目的 探讨膀胱肉瘤样癌的诊断、治疗及预后.方法 回顾性分析我院收治的10例膀胱肉瘤样癌患者的临床资料,对其临床特点、诊断及治疗进行分析.其中男9例,女1例,平均年龄64岁.9例以肉眼血尿为首发症状,1例以排尿困难为首发症状.10例患者均行手术治疗,行经尿道膀胱肿瘤电切术3例;行膀胱部分切除术1例;1例行TURBT后2个月出现复发,行全膀胱切除术+淋巴结清扫+输尿管皮肤造口术,1例行全膀胱切除术+输尿管皮肤造口术;1例行腹腔镜下全膀胱切除+输尿管皮肤造口术;1例行全膀胱切除术+正位可控回肠膀胱术;1例行TURBT后6个月出现复发,行全膀胱切除术+回肠膀胱术;1例行全膀胱切除+尿道切除术.结果 术后病理结果显示,肉瘤样癌6例,复合型癌(尿路上皮癌+肉瘤样癌)4例.免疫组化CK阳性10例,CK7阳性9例,Vim阳性10例.5例患者死于肿瘤转移,5例患者生存,其中1例复发并转移.结论 膀胱肉瘤样癌是一种少见的高度恶性的膀胱肿瘤,根治性全膀胱切除术联合综合治疗是目前的主要治疗手段,早期发现是改善该恶性肿瘤患者预后的必要条件.

Objective To investigate the effect of targeted inhibition of microRNA-106b (miR-106b) on the proliferation,invasion,and apoptosis of in vitro bladder cancer cells.Methods Cell transfection was used to construct the colonies of bladder cancer cells with targeted inhibition of miR-106b,and quantitative real time PCR was used to detect the silence of miR-106b.The bladder cancer cells were divided into blank control group (group A),negative control group (group B),and miR-106b small-molecule inhibitor transfection group (group C).Cell proliferation assay and colony-forming assay were used to measure the effect of targeted inhibition of miR-106b on the growth of bladder cancer T24 cell,Annexin V/PI was used to measure the effect on the apoptosis of T24 cells,and cell migration assay and invasion assay were used to measure the effect on the invasion of in vitro T24 cells.Results There were significant differences in miR-106b expression,survival rate of cells,number of cell colonies formed,cell apoptosis rate,and number of cells across membrane between group C and groups A/B (F=37.24-87.89,q=9.5716.53,P＜0.05).Conclusion Targeted inhibition of miR-106b can inhibit the proliferation,invasion,and apoptosis of bladder cancer cells in vitro,and miR 106b is the target gene for the treatment of bladder cancer.

目的 探讨原发性膀胱小细胞癌(SCCB)的临床特点、诊疗方法和预后情况.方法 回顾性分析2007年4月至2014年5月,青岛大学附属医院泌尿外科收治的7例SCCB患者的临床资料及随访结果.其中男5例,女2例,中位年龄65岁.7例患者均以无痛肉眼血尿就诊,均行手术治疗.4例患者行TURBT手术,1例患者行膀胱部分切除术+同侧髂血管淋巴结清扫术,1例患者行全膀胱切除+双侧输尿管造口术,1例患者行双侧输尿管皮肤造口术.结果 术后病理结果为SCCB或伴SCCB的复合性癌.免疫组化结果神经元特异性烯醇化酶均(+),1例突触素(-),3例嗜铬蛋白颗粒(+).5例患者死于全身肿瘤转移,2例分别随访16个月和35个月,目前仍存活,未见复发或转移.结论 SCCB是一种罕见的膀胱恶性肿瘤,手术联合化疗可提高疗效,改善预后.

