癌早期诊断的价值,本文分析了经PSA筛查诊断的≥75岁前列腺癌患者的临床和病理特点,并与同时期临床诊断的前列腺癌进行比较. 1 资料与方法 1.1 资料 2005年9月至2010年12月,对江苏省老年医学研究所和南京医科大学第一附属医院体检中心进行体检的50岁以上男性进行PSA筛查,病理诊断为前列腺癌的75岁及以上患者入选筛查组.

目的:探讨手术治疗阴茎Paget病对患者性生活质量的影响.方法:回顾性分析南京医科大学第一附属医院及江苏省省级机关医院自2008年至今手术治疗10例阴茎Paget病患者的临床资料.结果:10例均行局部扩大切除术及自身皮瓣修补术.术前3例无性生活,7例在术后2个月左右恢复性生活.总体患者术后3及6个月时的性生活质量比术前明显好转.结论:手术是治疗阴茎Paget病的一种有效的方法,可以改善患者的性生活质量,并且这种改善效果在术后3个月时最明显.

目的:探讨手术前注射定痉灵是否有利于提高输尿管镜手术成功率.方法:手术前注射定痉灵62例,常规注射镇静剂组71例,比较两组的手术时间与手术成功率.结果:两组的手术时间与成功率均有明显差异(P<0.05),定痉灵组的手术时间短,成功率高.结论:手术前注射定痉灵,能够有效松弛输尿管,使得输尿管镜探查更为容易,手术成功率明显提高.

Objective To determine the expression of P504S,EZH2 and pim-1 in prostate cancer and its correlation with Gleason score.Methods Immunohistochemical stain was used to study the expression of P504S,EZH2 and pim-1 in prostate cancer and benign prostate hyperplasia.Its expression level was analysed with respect to Gleason score.Results P504S,EZH2 and pim-1 was overexpressed in prostate cancer.And Gleason score was positively correlated with P504S(0.418,Ρ0.05),EZH2(0.268,Ρ0.05)and pim-1(0.567,Ρ0.01).Conclusions P504S,EZH2 and pim-1 are sensitive and specific marker for prostate cancer.The expression level of P504S,EZH2 and pim-1 was related to Gleason score.

目的:探讨体外冲击波碎石(ESWL)目前在肾、输尿管结石治疗中的疗效,加深对ESWL的理性认识。方法:总结2007年—2008年门诊及住院124例患者原位ESWL治疗后总体效果的评价,合并复习相关文献。结果:单纯ESWL治疗患者中以肾、输尿管上段结石疗效为佳。结论:ESWL在上尿路结石治疗中有其重要地位,是非铸形肾结石及输尿管结石治疗的首选。

2009年4月-2009年12月应用膀胱镜钬激光治疗外伤性截瘫并发膀胱结石患者7例,疗效满意,报告如下. 1临床资料 患者均为男性,年龄15～64岁;病史90～180 d;外伤致脊髓损伤,合并尿潴留,尿失禁.

OBJECTIVE:To investigate the perioperative treatment of senile patients with benign prostatic hyperplasia (BPH) undergoing transurethral electrovaporization of prostate (TUEVP).METHODS:Totally 131 BPH patients aged 75-88 years underwent TUEVP, general data and past history of illness of the patients obtained before surgery, including their mental state, self-care ability, diseases of the cardiovascular, cerebrovascular and respiratory systems, diabetes mellitus, thyroid diseases and medication, and preoperative routine examinations performed on the functions of the kidneys, lungs, heart and thyroid gland to assess their operation-endurance, chances of complications and perioperative countermeasures.RESULTS:Of the total number of patients, 128 recovered urination and 3 relapsed into urinary retention after withdrawal of the catheter, with 2 restored to health. One patient had to carry the stomal tube because of bladder contraction dysfunction, 2 (1.5%) developed secondary bleeding but recovered after conservative treatment, 1 (0.7%) deep vein thrombus, 1 acute hemorrhagic gastritis (0.7%) and 4 (3.0%) postoperative urinary tract infection, but with no TUEVP syndrome and no complications of the cerebrovascular and respiratory systems. A 3-6 months follow-up showed that IPSS decreased from 25.24 +/- 4.70 to 7.81 +/- 4.12, QOL dropped from 4.51 +/- 0.72 to 1.51 +/- 0.73, and Qmax increased from (10.14 +/- 6.31) ml/s to (18. 14 +/- 4. 12) ml/s.CONCLUSION:By proper perioperative treatment, TUEVP could be safely and smoothly performed in senile BPH patients, with fewer complications and better recovery.

