良性前列腺增生(BPH)是中老年男性的常见疾病,雄激素和年龄是主要致病因素,代谢综合征亦与BPH的发生密切相关.对初次就诊的BPH患者,需进行初次评估,特别强调患者的主观感受.大多数早期患者通过药物治疗可以改善症状;外科干预治疗以腔内手术为主,需严格遵守手术指征以确保手术疗效.本文就BPH病因、评估、手术指征、药物治疗、微创治疗进展进行介绍.

目的:应用星点设计-效应面法筛选复方益肾利石颗粒的最佳成型工艺.方法:以成型率、吸湿性、流动性和溶化性为评价指标,采用手工湿法制粒,考察辅料用量、润湿剂用量及浓度等影响颗粒剂成型的关键因素水平.利用星点设计-效应面法,以成型率、水分、吸湿性、溶化性、休止角、卡尔系数的总评归一值为评价指标,对辅料比(麦芽糊精占总辅料量的百分比)、药辅比(辅料量占总制剂处方的百分比)和乙醇含量(润湿剂浓度)等成型参数进行考察.结果:根据综合评分结果,优选得到复方益肾利石颗粒的最佳成型工艺为:辅料比60％,药辅比30％,乙醇浓度24％.3批验证得综合评分平均值为78.96,理论预测值为74.37,偏差率为2.99％,结果与预测值相对标准偏差均小于5％.结论:优化的最佳成型工艺稳定、可行,且得率高,重复性好,为院内制剂复方益肾利石颗粒剂制备工艺的确定及生产条件的控制提供了依据.

Background: Generally, little is known about prognostic factors in bladder cancer patients under 40 years of age. We therefore performed a retrospective study to identify prognostic factors in these younger bladder cancer patients. Methods: We collected clinicopathological data on bladder cancer patients ≤40 years old diagnosed between 1975 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database. Survival curves were generated using the Kaplan–Meier method, and the differences between groups were analyzed using the log-rank test. Univariate and multivariate Cox hazards regression analyses were performed to define hazard ratios (HRs) for cancer-specific survival (CSS). Results: There were statistical differences in race, histological type, cancer stage, tumor size, and surgery treatment groups between overall survival and CSS. Only tumor size and cancer stage were significant independent prognostic risk factors in younger bladder cancer patients for the prediction of CSS. Conclusion: Tumors greater than 30 mm in size and a more advanced stage of bladder cancer were indicative of a poor prognosis in bladder cancer patients ≤40 years old, and long-term follow-up is suggested.

目的 运用正交试验法优选复方益肾利石颗粒的提取工艺.方法 采用单因素和L9(34)正交试验对复方益肾利石颗粒进行提取工艺优化,以紫外分光光度法及高效液相色谱法测定总黄酮含量、川续断皂苷Ⅵ含量、柚皮苷含量、新橙皮苷含量及得膏率的综合评分为评价指标,对溶媒加入量、提取时间和提取次数进行优选.结果 优化最佳提取工艺为加8倍量水,浸泡30 min,提取3次,每次1 h.结论 本研究建立的提取工艺稳定可行,质量可控,为复方益肾利石颗粒的进一步开发奠定了基础.

摘要：目的 建立复方益肾利石颗粒的质量标准。方法 采用TLC法对本品中续断、枳壳进行定性分析；采用紫外分光光度法对本品中总黄酮的含量进行测定；采用HPLC法对本品中柚皮苷、新橙皮苷进行含量测定。结果 续断、枳壳的 TLC图斑点清晰，专属性强，阴性对照无干扰；总黄酮、柚皮苷、新橙皮苷检测质量浓度线性范围为：0.099~0.495mg/mL、0.042~0.288mg/mL、0.010~0.165mg/mL（R2=0.9999或R2=0.9991）；精密度、稳定性、重复性、加样回收率试验RSD均在3.0%以内。结论 该方法简便、快速、准确、重复性好，可用于复方益肾利石颗粒的质量控制。

目的 对复方益肾利石颗粒水提工艺进行优化及颗粒剂制备工艺的筛选.方法 采用正交试验法,以总黄酮总含量、川续断皂苷Ⅵ含量、柚皮苷含量、新橙皮苷含量及得膏率为评价指标,优化处方的水提取工艺;采用星点设计-效应面法,以成型率、休止角、吸湿率、溶化性等为评价指标,对颗粒的成型工艺进行筛选.结果 最优水提取工艺为:加8倍量水,浸泡30 min,煎煮提取1 h,提取3次,过滤,干燥制得干浸膏粉.以乳糖和麦芽糊精为稀释剂,加入30％乙醇溶液作为黏合剂制软材,干燥,整粒.制得的复方益肾利石颗粒在粒度、性状、溶化性、水分等方面均符合药典要求.结论 本复方益肾利石方水提工艺及颗粒剂制备工艺稳定可行.