患者女，72岁，因“发现左肾占位6 d”入院，既往有高血压、慢性阑尾炎病史。查体：T 35.5℃，BP 170／100 mm Hg，心肺未闻及异常，右下腹轻压痛，无反跳痛，双肾区无异常隆起及叩压痛。泌尿系彩超示左肾上极见一4.1 cm ×4.2 cm ×4.0 cm不均质回声团，内未见明显血流信号，提示左肾实性占位；下腹部平扫CT示左肾外可见最大截面约为46.9 mm ×37.3 mm稍高密度影，参考CT值约54 HU，部分与肾实质相连，边缘较清（图1）；下腹部动态增强CT 示左肾后外侧见最大截面约46.9 mm ×37.3 mm的稍高密度影，病变小部分与肾实质关系密切，左肾后缘整体呈受压改变，病变边缘较清，密度欠均匀，增强后病变内强化不明显，考虑左肾后外侧占位，肾脏来源肿瘤可能性大（图2）。

患者,男,65岁.因颅内血肿于2009年5月在我院神经外科住院治疗.留置尿管1周后,气囊闭塞,试行疏通气囊通道未成功.近尿道外口处剪断尿管,1周后复查B超,气囊内容约10 ml,仍在膀胱内.7.0～8.9 F Wolf输尿管镜自尿管旁直视下进境,进镜顺利,无阻力.进入膀胱后,即可见尿管气囊.6 F输尿管导管内的钢丝内芯直接将气囊刺破,顺利取出尿管.患者恢复好,无异常.

>例1 20岁,未婚。右侧睾丸肿大并坠胀不适2年于2009年3月2日入院。查体:右侧阴囊增大,约12 cm×10 cm×8 cm。睾丸与附睾分界不清,张力较大,有囊实、沉重感。透光实验(±)。实验室检查:血白细胞5.89×10～9/L,血红蛋白113 g/L,人绒毛膜促性腺激素(HCG)<0.5 IU/L,甲胎蛋白(AFP)

肾功能损害是BPH患者的常见并发症,严重时可致肾功能衰竭,及时发现、及时治疗仍可使患者转危为安,对于此类患者最重要的是确定治疗时机,延误治疗时机会造成难以挽回的后果.

目的:探讨成人节细胞神经母细胞瘤的临床和病理特点.方法:回顾分析2例成人节细胞神经母细胞瘤的临床资料和病理资料.结果:2例均为体检时发现,无自觉症状,实验室检均无异常.肿瘤大小分别为7cm×5 cm和5 cm×4 cm,包膜完整,均与周围组织有粘连,切面星鱼肉状,免疫组化NSE,Syn,CgA.S100及vimentin均为(+).1例术后随访17个月死亡,1例随访6个月无转移.结论:成人节细胞神经母细胞瘤临床少见,多为体检时发现.治疗最有效的方法是手术切除,可辅以放、化疗.

Objective To detect the specific protein expression in the urine of bladder transitional cell carcinoma(TCC),find out new tumor markers,and then explore the roles of those proteins in the pathogenesis of TCC and the value of proteomics in studying TCC.Methods Urine samples from 24 TCC patients and the control group(including 12 postoperative patients with TCC and 12 healthy volunteers)were analyzed using surface enhanced laser desorption/ionization-time of flight-mass spectrometry(SELDI-TOF-MS)ProteinChip technology,then the proteins which had been picked out would be identified in Swiss-Prot protein database.Results Some protein differences of protein were detected in the urine samples between TCC group and Control group by IMAC-Cu-3 chip,including six potential TCC biomarkers and two protein clusters.Combination of the 3438Da and 8002Da biomarkers significantly increased the sensitivity(83.3%)and the specificity(75.0%)for detecting TCC.The 3438Da biomarker had been identified as α-defensin and the 4310Da~5150Da protein cluster was identified as gp40 protein in the SWISS-PRO protein database.Conclusion SELDI-TOF-MS ProteinChip technology can directly,quickly and expediently pick out specific TCC biomarkers from the urine of patients.It will contribute to study the pathogenesis of TCC and provide a valuable approach in detecting tumor marker.

