▎前列腺决定了排尿的顺畅 老年男性的前列腺老化表现为前列腺腺体增生、体积变大,逐步压迫尿道,使局部的尿道变窄、阻力变大,尿液的排出也变得越来越不容易. 人正常排尿之前,尿液会暂时贮存在膀胱中.当膀胱逐渐充满尿液扩大时,会一直保持着正常的压力状态,而膀胱出口的地方,有着一套尿道括约肌,它就像一扇闸门一样一直关闭着,保持膀胱滴水不漏的状态.当膀胱内尿液充满到需要排泄时,膀胱肌肉会根据"指令"用力收缩开始排尿,大幅度提高膀胱内的压力,同时尿道括约肌这扇闸门充分打开,使膀胱内的尿液可以迅速通过尿道排出体外,完成一次正常的排尿过程.

良性前列腺增生是男性常见疾病,且患病率与病人年龄呈正相关.据统计,70 岁男性患病率已达到70 ％.前列腺增生的常见临床表现为尿频、尿急,严重者可出现膀胱梗阻、尿潴留、排尿困难等.目前,前列腺增生在药物治疗无效的情况下,多行以微创手术为主的外科治疗,如经尿道前列腺电切术、经尿道前列腺钬激光剜除术、经尿道前列腺等离子切除术[1].但这些手术对麻醉要求较高,有严重基础疾病的高龄老人或者不能耐受全身麻醉的病人无法接受手术,同时这些手术学习曲线较长,对医师的要求较高,故而并非适用于所有有外科治疗指征的前列腺增生病人.自Fabian[2]于1980年提出金属支架用于治疗前列腺增生后,其便成为治疗前列腺增生的众多手段之一.经过多年的临床应用,先后有多种金属支架上市并应用于治疗,本文通过对几种较为典型的支架治疗方法及效果的多中心研究进行分析、对比,对支架植入手术的相关问题进行探讨.

目的 探讨螺旋形热膨胀前列腺支架(Memokath)治疗高危良性前列腺增生病人的临床疗效.方法 回顾性分析南京医科大学附属老年医院2017～2018年间高危良性前列腺增生病人14例,年龄80～94岁,平均(82.0±4.5)岁.所有病人均行局麻下经尿道前列腺支架植入术.分别于术后1、3、6个月,行国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、残余尿量(RUV)检查并进行对比分析.结果 所有病人手术均获得成功,术后6个月IPSS评分为(10.54±2.14)分,Qmax为(10.24±3.52)mL/s,RUV为(17.23±8.43)mL.与术前比较,术后IPSS下降,Qmax水平升高,RUV减少,差异均具有统计学意义(P<0.05).术后出现尿路刺激征2例(14.2％),间断性肉眼血尿2例(14.2％),间断性尿路感染2例(14.2％).结论 采用Memokath支架是一种安全有效的治疗高危老年前列腺增生病人的方法,但其远期效果及其并发症还需进一步观察.

目的探讨一次性包皮套扎环行包皮环切术的优缺点。方法从手术时间、愈合时间、出血情况以及术后美观度这几个方面与传统包皮环切术比较。结果一次性套扎环在手术时间、出血情况和美观上均有明显优势,但在术后愈合时间上不及传统组。结论应用一次性套扎环治疗包皮过长具有操作简单、出血少、术后满意度高的优势,值得推广。

目的:探讨双导丝引导进镜法在硬性输尿管镜手术中作用.方法:回顾分析114例应用双导丝引导法行经输尿管镜碎石手术患者的临床资料,统计术中一次性进镜成功率及进镜相关并发症的发生率.结果:114例患者均一次进镜成功,成功率为100％.术中输尿管口挫伤2例,少量出血4例.术后随访12周,未见明显远期并发症.结论:双导丝引导进镜法是一种安全、有效的方法,其进镜相关并发症发生率极低,且无需特殊处理.

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.

Objective To investigate the association between functional polymorphism IVS8-poly (T) in cystic fibrosis transmembrane conductance regulator (CFTR) gene and prostate cancer risk.Methods A population-based case-control study was conducted including 230 prostate cancer patients and 230 agematched controls.PCR-STRP was used to analysis the IVS8-poly (T) tract in CFTR gene.Results The prevalences of the low expression allele,the IVS8-5T,in prostate cancer patients and controls were 1.52 ％ (7/460) and 5.22 ％ (24/460),respectively (x2 =12.489,P =0.002).Logistic regression analysis confirmed the 5T/7T genotype was in protective association with prostate cancer risk (OR =0.232,P =0.003,95 ％ CI0.090-0.599).Conclusion The low expression CFTR IVS8-5T allele contributes to a reduced risk of prostate cancer in Chinese Han population,and may be a protective factor against prostate cancer.

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.

OBJECTIVE:To understand long-term survival rate after combined androgen blockade (CAB) in patients with advanced prostate cancer.METHODS:A selected population of 59 patients with advanced prostate cancer were treated with CAB. 28.81% (17/59) of patients had clinical locally advanced disease (stage T3-4N0M0), and 45.76% (27/59) of patients had metastatic disease (stage TxNxM+). Overall, patients were followed for a median of 62 (range 6-136) months.RESULTS:Of the 59 patients with advanced prostate cancer, 3-year, 5-year and 7-year overall survival rates were 79.36%, 61.46% and 49.15%, respectively. The 5-year survival rate were 80.77% and 32.65% for clinical locally advanced disease and metastatic disease. Specifically, men with poorly differentiated prostate cancer had a 5-year survival of only 30% when compared with men with well-differentiated prostate disease who had a 5-year survival of 86.21%.CONCLUSION:Based on these findings, men with poorly differentiated cancer, stage T3c-4NxMx or TxNxM+ and PSA level above 30 microg/L had a high probability of dying from their advanced prostate cancer.

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.