Background:Although the efficacy and safety of monotherapy in the treatment of benign prostatic hyperplasia (BPH) have been established clinically, the efficacy and safety of dutasteride and finasteride have not been compared. The aim was to systematically evaluate the efficacy and safety of the two drugs in the treatment of BPH to provide medical evidence for clinical treatment.Methods:A search of relevant articles was conducted using the electronic databases PubMed, Embase, Medline, Cochrane Library, China Academic Journals Full-text Database (CJFD), Chinese Science and Technology Journal Database (VIP) and Wanfang Database. Randomized controlled trials (RCTs) comparing the efficacy of finasteride (control group) with that of dutasteride (experimental group) in the treatment of BPH with respect to the International Prostate Symptom Score (IPSS), the maximum urinary flow rate (Qmax), prostate volume (PV), quality of life (QOL), serum prostate-specific antigen (PSA) level and adverse drug reactions (ADRs) after medication were strictly evaluated and considered for inclusion. Rev Man 5.4 software was used for the meta-analysis.Results:A total of 8 RCTs were included, with a total of 2,116, patients. The meta-analysis showed that compared with finasteride, dutasteride can effectively improve the Qmax of patients with BPH [mean difference (MD) =0.32; 95% confidence interval (CI): (0.01, 0.63); P=0.04]. There was no significant difference in reducing IPSS [MD =0.13; 95% CI: (-0.55, 0.82); P=0.70], improving PV [MD =-1.25; 95% CI: (-3.30, 0.79); P=0.23], reducing QOL [MD =-0.44; 95% CI: (-0.93, 0.05); P=0.08] and serum PSA level [MD =-0.04; 95% CI: (-0.15, 0.07); P=0.50], and the occurrence of ADRs [relative risk (RR) =-0.01; 95% CI: (-0.05, 0.04); P=0.72], there was no significant difference.Discussion:Dutasteride is better than finasteride in improving the Qmax of patients with BPH. There was no statistically significant difference in symptoms, PV, PSA, QOL, or adverse reactions. Dutasteride is an effective and safe treatment for BPH. Due to the limitations of the methodological quality and sample size of the included studies, this conclusion needs to be verified by stratified RCTS with high volumes and long follow-up times.

Objective:To explore the efficacy and safety of transurethral anatomical vapor incision technique of prostate (VIT) with six-step method high power side-emitting greenlight laser in the treatment of benign prostatic hyperplasia (BPH).Methods:A retrospective analysis of 82 patients with BPH who used high power side-out green laser in the treatment from October 2018 to June 2020 in Gongli Hospital of Naval Medical University was performed. Among them, 40 patients were treated with six-step method VIT, and 42 patients were treated with photoselective vaporization of prostate (PVP). The two groups of patients were compared in age [(71.1±8.7)years vs.(72.1±7.0)years], prostate volume [75 (68.25, 89.00) ml vs. 73 (63.25, 85.00) ml], and peak urinary flow rate (Q max) [6.20 (5.20, 8.20) ) ml/s vs. 5.9 (4.75, 7.50) ml/s], post-void residual volume (PVR) [74.00 (42.50, 103.75) ml vs. 67.00 (58.00, 84.50) ml], international prostate symptom score (IPSS) [(21.2±5.2) vs. ( 21.0±3.9)], quality of life score (QOL) [5 (4, 6) vs. 5 (4, 6) ], prostate specific antigen (PSA) [6.20 (4.12, 8.43) ng/ml vs. 5.40 (3.88, 7.13) ng/ml ]. In general, there was no statistical difference ( P>0.05). The VIT group adopts the six-step method of marking, removing film, grooving, excision, trimming and crushing. In the PVP group, the prostate tissue was uniformly vaporized layer by layer from the inside to the outside. Perioperative indexes and complications were compared between the two groups. The Q max, IPSS, QOL, PVR and PSA between the two groups before and 3 months after surgery were compared. Results:All patients in the VIT group and PVP group successfully completed the surgery, and there was no case of transfer to TURP or open surgery. The average operation time was [60.00(50.00, 73.75)min vs. 70.00(50.00, 73.75)min] ( P<0.05). There was no significant difference in the amount of postoperative hemoglobin decline[15.00(10.00, 17.75)g/L vs. 16.00(14.00, 19.25)g/L], average bladder irrigation time[1(1, 1)d vs. 1(1, 1)d], indwelling catheterization time[3(3, 3)]d vs. 3(3, 3)d] and hospitalization time in patients after operation[4(3, 4)d vs. 4(4, 4)d] ( P>0.05). All patients had no blood transfusion, second bleeding, readmission, TURS, urethral stricture and urinary incontinence.There were 2 cases (5.0%) of postoperative urinary tract infection in the VIT group and 9 cases (21.4%) of postoperative urinary tract infection in the PVP group ( P<0.05), and they were cured after anti-inflammatory treatment. Three months after operation, Q max, IPSS, QOL, PVR and PSA in the two groups were significantly improved compared with preoperatively. Among them, the differences of IPSS [(5.7±2.5) points vs. (7.5±2.8) points] and PSA [2.65(2.10, 3.90)ng/ml vs. 4.00(2.45, 4.45)ng/ml] in the VIT group and PVP group after operation were statistically significant ( P<0.05). Conclusions:Applying the six-step method high power side-emitting greenlight laser transurethral anatomical VIT to treat BPH, there is less intraoperative and postoperative bleeding, short operation time, significant decrease in PSA, and fewer complications. It is a safe and effective minimally invasive technology for the treatment of BPH.

