目的:探索长期服用黄体生成素释放激素类似物(LHRH-a)对肾结石形成的风险,以及与骨质疏松、代谢综合征副反应之间的相关性.方法:采用前瞻性研究,共纳入40例前列腺癌患者,自纳入日均开始接受LHRH-a持续治疗方案;随访1年后,采集相关临床进行统计学指标分析.结果:在治疗1年后,患者PSA和睾酮水平明显下降(P<0.0001),股骨颈、全髋关节、腰椎部分骨密度T得分及Z得分均明显下降(P<0.001).患者血清指标中碱性磷酸酶、甘油三酯、钙、磷、骨钙素、beta-crosslaps、维生素D均升高(P<0.001);iPTH、雌二醇、PSA和睾酮指标均下降(P<0.001).患者空腹尿及24 h尿中钙/肌酐指标均高于治疗前(P<0.05、<0.001).24 h尿分析中钙排泄指数、钙排泄分数、肾小管再吸收磷酸盐、柠檬酸盐水平均高于治疗前(P<0.05).随访结束时检出随访期间形成肾结石患者共12例(30％).形成结石组患者腰椎骨密度T评分低于未形成结石组,beta-crosslaps水平高于未形成结石组,空腹尿钙/肌酐水平高于未形成结石组,差异均有统计学意义(P<0.05).进一步,对腰椎骨密度评分、beta-crosslaps水平和空腹尿钙/肌酐水平3个因素进行多因素非条件Logistic回归分析,结果提示只有beta-crosslaps水平与结石出现呈现相关性(P=0.012).结论:LHRH类似物在治疗前列腺癌的同时对机体骨代谢存在显著影响,将造成肾结石形成;而监测血清beta-crosslaps水平变化将有助于对肾结石的早期发现和干预.

目的:评价同期双侧输尿管软镜碎石术(SB-FURL)治疗双侧≤1.5 cm肾结石的有效性及安全性.方法:回顾性分析71例双侧≤1.5 cm肾结石的患者的临床资料,均采用SB-FURL治疗,结石最大径(11.8±2.3) mm.评估手术时间、结石清除率(SFR)、术后并发症发生率和重复治疗率.结果:71例患者平均手术时间为(55.3±25.7) min,住院天数为(2.4±2.1)d.一次SB-FURL术后SFR为73.2％(52/71),5例(7％)接受了≥2次的治疗.71例共行逆行软性输尿管镜下钬激光碎石术77次,平均1.08次/人.术后3个月总SFR为88.7％(63/71),总并发症发生率为12.6％(9/71),其中输尿管假道形成1例,输尿管穿孔并肾周血肿1例,术后发热6例(8.4％).结论:SB-FURL治疗双侧≤1.5cm肾结石是安全有效的,值得临床推广和应用.

目的 分析戈舍瑞林联合比卡鲁胺治疗前列腺癌的效果及不良反应.方法 40例前列腺癌患者,根据计算机随机分组法将其分为对照组及试验组,各20例.对照组采用比卡鲁胺治疗,试验组采用戈舍瑞林联合比卡鲁胺治疗.比较两组治疗效果及不良反应发生情况.结果 试验组总有效率为95％,对照组总有效率为65％,试验组总有效率高于对照组,差异具有统计学意义(P<0.05).试验组不良反应发生率为30％,对照组不良反应发生率为35％,试验组不良反应发生率低于对照组,但差异无统计学意义(P>0.05).结论 戈舍瑞林联合比卡鲁胺治疗前列腺癌效果显著,且不增加不良反应,值得临床推广应用.

Objective To investigate the expression of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphalase-3 (PFKFB3) gene in the prostate cancer tissues and its impact on the proliferation of prostate cancer cells PC3 and DU145.Methods Immunohistochemical staining was used to detect the expression of PFKFB3 in the prostate cancer tissues and the adjacent tissues (antibody concentration 1∶50).Real-time fluorescent quantitative polymerase chain reaction (FQ-PCR,40 cycles,188 bp) and Western blotting [30 μl,10％ sodium dodecyl sulfate polyacrylamide gel electropheresis (SDS-PAGE)] were applied to detect the mRNA and protein expression levels of PFKFB3 expression in the prostate cancer cells and prostate epithelial cells.After knocking out PFKFB3 gene,plate cloning (40 μmol/L H2O2) formation assay and cell growth assay [20 μl methyl thiazol tetrazolium (MTT)] were applied to measure the cell proliferation.Results The expression of PFKFB3 in the prostate cancer tissues (2.42 ±0.16) was significantly higher than that in the adjacent tissues (1.38 ±0.10,P =0.031).The mRNA and protein expression levels of PFKFB3 in prostate cancer cells were significantly higher than those in the prostate epithelial cells (P =O.015),2.0-2.6 times and 2.5-4.5 times respectively.When knocking out the PFKFB3 gene,cloning formation assay showed that the cloning formation rate decreased as 22％-35％ compared to the control (P =0.018).Cell grouth assay showed that the proliferation of prostate cancer cells was inhibited as 28％-30％ at day 4 (P =0.026).Conclusion PFKFB3 gene is highly expressed in prostate cancer cells and prostate cancer tissues.PFKFB3 plays a promotional role in the prostate cancer cells.

