Objective:To develop an improved wireless intelligent capsule cystoscope (WCE)for dynamic detection of bladder mucosa in a pig model.Methods:The WCE was introduced into a healthy experimental pig that under general anesthesia via urethra by applying an improved device. Multi-angle images of the bladder mucosa were then obtained by controlling the position of capsule cystoscope with an external magnetic field system. The shutter speed of the WCE was 2.5 fps and was automatically converted to 1.5 fps 30 minutes after initiation. The Vue software was utilized to download the shoot pictures which were former received by a computer via wireless transmission. The pig was roused and sent to the pigpen, without limitations in moving. The improved WCE was connected with a 2 cm thread. 12 hours later, the dilated sheath was inserted again, and the capsule was removed by a foreign body forceps under observation of a ureteroscopy.Results:The WCE was successfully placed and removed from the pig's bladder with the application of the improved devices. Over 20 thousand images that with 60K pixels of bladder mucosa were captured by the WCE at various angles within 12 hours, which revealed the process of urine filling and excreting in a time-dependent way. No notable adverse effects (bleeding, urinary tract injury, etc) were noted during the process of cystoscope placement, image acquisition, transmission, and removal.Conclusion:This study developed a novel WCE that could dynamically, intelligently and accurately monitor all aspects of the pig bladder mucosa, and has preferable application prospect.

目的 设计一种简易离体猪胃模型,通过举办8期胃内镜黏膜下剥离术(ESD)培训班来评估其应用效果.方法 前瞻性研究2018年12月-2020年10月重庆医科大学附属第一医院消化内科设计的一种简易离体猪胃模型,探讨其在ESD学员培训中的应用效果.共举办8期猪胃ESD手把手教学培训班,选用12个猪胃,共培训学员72例,其中公立医院46例、私立医院26例.将当天新鲜购买未经冷冻的重量在0.6～0.9 kg的猪胃洗净后,用民用缝衣针线或医用外科缝合针线将猪胃缝合完整,仅保留食管入口,再将猪胃固定于厚度为2 cm的珍珠棉泡沫板上(长60 cm,宽40 cm),每个猪胃需要固定5个点,猪胃与泡沫板之间预先放置手术电刀所需的电极板,胃镜通过食管入口后,用外科止血钳夹闭食管入口处,防止漏气.将上述装置平放于手术平台上,尽量防止移动.ESD手术流程参照传统ESD操作流程进行,通过评估手术操作时间、完整切除率、完成率、成功率和后期能否独立开展ESD工作等来判断该模型的应用效果.结果 所有学员在培训当天使用该模型独立完成1例ESD操作,多采用口袋法完成ESD,完成时间为30～50 min,平均(38.6±5.3)min,完整切除率为95％,完成率为98％,成功率为98％,整个过程中医生和助手均不需要对模型进行按压或校正,胃腔始终能保持扩张状态.部分学员熟练操作后,甚至可以在没有助手辅助的情况下独立完成整个ESD.通过培训,学员返回自己医院后,可以独立制作该模型进行反复的ESD练习,有3名医生通过培训后,能独立进行临床ESD工作.结论 简易离体猪胃模型设计简单,所需材料容易获得,缝合方式可靠,基本不会漏气,视野清晰,手术操作流畅,可以良好地模拟ESD操作,值得临床推广应用.

目的 评估显微镜下精索静脉结扎术对患者性功能的影响.方法 回顾性分析2017年3月至2018年8月于该院采用显微镜下精索静脉结扎术治疗的精索静脉曲张患者35例作为研究对象.统计分析患者术前与术后3个月血清总睾酮、国际勃起功能指数-5(IIEF-5)量表和中国早泄患者性功能评价表(CIPE)评分的情况.结果 35例患者均符合纳入标准并完成术后随访.其中血清总睾酮术后3个月[(368.08±53.40)ng/dL]较术前[(327.80±49.97)ng/dL]升高,差异有统计学意义(P<0.05),术后3个月IIEF-5评分[(19.09±1.65)分]较术前[(16.89±1.89)分]改善,差异有统计学意义(P<0.05).术后3个月CIPE评分[(31.43±6.27)分]较术前[(30.91±5.35)分]稍提高,但差异无统计学意义(P=0.401).结论 显微镜下精索静脉结扎术可以提高患者血清总睾酮,也可明显改善患者的勃起功能,但对早泄的改善不明显.

目的 探讨同期腔内手术治疗输尿管中下段结石合并前列腺增生的有效性及安全性.方法 回顾性分析重庆医科大学附属第二医院泌尿外科2016年1月至2018年7月收治的68例输尿管中下段结石合并前列腺增生患者的临床资料,其中同期手术组32例,分期手术组36例.比较两组患者的碎石成功率、手术时间、住院时间、并发症发生率及术后3个月的前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)、残余尿量(PVR)等指标的差异.结果 同期组与分期组患者在手术时间[(118.03±14.56)min vs(122.36±11.23)min]、碎石成功率(90.6％vs 94.4％)、并发症发生率(18.8％vs 11.1％)方面比较,差异均无统计学意义(P>0.05);但同期组患者的总住院时间为(9.85±1.18)min,明显短于分期组的(14.05±1.03)min,且差异有统计学意义(P<0.05);同期组与分期组患者术后3个月的IPSS[(5.22±1.84)分vs(5.56±2.16)分]、QOL[(1.34±0.83)分vs(1.53±0.91)分]、Qmax[(18.72±2.04)mL vs(19.28±2.65)mL]及PVR[(22.63±13.15)mL vs(28.58±17.30)mL]比较,差异均无统计学意义(P>0.05).结论 同期腔内手术治疗输尿管中下段结石合并前列腺增生是安全、有效的,但术前应充分评估患者的病情,严格把握手术适应证.