目的 探讨智能互动定性定量分析(IQQA)技术应用于中度复杂性肾肿瘤腹腔镜肾部分切除术的可行性、安全性和有效性.方法 选择2018年1月—2019年6月收治的16例中度复杂性肾肿瘤(R.E.N.A.L评分＞6?9分)患者,男10例、女6例,年龄为(55.8±8.3)岁,肾肿瘤R.E.N.A.L评分为(7.6±0.7)分.所有患者均于IQQA技术支持下行腹腔镜肾部分切除术.获取肾脏CTA检查的原始影像学数据,利用IQQA平台进行三维重建,通过操作平台多角度旋转、多层面系统化分析肾肿瘤与血管、集合系统的毗邻关系,进行手术规划和模拟,制订出个性化、精准的腹腔镜下肾部分切除术的方案.记录患者的手术时间、肾动脉阻断时间、术中出血量、术后引流管留置时间、术后并发症发生情况、术后住院天数,以及手术前和术后3个月血清肌酐水平、患肾肾小球滤过率(GFR).术后3个月随访时复查胸部CT、肾脏CT,观察肿瘤有无复发和转移.结果 16例患者均顺利完成手术,无1例患者中转开放性手术或改行根治性肾切除术.手术时间为(74.7±12.7)min,肾动脉阻断时间为(21.8±4.4)min,术中出血量为(63.8±38.9)mL;术后引流管留置时间为(6.3±1.6)d,术后住院时间为(6.9±1.7)d.术后患者均无出血、漏尿、感染、切口裂开、肺部感染等并发症发生.术后3个月血清肌酐水平为(80.6±11.4)μmol/L,与术前的(82.8±9.5)μmol/L的差异无统计学意义(P＞0.05).术后3个月患肾GFR为(49.6±7.9)mL/min,显著低于术前的(56.0±6.9)mL/min(P＜0.05).术后3个月患者胸部CT、肾脏CT检查均未见肿瘤复发和转移.结论 在IQQA技术辅助下对中度复杂性肾肿瘤行腹腔镜肾部分切除术更加精准,有利于提高中度复杂性肾肿瘤行腹腔镜肾部分切除术的成功率,患者肾功能得以较好的保护,该方法在技术上安全、可行.