Objective To evaluate the efficacy and safety of transurethral bladder tumor and prostate resection simultaneously. Methods A total 167 cases of bladdr tumor complicated with benign prostate hyperplasia ( BPH) were treated from June 2003 to February 2009 in our hospital. The patients in test group (n=108) underwent TURBt and TURP at the same time, and those in control group received TURBt only. There was no significant difference between two groups in age, tumor size, tumor location, tumor stage and grade, internationl prostate symtoms score (IPSS). Results All operations were preformed successfully, and no bladder perforation happened. One month postoperation urinary infection rate in test group (6.5% ) was lower than that in control group (35. 6% ) ,P <0. 01. The tumor recurrence rate in test and control groups was 29. 6% and 40. 7% respectively,P <0. 05. The recurrence time in test and control groups was 23. 2 months and 18. 5 months respectively ,P <0. 05. There were 3 and 2 cases of prostate seeding in test group and control group, respectively,P>0.05. Conclusion Transurethral bladder tumor and prostate resection simultaneously is safe and effective for patients with bladder tumor complicated with BPH. It can reduce postoperative urinary infection rate and tumor recurrence rate, but can't increase prostate tumor seeding.

Objective To introduce the experience of surgical access to left renal pedicle at the level of Treitz ligament in complicated nephrectomy.Methods A total of 51 left transperitoneal nephrectomies,in complicated cases such as big renal carcinoma(with or without renal vein cancer embolus),transition cell carcinoma of renal pelvis and pyonephrosis,were performed from September 1997 to December 2008,by direct access to left renal pedical at the level of Treitz ligament.The anatomy and relationship of Treitz ligament,renal vein,aorta,adrenal vein and inferior mesenteric vein were reviewed and the key point of procedures was described.Results All operations were performed successfully,no operative death,and no severe intraoperative and postoperative complications occurred.The time required to explore the renal vein and to deal with renal pedicle were 3 to 5 minutes,10 to 20 minutes,respectively,after entering the abdominal cavity.Conclusions This access to renal pedicle is technically feasible and operation through it has following advantages:①Easy to approach the renal pedicle in the aspects of anatomy and it is safe,quick to deal with renal pedicle with less blood loss.②It follows the classic principles of radical nephrectomy allowing to perform the procedure without any manipulation of the tumor.This surgical access is especially suitable for complicated left nephrectomy such as radical nephrectomy(with renal vein cancer embolus) and pyonephrosis.

Objective To evaluate the effects of ultrasound-guided percutaneous nephrolithotomy(PCNL) combined with pneumatic and ultrasosonic lithotripsy in the treatment of complex renal calculus. Methods This tecnique was applied in 29 patients with complex renal stone,of whom,the size of stone of 2.5 cm was found in 25 cases,staghorn sone in 18,multiple stones in 23,infective stone in two,and stone in solitary kidney in three cases. Results Single-channel technique was used in 26 cases,dual-parthway in two.The total stone clearnace was 71.4%(20/28).The mean time spent(range) in operation was130 min(40-260).Nephrostomy was done in one case due to intraoperative bleeding,who was scheduled for second-stage surgery.Postoperatively,embolization of renal artery was done in one cases due to renal arteriovenous fistula.No postoperative hemorrhage or infection was recorded. Conclusion The combined technique used in this study is effective and safe for complex renal calculus.A great attention shoud be paid to severe complications and coping measures be prepared any time.

接受单纯开放性肾脏切除术的患者共42例,随机分为水囊扩张腰部小切口组21例(1组)和11肋间切口组21例(2组)。两组均成功完成手术。1、2组手术时间分别为109.81、104.9 min,切除标本分别为153.81、156.19 mg,两组相比,P均>0.05;1、2组切口长度分别为9.92、19.35 cm,术中失血量分别为104.9、253.1 ml,术后强痛定用量分别为48.81、200.22 mg,术后并发症发生率分别为9.5%、23.8%,住院时间分别为6.4、10.4 d,恢复到正常生活的时间分别为20.43、32.71 d,住院花费分别为6.54、8.59千元,两组相比,P均<0.05。认为水囊扩张腰部小切口单纯肾切除术与传统11肋间切口相比,同样安全可靠,而且切口小、出血少,患者痛苦小、术后恢复快。