1 病例 患者男,78岁,因"突发性持续右下腹痛4 h"入院,伴恶心、呕吐、腹泻,非血性,自述有冠心病伴房颤史.查体,体温38℃,脉搏90次*min-1,血压130/85 mmHg.

Purpose:To evaluate the value of transrectal color Doppler in benign prostatic hyperlasia (BPH) and prostate cancer. Method: 18 normal subjects, 53 BPH and 14 prostate cancer cases were studied by transrectal color Doppler flow image (CDFI).Results:CDFI reveals a marked increase in blood flow of BPH and prostate cancer. In BPH, the flow signals mostly occurrd in the inner or central gland, and it was symmetric without an obvious focus. In prostate cancer, it was depicted with obviously abnormal flow within and around the cancer lesion or hypoechoic nodule. But there were no statistically significant differences in the resistive indexes between BPH and prostate caner.Conclusion:Transrectal color Doppler scanning could delineate lesions that difficult to see at gray-scale scanning, which had a little additional value over gray-scale scanning alone in diagnosis of prostatic disease.

我科1998年4月～2001年3月对278例前列腺增生症病人施行经尿道前列腺汽化电切术(TUEVAP),取得满意疗效.现报道如下.1 临床资料1.1 一般资料 278例前列腺增生病人全部经肛门指检、B超检查前列腺三径、残余尿测定、尿流率检查、前列腺特异性抗原(PSA)检查,并经术后病理证实诊断无误.年龄60～88岁,平均(70.90±6.43)岁.前列腺重量(53.14±28.9) g.278例中有42例伴慢性尿潴留病人术前已行耻骨上膀胱造瘘术(SPC)(15.11%).肾盂积水17例(6.11%),肾功能不全23例(8.7%),高血压81例(29.49%),冠心病43例(15.47%),慢支肺气肿22例(7.91%),慢性心衰8例(2.88%),糖尿病42例(15.11%),房颤14例(5.03%),脑梗死后遗症24例(8.63%),心电图明显异常71例(25.54%).

阴茎结核少见,我们收治1例,报告如下. 患者,50岁.1999年4月曾行包皮环切术,术后2个月无意中发现阴茎根部背侧局部硬结,无疼痛等不适症状,排尿无影响,阴茎勃起时硬结处局部有紧箍感,影响勃起,曾用维生素E等药物治疗,硬结无变化.2001年2月就诊以"阴茎海绵体硬结症"住院.

目的探讨前列腺增生症汽化电切术后排尿困难的原因.方法:对278例前列腺增生症汽化电切术后部分病人发生排尿困难的回顾性分析.结果 18例病人拔除导尿管后即发生排尿困难,另13例病人逐渐出现排尿困难.结论前列腺增生症汽化电切术后排尿困难是由于膀胱出口水肿,残留血块、组织块阻塞;也可因伴发尿道狭窄,汽化电切不到位 ,神经元性膀胱等引起.如处理适当多可恢复,注意手术操作环节,术后处理适当可以减少其发生.

我们1997年2月～2001年3月,应用视频汽化电切术治疗老年人下尿路疾病316例,取得良好的临床效果.现报道如下.

目的: 了解经尿道前列腺汽化切割术(TUEVAP)对性功能的影响. 方法: 参考英国激光泌尿协会尿道激光治疗良性前列腺增生(BPH)随访表,设计性功能调查表包括性欲、阴茎勃起硬度、射精情况、勃起功能障碍(ED).BPH病人汽化切割术后半年填表. 结果: 118例病人均填表完整,27.1%(33/118)病人性欲下降;31.7%(37/118)病人阴茎勃起硬度下降.94例术前性功能正常的病人,术后发生逆行射精者占35.1%(33/94);术后ED者占8.5%(8/94). 结果: TUEVAP对性功能有不利影响,临床应予以重视.

目的:研究舍尼通治疗良性前列腺增生症(BPH)的疗效.方法:对门诊67例患者分组,舍尼通组37例单用舍尼通治疗,联合用药组30例应用舍尼通和特拉唑嗪治疗.结果:舍尼通组治疗10个月后症状评分和前列腺体积均有明显改善(P＜0.05),而尿流率、残余尿量和生存质量评估无明显好转.联合用药组治疗2个月后最大尿流率和残余尿量有明显改善(P＜0.05);治疗10个月后尿流率有进一步改善,但前列腺体积和生存质量评估无明显变化.结论:舍尼通治疗BPH作用缓和,适用于轻、中度患者,但并不推荐和特拉唑嗪联合应用.