Objective:To analyze the clinical efficacy and safety of transurethral MoLEP for massive prostatic hyperplasia (BPH) ≥80 ml.Methods:A total of 37 patients with BPH who were admitted to Gongli Hospital of Naval Military Medical University from April 2019 to October 2019 were reviewed. Among them, 19 patients were treated with moses laser enucleation of the prostate (MoLEP) and 18 patients were treated with holmium laser enucleation of the prostate (HoLEP). Statistics and comparison of the efficacy and the incidence of complications between the two groups of patients to determine the efficacy of MoLEP on large-volume BPH.Results:There were significant differences between the two groups in terms of postoperative bladder flushing time (0.87±0.23) vs (1.17±0.38) d, length of hospital stay (3.53±0.84) vs (4.22±1.22) d, and hemoglobin reduction (18.89±7.70) vs (17.67±6.73)g/L (P<0.05); In terms of IPSS , QOL, RUV and Qmax, at 3 months after operation, both groups were improved before surgery, there was no significant difference between the two groups (P>0.05). There were also no significant differences in complications such as postoperative urinary tract infection, dysuria, and urinary incontinence (P>0.05); there were no transurethral resection syndrome and blood transfusion in both groups.Conclusions:MoLEP and HoLEP have similar effects, but in MoLEP group, the postoperative bladder irrigation time, indwelling catheterization time, and hospitalization time are significantly shortened, and the intraoperative blood loss is less, which has obvious advantages.

在高清数字输尿管软镜(flexible Ureteroscopy,FURS),一次性电子输尿管软镜,机器人辅助输尿管软镜,超细经皮肾镜(ultra mini percutaneous nephrolithotomy,UMP) 和超微经皮肾镜(super mini percutaneous nephrolithotomy, SMP)等泌尿外科腔镜设备及技术高速发展的今天,尿路结石的外科治疗趋势已逐渐向腔内发展 [1].在西欧国家,作为体外冲击波碎石术(extracorporeal shock wave lithotripsy, ESWL)的发源地,其应用也在逐渐减弱,而FURS则在不断发展 [2].近十余年来美国的数据表明,随着输尿管结石患者的增多,用腔镜治疗的数量和占比都明显增加,而ESWL的绝对数量虽有所增加,但占比却呈逐渐下降趋势 [3]. Cone通过决策分析模型计算出当ESWL 的结石清除率(stone free rate,SFR)(57％～76％)时, URL是最符合成本效益的治疗选择 [4].不过Scotland等 [5]回顾性研究后发现即使是用ESWL治疗输尿管下段结石,其单次治疗SFR为78.8％,两次治疗后可达87.5％,故认为ESWL仍是治疗输尿管下段结石的有效方法.目前体外碎石应用研究的主要方向除了改进碎石技巧外,重点放在了优化病例选择上.

目的:探讨腹腔镜保留肾单位手术中应用"2+1"缝合技术联合早期序贯开放血流法治疗T1b期单发肾肿瘤的安全性及疗效.方法:回顾分析2017年1月至2018年7月为22例T1b期单发肾肿瘤患者采用"2+1"缝合技术联合早期序贯开放血流法行腹腔镜保留肾单位手术的临床资料,肿瘤直径平均(5.4±0.8)cm,R.E.N.A.L评分平均(7.5±0.8)分.结果:患者均顺利完成手术,无一例中转开放手术.手术时间平均(136.5±31.2)min,术中出血量平均(135.0±40.6)mL,热缺血时间平均(15.0±2.3)min,术中、术后无一例输血,切缘均为阴性,术后均无漏尿、切口感染、患侧肾脏萎缩等并发症发生.结论:腹腔镜保留肾单位手术中应用"2+1"缝合技术联合早期序贯开放血流法治疗T1b期单发肾肿瘤,术中出血可控,热缺血时间可得到较好控制,手术安全、可靠.

