目的 探讨不同手术方式治疗移植肾输尿管上段结石的疗效及安全性.方法 回顾性分析2013年1月-2020年6月在湖北医药学院附属国药东风总医院移植中心接受手术治疗的移植肾输尿管上段结石患者50例的临床资料,其中20例行输尿管软镜碎石取石术为软镜组,20例行经皮肾镜碎石取石术(PCNL)为PCNL组,10例接受常规开放手术为开放组.对比分析各组的术中输血例数、手术时间和住院时间、术后的结石清除率和肾积水缓解率、血肌酐变化值以及术后1个月的疼痛及不良反应发生率.结果 软镜组住院时间(5.0±0.86)d、手术时间(42.3±5.72)min均显著优于PCNL组、开放组(P＜0.05);PCNL组(1例)、软镜组(0例)的输血例数均显著优于开放组(4例),差异有统计学意义(P＜0.05);各组的结石清除率、肾积水缓解率、术后1 d、1个月的血肌酐变化对比差异均无统计学意义(P＞0.05);在术后第5天软镜组(32.20±1.88)μmol/L的血肌酐值均显著高于术后1 d、1个月(P＜0.05).结论 采用本次实验提出的3种不同手术方式均可清除输尿管上段结石,以保持泌尿系统的畅通,保护肾功能.效果最优的为输尿管软镜碎石取石术,具有住院时间短、恢复快、创伤小、不良反应发生率低等优点.

Objective:Isolation by size of epithelial tumor cells (ISET) can screen tumor cells larger than normal blood cells on the surface of the membrane and play an important role in the detection of peripheral blood circulating tumor cells (CTC). At present, there are few studies on ISET in patients with urinary tumors. This article explores the clinical effect of ISET in detecting peripheral blood CTC in patients with urinary tumors, and discusses the significance of using ISET method in patients with urinary tumors.Methods:From April 2018 to April 2019, 98 patients with renal cell carcinoma who were hospitalized in our hospital were enrolled in the experimental group. Twenty-four healthy volunteers selected in the same period were used as the control group. The patients were preoperatively collected for blood, and healthy volunteers were bled on an empty stomach. The blood samples were detected by isolation by size of epithelial tumor cells using a CTC-Biopsy detector. According to the clinicopathological features, the effect of ISET in the detection of peripheral CTC in renal cancer patients was analyzed.Results:Two groups of subjects were tested by ISET technique. No CTC were found in healthy volunteers. In the renal cancer patients, 51 patients were positive for peripheral CTC. Kendall correlation analysis showed that the peripheral CTC were correlated with pathological stage, platelet level, lymph node status and vascular invasion under the ISET method ( P<0.05). Conclusions:ISET technology is effective in the detection of peripheral blood CTC in renal cancer patients. The ISET technique has a correlation between the detection results of peripheral CTC in patients with renal cell carcinoma and pathological staging, hemoglobin and other clinicopathological factors. It is speculated that ISET technology has a certain predictive effect on the prognosis of patients with renal cell carcinoma.

Objecitve To study the inhibitory effect of pioglitazone on inflammation factors in patients with bladder cancer. Methods A total of 100 consecutives diagnosed as bladder cancer from Februray 2013 to Februray 2014 were individed ran-domly into experiment and control groups and each of 50 cases.All patients received the appropriate operation or chemother-apeutic regimens,and the patients in experiment group received pioglitazone (15 mg/d×12 weeks)at the same time.Then to compare expression differences of high-sensitive C reactive protein (hs-CRP),tumor necrosis factor alpha (TNF-alpha),in-terleukin (IL-6)and HOMA-IR,MCP-1,MIP-1 levels.Results The levels of hs-CRP,TNF-αand IL-6 in the two groups af-ter treatment were all lower (P <0.05),and in experiment groups they were significantly lower than control group (P <0.05).The levels of HOMA-IR,MCP-1 and MIP-1 in the two groups after treatment were all lower (P <0.05),and in ex-periment groups they were significantly lower than control group(P <0.05).The complication rate in the two groups were no statistical difference (P >0.05).Conclusion Pioglitazone could improve clinical effect and prognosis by lowing inflam-mation factors including hs-CRP,TNF-α,IL-6,HOMA-IR,MCP-1 and MIP-1 in patients with bladder cancer.