目的 对U F-500i尿有形成分分析仪(UF-500i)、迪瑞H-500尿干化学分析仪(H-500)及尿沉渣镜检检测尿液成分的结果进行分析,建立显微镜复检规则.方法 收集687份住院和门诊患者尿液标本,分别完成H-500检测、UF-500i检测及尿沉渣镜检,以尿沉渣镜检结果 作为金标准.结果白细胞结果显示,H-500灵敏度为84.0％,U F-500i灵敏度为98.6％,H-500联合UF-500i灵敏度为100.0％;红细胞结果显示,H-500灵敏度为93.9％,UF-500i灵敏度为86.5％,H-500联合UF-500i灵敏度为97.8％;管型结果显示,UF-500i灵敏度为81.3％,H-500联合U F-500i灵敏度为100.0％;上皮细胞及结晶结果显示,UF-500i灵敏度均为100.0％.结论 H-500、UF-500i各有其优缺点,将两种方法联合检测尿液成分,可降低漏检率,但不能替代尿沉渣镜检,需要参照相应的复检规则进行复检,以保证检测结果的准确性.

目的 评价手术治疗复发性胸壁结核的临床效果.方法 回顾性分析我院2013年1月～2017年6月收治的96例复发性胸壁结核患者的历例资料,统计分析手术治疗后原切口和非原切口的愈合及复发情况,并将患者病灶表现与手术效果进行皮尔逊相关分析.结果 从复发部位看,非原切口复发24例(25％),原切口复发72例(75％),两者差异有统计学意义(x2=65.68,P＜0.001);从性别上看,原切口复发男性50例(69.44％),女性22例(30.56％),两者差异无统计学意义(x2 =0.78,P＞0.05).96例复发性胸壁结核患者经手术治疗后,甲级切口愈合90例(93.75％),延期愈合6例(6.25％);术后随访1年,仅在原切口的结核病灶复发4例,6例切口延期愈合患者经再次手术治疗后均治愈.在手术治疗复发性胸壁结核的疗效中,术后近期及随访1年后为甲级愈合与胸壁结核CT分型为哑铃型的呈负相关,与原切口复发部位和疼痛呈负相关;延期愈合与胸壁结核CT分型为哑铃型呈正相关,与原切口复发部位和疼痛呈正相关.结论 针对复发性胸壁结核,手术治疗能够直接清除病灶,同时采用抗痨及抗感染处理,治疗效果良好.

肾癌是泌尿系统高发肿瘤,近年发病率逐年升高.从分子病理学分类,肾癌有10余种亚型,其中透明细胞癌(clear cell renal cell carcinoma, CCRCC)是其主要病理类型[1].由于肾癌早期临床症状隐匿, 20% ~30%患者首次就诊时已处于进展期;而且肾癌患者放射治疗、化学治疗及内分泌治疗效果均不理想,即使原位肾癌经过手术治疗后,仍有30%患者最终进展为转移性肾癌[2].转移性肾癌经治疗后,病死率居高不下,5年生存率仅仅10%左右,中位生存时间只有不到10个月[3-4].因此,如何治疗转移性肾癌并延长患者生存时间、提升患者生活质量仍是目前研究的重点.目前,美国和欧盟批准上市的治疗晚期肾癌——转移性肾癌的药物有12种,现将这些药物的药理机制以及治疗效果进行综述如下.

Objective To analyze the safety and efficacy of simultaneous bilateral flexible ureteroscopy lith-otripsy(SB-FURL)for bilateral renal stones.Methods A retrospective analysis of 101 patients who under-went bilateral flexible ureteroscopy lithotripsy in the hospital from April 2015 to May 2017 were selected.And 76 of them met the research criteria,39 patients who underwent SB-FURL and 37 patients who underwent staged bilateral FURL were selected into simultaneous group and staged group respectively.The Stone Free Rate(SFR)one month after surgery,overall operative time,overall hospital stay and complication rate between two groups were compared.Results The patients′ surgeries of two groups were completed successfully.No significant difference were found between two groups about overall operative time,complication rate and SFR (P>0.05).While the SB-FURL group′s average overall hospital stay was significantly shorter than staged bi-lateral FURL group(P<0.05).No ureteral perforation and ureteral mucosal avulsion occurred in surgeries in the two groups,and there were no serious complications of urinogenic sepsis and renal insufficiency after sur-geries.Conclusion SB-FU RL is safe and effective in the treatment of bilateral renal calculi in selected pa-tients.

