Objective:To investigate the effect of transurethral needle electrode enucleation combined with immediate intravesical instillation on bladder tumor and its influence on the recurrence rate.Methods:A total of 76 patients with bladder cancer treated in Zhengzhou Central Hospital Affiliated to Zhengzhou University from June 2017 to June 2021 were selected. According to dichromatic sphere method, they were divided into control group and observation group, with 38 cases in each group. The control group was treated by transurethral resection of bladder tumor (TURBT) combined with intravesical instillation, and the observation group was treated by transurethral enucleation of bladder tumor with needle electrode combined with immediate intravesical infusion. The therapeutic effect, the levels of serum factors, complication rate and recurrence rate after 1-year follow-up of the two groups were compared.Results:There was no significant difference in operation time, blood loss, hospital stay between the two groups ( P>0.05). There was no significant difference in levels of serum factors between the two groups before and after treatment ( P>0.05). There was no significant difference in the incidence of complications between the observation group (13.16%, 5/38) and the control group (18.42%, 7/38), P>0.05. After 1-year follow-up, the recurrence rate in the observation group (2.63%, 1/38) was lower than that in the control group (18.42%, 7/38), P<0.05. Conclusions:Transurethral needle electrode enucleation combined with immediate intravesical instillation has good safety in the treatment of bladder tumor, and it can significantly reduce the recurrence rate.

目的:探讨后腹腔镜输尿管切开取石术(RLU)治疗上段输尿管结石对患者疼痛介质、术后并发症的影响.方法:选取郑州大学附属郑州中心医院2019年1月至2022年1月期间收治的60例上尿路结石患者,按随机数字表法分为对照组与观察组,各30例.对照组患者予以经输尿管镜取石术(URL)治疗,观察组患者予以RLU治疗,随访3个月.比较两组患者的术中出血量、手术时间、住院时间、疼痛评分、疼痛介质、炎症指标、肾功能指标、生活质量、一次性结石清除率及并发症.结果:观察组患者的术中出血量较对照组少,手术时间较对照组短,疼痛评分较对照组低,差异具有统计学意义(P＜0.05).两组患者的住院时间比较,差异无统计学意义(P＞0.05).术后观察组患者的前列腺素E2(PGE2)、前列腺素F2α(PGF2α)较对照组低,差异具有统计学意义(P＜0.05).术后观察组患者的C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)较对照组低,差异具有统计学意义(P＜0.05).术后观察组患者的血肌酐(SCr)、尿素氮(BUN)较对照组低,差异具有统计学意义(P＜0.05).术后观察组患者的生活质量评分较对照组高,差异具有统计学意义(P＜0.05).观察组患者的并发症发生率为6.67％,较对照组的26.67％低,差异具有统计学意义(P＜0.05).观察组患者的一次性结石清除率为96.67％(29/30),较对照组的73.33％(22/30)高,差异具有统计学意义(P＜0.05).结论:RLU治疗上尿路结石效果更佳,能够减少疼痛介质释放,减轻炎症反应及肾功能损害,一次性结石清除率高,且并发症少,利于改善患者生活质量.

目的:探讨成人Xp11.2易位/TFE3基因融合相关性肾癌(简称Xp11.2肾细胞癌)的临床特征、治疗及预后.方法:回顾性分析2015年8月～2017年3月我院收治的26例Xp11.2肾细胞癌成人患者的临床资料,分析该类型肿瘤的影像学特征、诊断、治疗方法及预后.结果:26例患者中,男10例,女16例;年龄19～59岁,平均31.4岁.其中13例行腹腔镜肾癌根治术,2例行腹腔镜肾部分切除术,3例行机器人辅助腹腔镜肾癌根治术,2例行机器人辅助腹腔镜肾部分切除术,5例行开放肾癌根治术,1例肾癌根治术后因纵隔转移穿刺确诊后行靶向药物治疗.术后病理结果均提示Xp11.2肾细胞癌.术后平均随访时间12(1～36)个月,1例患者因肿瘤全身多发转移死亡,2例失访,其余23例均预后较好.结论:Xp11.2肾细胞癌临床发病率较低,诊断主要结合其特征性的影像学表现、免疫组织化学染色及FISH确诊实验,手术主要以肾癌根治性切除术为主,短期随访预后尚可,但仍需长期随访.

AbstractBackgroundEarly identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients.MethodsA total of 186 bladder cancer patients who underwent robot‐assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected.ResultsMedian follow‐up time after RARC was 20.6 months (1.2‐43.7 months). Fifty‐one patients (27.4%) died during follow‐up and 31 within 1 year from surgery (1‐year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age (P = 0.004), advanced clinical stage (P = 0.005), presence of hydronephrosis (P = 0.021), higher fibrinogen (P = 0.007), higher PLR (P = 0.031), and lower PNI (P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734‐30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138‐5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC.ConclusionAge and preoperative elevated plasma fibrinogen level were independent predictors for 1‐year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision‐making process for patients with bladder cancer.

目的 探讨化学发光免疫法(CLIAS)检测血浆醛固酮、肾素对醛固酮腺瘤(APA)的筛查价值.方法 选取确诊为APA并经手术治疗的患者79例及确诊为原发性高血压(EH)的患者96例,采用CLIAS检测所有患者血浆醛固酮、肾素水平.比较APA患者术前、术后血浆醛固酮、肾素水平及醛固酮/肾素比值(ARR).采用受试者工作特征(ROC)曲线评价ARR诊断APA的性能.结果 APA组血浆醛固酮水平及ARR明显高于EH组(P<0.05)、血浆肾素水平明显低于EH组(P<0.05).ROC曲线分析结果显示,立位ARR诊断APA的曲线下面积为0.938,最佳临界值为42.8,敏感性为98.0％,特异性为91.6％,约登指数为0.896.与术前比较,APA患者术后立位醛固酮水平明显降低(P<0.05),肾素水平明显升高(P<0.05),ARR明显下降(P<0.001).结论 CLIAS可作为血浆肾素、醛固酮检测的有效方法,在APA筛查中具有重要价值.

目的 比较达芬奇机器人辅助腹腔镜与腹腔镜肾部分切除术治疗复杂性肾肿瘤(R.E.N.A.L.评分≥7分)的效果和安全性.方法 选择2013-01—2017-12间由同一术者实施肾部分切除术的135例R.E.N.A.L.评分≥7分的复杂性肾肿瘤患者.按手术方式不同分为2组.观察组80例行达芬奇机器人辅助腹腔镜手术,对照组55例;行腹腔镜手术.比较2组手术效果.结果 2组患者的年龄、性别、肿瘤直径、R.E.N.A.L.评分和术后住院时间比较,差异均无统计学意义(P>0.05).观察组手术时间、热缺血时间、术中出血量和术后并发症发生率均低于对照组,差异均有统计学意义(P<0.05).结论 对于R.E.N.A.L.评分≥7分的复杂性肾肿瘤患者,机器人辅助腹腔镜手术的手术时间和热缺血时间更短,能最大程度保护肾功能,将成为治疗高度复杂性肾肿瘤的主要方式.

物理实验是物理学的基础.近几年,对学生实验能力的培养与考查日益受到重视,考查内容主要是学生会否正确使用实验仪器,是否会对实验仪器进行调整,是否能按正确步骤进行实验,能否在实验中正确测出实验数据等.学生动手实验能力的培养成为教学的重要内容.