Objectives:To study the effect of Fasudil combined with alpha lipoic acid in treatment of type 2 diabetes patients with impotence.Methods:A total of 76 patients diagnosed as type -2 diabetes with impotence from June 2013 to April 2014 in our hospital were selected.The mean age was (46.7 ±7.2)years;the mean dia-betes course was (6.2 ±2.8)years and the mean body mass index was (25.4 ±1.3)kg/m2 .The 76 patients were divided randomly into experiment group (n =40)and control group (n =36),all receiving glucose control.The pa-tients in experiment group received Fasudil 60mg and alpha lipoic acid 600mg +250mL NS once per day,for 4 weeks.The patients in control group received Tadalafil 5mg.Results:There was no loss of cases.the total efficacy rate in experiment group was significantly higher than that in control group (95.0% vs.80.5%,P <0.05);the IIEF -5,EHGS score and brachial artery FMD value in experiment group were significantly higher than these incontrol group (P <0.05);the incidence of complications in experiment group was significantly less than that of con-trol group (7.5% vs.13.9%,P <0.05).Conclusion:Fasudil combined with alpha lipoic acid can greatly im-prove the treatment effect of patients with type 2 diabetes and impotence.

目的:探讨RNA干扰抑制DNMT基因对小鼠肿瘤体积和原癌基因表达的影响.方法:将30只胰腺癌模型裸鼠平均分为空白组、对照组与实验组,空白组腹腔注射普通细胞培养液50 mg·kg-1,对照组腹腔注射转染空载体细胞培养悬浮液50 mg·kg-1,实验组腹腔注射转染RNA干扰DNMT1 siRNA载体细胞培养悬浮液50 mg·kg-1,均连续注射15 d.结果:胰腺癌模型裸鼠的肿瘤结节明显、瘤体不规则、没有破溃与坏死,肿瘤生物学特性稳定.实验组肿瘤生长曲线平缓,但未停滞;空白组与对照组肿瘤生长较快,曲线陡直,处理后各组体积比较差异有统计学意义(P＜0.05).3组处理前的裸鼠体质量差异无统计学意义,处理后实验组的体质量明显低于其他两组;同时处理处死后实验组的瘤质量也明显低于其他两组,实验组肿瘤生长明显受抑制,差异均有统计学意义(P＜0.05).处理后空白组与对照组的肿瘤表面血管丰富,色泽红润;实验组的肿瘤体积明显缩小,表面浅黄色,未见肿瘤转移灶,可见部分细胞核固缩、裂解,出现凋亡.免疫组化分析结果显示处理后实验组的AFP与Ki-67的相对表达量均明显低于对照组与空白组(P＜0.05).结论:RNA干扰抑制DNMT基因在裸鼠肿瘤的应用能抑制原癌基因表达,抑制肿瘤体积与体质量的增加,从而有利于发挥抗肿瘤作用.

目的 探讨法舒地尔联合α-硫辛酸治疗勃起功能障碍(ED)的疗效及安全性.方法 连续选择2013年2月至2014年2月在湖北医药学院附属东风医院就诊的已婚且治疗意向较强的ED患者90例,将其完全随机分成对照组和观察组,各45例.对照组接受常规改善循环治疗,治疗3周;观察组采用法舒地尔联合α-硫辛酸治疗,治疗3周;对比2组患者治疗前后国际勃起功能障碍指数-5(HEF-5)问卷表评分、阴茎勃起硬度评定及平均血压和心率的差异.结果 随访6个月后,与治疗前比较,2组患者的HEF-5评分及勃起硬度分级均升高[对照组HEF-5评分:(17.5±3.1)分比(14.4±6.7)分,勃起硬度分级:(3.0±0.2)级比(2.1±0.6)级;观察组HEF-5评分:(18.1±2.2)分比(14.6±4.7)分,勃起硬度分级:(3.7±0.5)级比(2.0±0.4)级],且观察组升高更明显,差异均有统计学意义(均P＜0.05).观察组总有效率明显高于对照组,差异有统计学意义[84.4％ (38/45)比68.9％ (31/45),P＜0.05].2组患者的平均血压和心率无明显改变,差异均无统计学意义(均P＜0.05).结论 法舒地尔联合α-硫辛酸治疗ED,具有较好的有效性及安全性.

目的:分析阴囊钙质沉积症(SC)误诊原因并复习相关文献,提高临床医生对SC的认识.方法:1例阴囊皮肤多发结节患者,因误诊为阴囊皮肤多发皮脂腺腺瘤,行较大结节逐个切除术.数月后小结节增大,上级医院确诊为SC,行阴囊局部病变皮肤切除术.结果:两次手术切口均恢复良好,随访2年无复发.结论:SC是罕见的良性疾病,发病原因不明,确诊后行阴囊局部病变切除术是治疗的关键.