Objective: To explore the curative effect of the two approaches for cases with renal cyst through peritoneal and retroperitoneal surgery under a laparoscope.Methods: Fifty-seven patients were diagnosed as renal cyst,19 of which were operated on through peritoneal approach,and 38 through retroperitoneal approach.Results: All the operations were successfully performed.The operation took 45～160 min in peritoneal approach group(mean: 90min) with bleeding 10～25 mL(mean:16 mL) and 40～90 min in retroperitoneal approach group(mean: 55min) with bleeding 15～35 mL(mean:22 mL).No intraoperative and postoperative complications occurred in the hospital.Conclusion: Laparoscopic renal cyst unroofing is a safe and effective procedure.It is much better that the approach will be adopted according to the situation of patients and the practical standard of operators.

2006-209年我们采用尿道外口切开治疗男性尿道外口狭窄患者120例,效果良好.现报道如下. 对象与方法 本组120例.

Objective To discuss the methods of diagnosis and treatment of malignant melanoma of penis.Methods The clinicopathological characteristics,procedures of diagnosis and treatment,and prognosis of 4 cases of malignant melanoma of penis were retrospectively analysed.Results All the 4 cases were confirmed as malignant melanoma of penis by pathological examinations.One case was classified as stageⅠ (T1N0M0) and the other three cases stage Ⅲ (T3N2M0,T3N2M0 and T4N3M0,respectively).Partial penectomy was performed in three cases and radical penectomy in the other one,and all were conducted bilateral inguinal lymphadenectomy.Patients were followed up for 6 to 60 months,and two died.Conclusion Preexisting nevi may be risk factors for development of malignant melanoma of penis,and early diagnosis and proper surgical therapy are of paramount importance in improving the prognosis.

目的:探讨膀胱鳞状细胞癌的发病、诊断、治疗及预后.方法:回顾性分析8例膀胱鳞状细胞癌患者的临床资料,结合国内外文献进行分析讨论.结果:8例患者年龄44～74岁.行膀胱全切术3例,膀胱部分切除5例.7例患者随访1～10年,2年和5年生存率分别为43%(3/7)和14%(1/7).结论:膀胱鳞状细胞癌是一种高度恶性肿瘤,预后差,早期诊断和治疗对患者来说非常重要.膀胱根治性切除仍是目前较好的治疗办法.

Objective To investigate the causes,treatments,and prevention of dysuria after transurethral resection of prostate (TURP). Methods The clinical data of 49 cases of dysuria post-TURP that were treated in our hospital from July 2004 to September 2008 were analyzed retrospectively. Results Among the cases,6 patients received silica catheterization again because of edema of the bladder neck and urethra; 9 underwent catheterization after bladder flush for delayed prostate bleeding; 20 underwent urethral dilatation or meatotomy due to meatal stenosis,5 received urethral dilatation for urethral stricture; urethral dilatation or direct vision internal urethrotomy were performed on 4 cases who had bladder neck fracture; TURP was carried out for a second time in 4 cases because of glandular residual; suprapubic cystostomy was made in 1 case of colonal carcinoma for long-term bed rest. All cases were cured after the treatment. Conclusions Meatal stenosis is the most common cause of dysuria post-TURP.Urethral dilatation is the first choice for the disease.

男性尿道外口狭窄是泌尿外科的常见病,大多需行尿道外口切开手术治疗.2006年以来,我院治疗尿道外口狭窄患者120例,术中应用直钳钳夹狭窄尿道止血,收效良好,介绍如下.

Objective: To observe the therapeutic efficacy of naloxone for acute alcohlism.Methods: 116 patients with acute alcoholism were randomly divided into two groups naloxone group(68 patients) and control group(48 patients).Results: The former group was superior to the latter group.The drug showed its effectiveness more quickly in the former than in the latter and the cure time was also seen earlier in the former.Conclusion: Naloxone has a significant effectiveness for acute alcoholism.