Objective:To explore the safety and efficacy of laparoscopic non-blocking partial nephrectomy assisted by high power lateral green laser in the treatment of T 1a renal tumor. Methods:The clinical data of 10 patients with T1a stage renal tumor from February 2021 to April 2021 in department of urology, Gongli hospital affiliated to Naval Military Medical University were retrospectively analyzed. There were 7 males and 3 females, aged 47.0-74.0 years, with average of(58.8±9.7)years old. The diameter of the tumor ranged from 2.0 cm to 3.8 cm, with an average of (3.1±0.6)cm. There were 6 cases on the left side and 4 cases on the right side, locate on lumbar side in 9 cases and ventral sied in 1 case. The R. E.N.A.L score was 4.0-6.0, with an average of (5.0±0.8). The preoperative creatinine was 66.9-90.1μmol/L, with an average of (75.1±9.0)μmol/L, preoperative GFR of 44. 6- 67. 3 ml /min, with an average of(56.7±7.7)ml/min, preoperative hemoglobin level of 119.0-156.0g/L, with an average of (135.8±11.4)g/L. All patients underwent laparoscopic non-blocking partial nephrectomy assisted by 180w lateral green laser, free the surrounding area of the tumor fully and completely expose the renal tumor. The laser fiber was placed through the green laser hand piece, and the fiber was connected with normal saline to wash the strip. The initial green laser vaporization power was set at 80W, and the hemostasis power at 35W.About 3mm away from the edge of the tumor, and one optical fiber away from the renal parenchyma, the renal parenchyma was cut with 80W power. In order to reduce the interference by smoke, high-pressure flushing was used through the optical fiber while vaporizing, and an attractor was used to push and peel the tumor. In case of bleeding during operation, hemostatic power can be used to close the bleeding point and gradually advance until the tumor was completely removed. The wounds of renal inner medulla and renal outer cortex were continuously sutured in 1-3 layers with barbed suture. It involved 9 cases via retroperitoneal approach and 1 case via abdominal approach. The operation time, postoperative hemoglobin decrease, extraction time of negative pressure drainage, postoperative hospital stay, postoperative pathology and postoperative complications were recorded, and the serum creatinine level and GFR level of the affected side were followed up 1 month after operation.Results:All the operations were successfully completed, and there was no conversion to open surgery or radical nephrectomy. One case changed to scissors fast resection and sutured hemostasis due to severe intraoperative bleeding. The operation time was 90.0-120.0 min, with the average of (104.5±9.0)min. The postoperative hemoglobin level was 96.0-132.0g/L, with an average of (115.2±11.8)g/L, and the difference was statistically significant ( P<0.05). The postoperative hemoglobin decreased from 12.0g/L to 25.0g/L, with an average of (20.6±4.6)g/L. The time of vacuum drainage was 5.0-7.0 days, with an average of (5.7±0.7)d. Postoperative hospital stay was 6.0-8.0 days, with an average of (6.7±0.7)d. No bleeding, urinary leakage and other complications occurred in all patients. There were 7 cases of clear cell carcinoma, 2 cases of papillary renal cell carcinoma and 1 case of angiomyolipoma. All margins were negative. One month after operation, creatinine ranged from 66.0 to 90.4μmol/L, with an average of (76.8±8.3)μmol/L, which was not significantly different compared with that before operation ( P>0.05). One month after operation, GFR was 45.1-60.8 ml/min, and with an average of (55.5±4.7)ml/min, and there was no significant difference compared with preoperative data( P>0.05). Conclusions:For T 1aN 0M 0 stage and exophytic renal tumors, laparoscopic non-blocking partial nephrectomy assisted by lateral green laser is safe and effective.

目的 探讨葡萄糖易化转运蛋白9(SLC2A 9)基因rs938552位点多态性与肾结石的关系.方法 选择华东地区高尿酸血症合并肾结石患者(病例组)及健康对照组各300例,用聚合酶链式反应(PCR)扩增SLC2A 9基因SNP位点rs938552序列,Sanger法测序扩增产物;同时检测病例组血清、尿液的生化代谢指标;采用红外光谱分析法检测病例组结石成分.分析病例组与对照组中基因型分布差异;分析病例组中不同基因型携带者的血、尿电解质、尿酸等代谢水平的差异;分析病例组中结石成分的差异.结果 SLC2A 9基因rs938552位点基因型与等位基因频率在病例组和健康对照组差异均有统计学意义(P均<0.001),携带杂合型(CT)和突变型(TT)的人群患肾结石的风险是携带野生型(CC)人群的2.933倍(OR=2.933,95％CI:1.632～5.264,P<0.001);病例组中CC基因型者血液尿酸、尿液尿酸和尿钙均低于CT+TT基因型者,前者尿pH值高于后者(P均<0.05),其他代谢指标差异均无统计学意义(P均>0.05);病例组中携带CC基因型者与携带CT+TT基因型者比较,后者结石成分草酸钙和尿酸的比例高于前者(P均<0.05).结论 SLC2A 9基因rs938552位点多态性与华东地区汉族人群患肾结石的风险有关联.