睾丸横过异位(transverse testicular ectopia,TTE)临床十分罕见,特征性表现为一侧睾丸移位至对侧腹股沟管,常合并腹股沟疝.我院在2008年收治一例,治疗后经4年随访患者恢复良好,现报告如下. 1 临床资料 6岁男性患儿,因右侧腹股沟疝在外院行疝囊高位结扎术,术后半月发现右侧阴囊空虚在我院就诊.体格检查:患儿体型及阴茎发育良好,双侧阴囊发育不良,右侧明显,左侧腹股沟外环上方可触及类圆形包块,大小约2 cm×2 cm×1.5 cm,右侧腹股沟区陈旧手术瘢痕,阴囊及腹股沟区未触及包块.B超检查提示右侧腹股沟、盆腔及腹膜后未发现包块,左侧腹股沟外环处可见睾丸样结构两枚,一枚位于腹股沟浅环处大小正常,一枚位于深环处,大小约1.5 cm× 1.5 cm×1.0 cm.生化检查正常,性激素正常,HCG及AFP检查正常.进一步行盆腔MR与B超检查结果一致,初步考虑为左侧隐睾伴腹股沟斜疝,右侧易位睾丸决定行手术探查.

[Objective]To compare the efficacy and safety between the pneumatic lithotripsy combined with ultrasonic lithotripsy and pneumatic lithotripsy alone for renal calculi. [Methods]148 patients who were given percutaneous nephrolithotomy(PCNL) in Dongfeng Hospital Affiliated to Hubei University of Medicine from May 2005 to February 2011 were analyzed retrospectively,and they were divided into pneumatic lithotripsy alone(group A) and pneumatic lithotripsy combined with ultrasonic lithotripsy(group B).The stone size,location,operation time,hospitalization days,incidence of postoperative infection,hemoglobin loss,average number of PCNL,initial and total success rate of stone clearance of two groups were analyzed and compared. [Results]There was no significant difference in stone size,location,average number of PCNL,initial and total success rate of stone clearance between two groups(P0.05).The operation time,hospitalization days and hemoglobin loss of group B were significantly lower than those of group A(P0.05).There was no puncture related complications,such as pneumothorax and pleural effusion,and all patients had no postoperative infection. [Conclusion]The pneumatic lithotripsy combined with ultrasonic lithotripsy can effectively reduce operation time,hospitalization days and hemoglobin loss,and it is more effective and safe than pneumatic lithotripsy alone.

目的通过对比直肠超声引导下经会阴6针法与经直肠五区13针法前列腺穿刺活检对前列腺癌的阳性率、穿刺并发症、探讨两种穿刺方法的优缺点。方法回顾性分析120例超声引导下前列腺穿刺活检病例,其中经会阴60例,经直肠60例。通过统计学分析比较两种方法前列腺癌阳性率、穿刺并发症发生率,评价其优缺点。结果超声引导下经会阴6针法前列腺癌阳性率20.0%,发热(6.7%)、疼痛(8.3%)、血尿(10.0%)、尿潴留(5.0%);超声引导下经直肠五区13针法前列腺癌阳性率36.7%、并发症发热(10.0%)、疼痛(5.0%)、血尿(8.3%)、尿潴留(3.3%)、血便(5.0%)。两种方法比较,后者前列腺癌阳性率明显增加(χ2=4.10,P<0.05),穿刺并发症无统计学差异(P>0.05)。结论超声引导下经直肠五区13针法前列腺穿刺操作简单、前列腺癌阳性率高。

Objective:To summarize and improve the diagnosis and treatment of Fournier's gangrene.Methods: Analyzed the clinical data retrospectively of five patients with Fournier's gangrene treated in Dongfeng Hospital, and reviewed the relative literature.Results:2 cases were accompanied by diabetes.All patients underwent the treatments including open decompression urgently,thorough debridement repeatedly.applied broad-spectrum antibiotics combinedly and systemic nutritional support.4 cases performed secondary suture,and the other one performed skin prosthetics due to larger skin defect.Conclusions:Early diagnosis.open decompression and debridement urgently,applied broad-spectrum antibiotics combinedly play vital roles in the prognosis of Fournier's gangrene.