Objective:To assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) on upper ureteral calculi ＞1.5 cm.Method:From July 2014 to March 2016,133 patients with upper ureteral calculi ＞ 1.5 cm who were treated in our hospital were restrospectively analyzed.Fifty-two patients were treated by PCNL,while 81 patients were treated by ureteroscopic lithotripsy (URL).The clinical data including stone-free rate,operating time,complication rate,et al.were analyzed and compared between two groups.Result:The clinical data of all patients were as follows:the average operating time of PCNL group and URL group were (37.6±13.8) minutes and (44.1±12.5) minutes respectively (P=0.006);the postoperative stone-free rate of two groups were 92.3％ and 75.3％ (P=0.013);the reduction of hemoglobin were (8.06±8.1) g/L and (4.8 ±5.4) g/L (P=0.006);the average postoperative length of stay were (5.4±1.9) days and (2.0±1.3) days (P＜0.01);the rate of auxiliary treatment were 3.8％ and 16.0％ (P=0.030).All the above data showed statistical difference.However,the complication rate of PCNL group and URL group were 13.5％ and 19.8％ (P =0.349),which showed no statistical difference.Conclusion:PCNL is effective and safe on treating upper ureteral calculi ＞ 1.5 cm.Compared with URL,PCNL shows shorter operative time,higher stone-free rate and lower retreatment rate.

Objective To study the efficacy and safety of supracostal access for percutaneous nephrolithotomy.Methods 310 patients underwent percutaneous nephrolithotomy by the same surgeon,of whom 117 cases had a 11-12 intercostal access,193 cases had a 12 subcostal access.All patients received CT or IVP+CT scan.Data were analyzed prospectively for stone clearance rates,hospital days and postoperative complications.Results In the intercostal access and subcostal access group,the hospital days were(8.15±2.13)d,(8.36±2.03)d,stone clearance rates were 78%(91/117) and 71%(138/193)respectively.2 patients by subcostal access did embolization for serious bleeding.Conclusion The supracostal approach is found to be effective as well as safe.

Objective To discuss the clinical features, diagnosis and therapy of primary adrenal lymphoma (PAL) . Methods Two patients (65-year old and 52-year old respectively) who complained vague pain were analyzed. Occupying lesions in adrenal gland were discovered by computed tomography (CT) and diagnosed by needle biopsy and laparoscopic surgery. Results The two patients in our hospital were diagnosed as nonHodgkin's lymphoma. They were treated with chemotherapy and one of them was partial response. Literatures on PAL were reviewed. In the literature, 7 of the 65 patients achieved complete response, 15 partial response, 43 death or unspecified and the survival duration was 3 days to 26 months. Conclusions Most of PAL are bilateral, without specific clinical characters. Neele biopsy is the first choice to make the diagnosis. The therapeutic modalities for PAL include surgery, chemotherapy, surgery followed by chemotherapy as well as radiation therapy. The prognosis of PAL is poor if other organs are involved.

Objective:Evaluate the relationship of complications and indwelling time of double-J ureteral stents after ureterscopic holmium-laser lithotripsy. Methods:170 patients were divided into two groups randomly. groupⅠ(stents indwelling 4 weeks),groupⅡ(stents indwelling 2 weeks).Complications of two groups were compared. Results:During the indwelling time,two groups presented urinary irritative sypmtoms were 81(93%)and 51(61%)P0.01,infection were 71(82%)and 39(47%)P0.01,flank pain were 26 (30%)and 10(12%)P0.05,encrustation were 23(26%)and 9(11%),P0.01 respectively,hemaurine were both 100% in two groups. Two weeks after removing the Double-J stents,urinary irritative sypmtoms were 3 (3.4%)and 2 (2.4%),microscopic hematuria were9 (10%)and 6(7%),infection were 7(8%)and 3(4%),flank pain were 0 in two groups,there were no significant statistically differences between the two groups. Conclusion:For the patients who received ureterscopic holmium-laser lithotripsy,shortening indwelling time could be safe and decrease urinary irritative sypmtoms,hemaurine,infection and flank pain.

Objective To investigate the surgical technique of retroperitoneoscopic radical resection for the renal pelvic carcinoma or ureter carcinoma,and to evaluate the clinical value and efficacy of retroperitoneoscopic combined with hypogastrium minor incision.Methods A retrospective study was performed on the clinical data and the surgical technique of 18 patients with renal pelvic or ureter carcinoma,underwent retroperitoneoscopic combined with hypogastrium minor incision.Results All cases underwent operations successfully.The mean time of operative was 120-176 min,and 110-200 ml for blood loss.Food intake was started 26-48 h after operation.Activity get out of bed was 30-48 h after operation,and patient discharged from hospital within 6-8 days after surgery.No complications happened in hospital.Follow up continued for 2-36 months after surgery,and no recurrence or metastasis was reported.Conclusions Retroperitoneoscopic combined with hypogastrium minor incision for upper urinary casts tumor is a safe and effective way for patients with renal pelvic or ureter carcinoma.Compared with open surgery,it has the advantages of short operative time,small incision,less blood loss,and more rapid recovery.