Objective:To investigate the feasibility, safety and effectiveness of laparoscopic partial nephrectomy for cystic tumor of the renal hilus.Methods:The data of 6 patients with cystic tumor of renal hilus treated by laparoscopic partial nephrectomy in the three centers from January 2017 to December 2019 were analyzed retrospectively. There were 5 males and 1 females, with a median age of 45(10) years and body mass index of 23.3(1.5) kg/m2, maximum tumor diameter 3.7(0.4) cm, the R.E.N.A.L score 8.5(1.0), the tumor stage was T1. The preoperative creatinine level was 68(12) μmol/L. The glomerular filtration rate (GFR) was 47.3(5.5) ml/min. The hemoglobin level was 138(17) g/L. The success rate, opening rate, operation time, artery blocking time, intraoperative bleeding volume, postoperative drainage tube retention days, postoperative complications, postoperative hospital stay days, renal function and tumor prognosis indexes of 6 patients were collected for statistical analysis.Results:Laparoscopic partial nephrectomy was successfully completed in all patients, and there was no conversion to open surgery or radical nephrectomy. The median operation time was 112(20) min, the renal artery occlusion time was 34(7) min, the intraoperative hemorrhage was 33(22) ml, and the postoperative hospital stay was 6.5(1.0) d. There were no postoperative complications such as bleeding and urinary leakage. Postoperative pathology showed 5 cases of renal malignant tumor and 1 case of renal cyst. The surgical margin was negative. The median creatinine was 81(12) μmol/L in 3 months after operation, which had no significant difference compared with that before operation (P>0.05). The GFR of kidney in 3 months after operation was 37.0(4.4) ml/min, which had significant difference compared with that before operation (P<0.05). The hemoglobin level was 127(15) g/L after operation, and the difference was statistically significant compared with that before operation. After 3 months follow-up, no tumor recurrence or metastasis was found in CT.Conclusion:Laparoscopic partial nephrectomy is a feasible method for the patients with cystic renal carcinoma in the hilum of kidney, which is beneficial for the better protection of renal function and the exact perioperative effect.

目的 分析评估经尿道摩西技术钬激光前列腺剜除术(MoLEP)治疗长期维持抗凝治疗的良性前列腺增生(BPH)患者的有效性及安全性.方法 回顾性分析2019年4-9月海军军医大学公利医院行MoLEP术治疗41例BPH患者的临床资料,将长期抗凝治疗的15例BPH患者设为抗凝组,未服用抗凝剂26例患者设为未抗凝组.记录两组患者基本情况,比较两组术后血红蛋白下降量、手术时间、剜除时间、术后膀胱冲洗、留置导尿及住院时间;评估术中术后输血、二次出血、再住院、电切综合征、排尿困难、尿失禁等并发症情况;比较两组术前和术后3个月患者最大尿流率(Qmax)、国际前列腺症状评分(IPSS)、生活质量评分(QoL)、残余尿(PVR)变化情况,判断MoLEP对长期口服抗凝剂BPH患者的安全与疗效.结果 所有患者均顺利完成手术,无中转开放或经尿道前列腺电切术.抗凝组与未抗凝组患者术后血红蛋白下降量[(18.47±8.46)v s.(14.19±7.74)g/L]、手术时间[(62.00±20.16)vs.(58.88±16.56)min]、剜除时间[(43.67±16.50)vs.(40.50±14.40)min]、术后膀胱冲洗时间[(1.13±0.35)vs.(1.08±0.27)d]、术后留置导尿时间[(3.07±0.70)vs.(2.92±0.74)d]、术后住院时间[(4.07±0.70)vs.(3.92±0.74)d]差异均无统计学意义(P>0.05).两组术中、术后无输血、电切综合征发生,术后3月无二次出血、再入院、排尿困难、尿失禁患者.抗凝组与未抗凝组术后3个月Qmax[(18.81±5.67)vs.(17.39±3.78)mL/s]、IPSS评分[(5.8±2.8)vs.(6.5±2.8)]、QoL评分[(1.3±0.8)vs.(1.2±0.7)]、PVR[(12.53±20.69)vs.(10.50±12.15)mL]差异均无显著性(P均<0.05);但组内比较,术后3个月均优于术前,差异存在统计学意义(P<0.05).结论 MoLEP术中出血少,疗效确切,是值得推广的治疗口服抗凝剂患者安全有效的手术方式.