目的探讨肾嗜酸细胞瘤的诊断和治疗。方法回顾性分析肾嗜酸细胞瘤患者的临床资料,结合文献资料复习讨论。结果1例肿瘤位于左肾中上段,1例位于左肾盂输尿管,分别行左肾根治性切除和左肾、输尿管根治性切除。肿瘤切面呈灰褐色,质软;镜检瘤细胞均呈圆形或类圆形,胞质富含浓染嗜酸颗粒,核泡状,瘤细胞呈巢状、管状、微囊状或卵圆形片状排列,瘤组织中心部可见玻璃样变无细胞区;免疫组化:bcl-2(+)、PCNA(++)或(-)。结论肾嗜酸细胞瘤系肾脏的良性倾向肿瘤,术前诊断较困难,瘤体中心区星形瘢痕是本痛的特征性影像学改变。治疗以保肾手术首选,但因其易合并肾恶性肿瘤,应密切随访。

Objectives To study the diagnosis and treatment of renal oncocytoma. Methods Twelve cases of renal oncocytoma were reported here and the literatures were reviewed. Results 9 males,3 females, aged 46 ～ 78 years, mean 62 years. Tumor diameter 2.0 ～ 9.0cm, mean 5.4cm. One case was found because of painless gross hematuria 2 weeks. Other 11 cases were found by medical examination. CT scan shows 2 cases of central starshaped low - density shadow. The tumor were well - circumscribed, homogeneous and brown in color without haemorrhage and necrosis. On light microscopy, there was strong eosinophilic cytoplasm with granules, the tumor cells being tubular or no mitosis. The immunohistochemical staining was positive for Cytokeratin and EMA, whereas negative for Vimentin. Conclusions Renal oncocytoma is a type of benign, parenchymatous tumor, and it has no specific clinical feature. Imaging can help the diagnosis. The diagnosis can be established on histopathologic, immunohistochemical tests. Nephron sparing surgery(NSS) is the first choice treatment. Follow up is essential.

泌尿系结核并发膀胱肿瘤临床较少见,1998年10月至2006年1月我院收治6例,其中误诊、漏诊4例,现报告如下.

目的 探讨膀胱嗜铬细胞瘤诊断与处理的方法,提高诊治水平.方法 回顾性分析4例膀胱嗜铬细胞瘤患者的临床资料.结果 3例在镜检中出现头痛、多汗、高血压等症状, 4例术前均确诊;术中血压变化2例;4例术后病理均证实为嗜铬细胞瘤,随访症状均消失,未见复发和恶变.结论 排尿时典型发作的高血压为其主要症状,如B 超、CT及膀胱镜检查发现黏膜下肿块,应高度怀疑本病;尿儿茶酚胺测定可作为定性诊断;充分术前准备是保证手术安全的关键;治疗应手术切除,术后要密切随访.

Objective To assess the safety and efficacy of transurethral plasmakinetic resection of prostate(PKRP) for the treatment of prostate hyperplasia.Methods 50 cases of benign prostate hyperplasia(BPH) were treated by PKRP and had been followed up for 1-3 months.Results The peak flow rate of urine increased from (7.2±2.1)ml/s to (18.6±4.2)ml/s after operation and the international prostate symptom score(IPSS) decreased from (27.2±5.6) to (10.3±3.8).Conclusion The PKRP is a new and feasible procedure for treatment of BPH.

目的 探讨后腹腔镜下输尿管切开取石术的适应证、技术要点及临床价值.方法 采用后腹腔镜下输尿管切开取石术治疗输尿管上段结石24例,结石直径15～28 mm;其中20例曾经1～2次体外冲击波碎石无效,4例经输尿管镜取石失败.全部病例均采用经后腹腔途径切开取石.结果 本组22例手术取得成功,2例改开放手术.手术时间35～120 min,平均65 min,术后恢复顺利,随访2～32个月,23例患者肾输尿管积水均明显好转,肾功能改善.1例患者术后半年又出现重度肾积水,行输尿管狭窄段切除吻合术后治愈.结论 后腹腔镜下输尿管切开取石术,可以完整取出结石,具有微创的优势,是治疗输尿管上段结石较理想的方法.

病历摘要 患者女,80岁,因右侧腰痛2个月,于2006年1月16日入院.患者自2个月前渐感右腰胀痛,无肉眼血尿,近日发热(37.6℃～38.5℃)1周,曾应用抗生素,入院时体温已正常.近来消瘦较明显.