目的:探讨葡萄糖易化转运蛋白9(SLC2 A9)基因SNP位点多态性与机体生化代谢及肾结石的相关性和可能机制.方法:选择2015年1月～2017年12月在我院就诊的华东地区汉族人群肾结石患者300例(结石组)和健康志愿者300例(健康对照组),用聚合酶链式反应(PCR)扩增SLC2A9基因3个SNP位点(rs938552、rs1014290和rs4311316)序列,Sanger法测序扩增产物;同时检测结石组血清、尿液中钙、磷、尿酸等生化代谢指标.分析结石组与健康对照组中基因型分布差异以及结石组中不同基因携带者的血、尿电解质、尿酸等代谢水平的差异.结果:SLC2 A9基因SNP位点rs938552存在多态性,其基因型分布在结石组和健康对照组之间比较差异有统计学意义(OR =0.341,95％ CI:0.206～0.563,P＜0.01),携带有杂合型(C/T)和突变型(T/T)的人群患肾结石的风险是携带野生型(C/C)人群的2.933倍;结石组中C/C基因型者血尿酸、尿尿酸、尿钙均低于C/T+T/T基因型者,C/C基因型者尿pH值高于C/T+T/T基因型者,差异均有统计学意义(P＜0.05),其他代谢指标无统计学意义;C/C基因型与C/T+T/T基因型比较,后者结石的主要成分草酸钙和尿酸的比例明显高于前者(P＜0.05).位点rs1014290和rs4311316在结石组和健康对照组基因型分布比较差异无统计学意义(OR=0.608,95％CI:0.364～1.014,P＞0.05;OR=0.641,95％CI:0.407～1.008,P＞0.05),其C/C基因型与C/T+T/T基因型比较,血尿生化及结石主要成分无统计学意义(P＞0.05).结论:SLC2 A9基因rs938552位点多态性与华东地区汉族人群患肾结石的风险有关联,SLC2A9基因rs938552位点可能通过调节尿酸和钙的代谢来影响结石的形成.

目的 探讨泌尿系结石患者的结石成分及其与肾功能损伤的关系.方法 收集该医院诊断和治疗的泌尿系结石患者641例,经手术、体外冲击波碎石、自行排出等方法获得结石,运用红外光谱分析法进行结石成分测定,并对患者进行发射单光子计算机断层扫描仪(ECT)肾功能检测.结果 641例泌尿系结石患者中,男、女性别比为2.02:1.发病年龄18～86岁,45～54岁年龄段构成比占35.1％.在641例结石样本中,以草酸钙为主的结石占80.03％,磷酸钙为主的结石占16.07％,尿酸为主的结石占2.03％,六水磷酸镁铵为主的结石占1.87％.ECT肾功能检测结果可见,肾小球滤过率(glomerular filtration rate,GFR)正常者42例(占6.55％),轻中度降低者453例(占70.67％),有146例患者明显降低(占22.78％),尿酸为主要结石成分的患者GFR值均低于其他三种成分者(P均<0.05).结论 上海浦东地区泌尿系结石患者结石成分以草酸钙为主,以尿酸为主的结石对患者肾功能损伤较重.

目的 探讨银杏叶提取物(EGb)对体外冲击波碎石术(ESWL)所致的早期肾损伤是否有保护作用.方法 80例行ESWL术的单侧肾结石病人按随机数字表法分成观察组和对照组,每组40例,观察组于ESWL术前0.5 h开始,给予银杏叶提取物20 mL加入生理盐水250 mL静脉滴注,每12小时1次,给药5 d;对照组同时间节点给予生理盐水250 mL静脉滴注.两组分别收集ESWL术前2 h、ESWL术后2 h、6 h、12 h、24 h、1周尿液标本10 mL,测定尿液中的中性粒细胞明胶酶相关载脂蛋白(uNGAL)和尿胱抑素C(uCys-C)水平.结果 uNGAL在两组中于ESWL术后2 h开始升高,12 h达到高峰,1周时恢复到术前水平.观察组uNGAL于ESWL术后12h为(17.56±3.94)ng/mL,低于对照组(22.68±4.82)ng/mL,其差异有统计学意义(t=3.56,P=0.025).uCys-C在两组中于ESWL术后6 h开始升高,12 h达到高峰,24 h有所下降,1周时仍高于术前水平.观察组uCys-C于ESWL术后12 h达(35.61±6.24)ng/mL,低于对照组(41.28±5.57)ng/mL,其差异有统计学意义(t=4.47,P=0.017).结论 EGb能有效防护ESWL所致的早期肾小球和肾小管的损伤,其机制尚需进一步研究.