目的:探讨与高龄患者前列腺癌相关的危险因素,为前列腺癌的临床防治提供可靠依据.方法:回顾性选取 2016 年 1 月至 2021 年 6 月在河南中医药大学第一附属医院行前列腺组织病理检查的高龄患者病历资料 102例,其中前列腺癌患者 46 例为前列腺癌组,非前列腺癌患者 56 例为非前列腺癌组.前列腺癌组依据前列腺病理结果及Gleason评分又分为高危组(22 例)和非高危组(24)例.收集所有患者一般资料[年龄、体质量指数(BMI)、糖尿病、吸烟史等],经单因素、Logistic多因素分析高龄患者前列腺癌相关危险因素.结果:前列腺癌的发生可能与年龄、饮酒史、吸烟史、糖尿病史、高血压史无关(P＞0.05);但可能与 BMI、糖化血红蛋白(HbA1c)、前列腺特异性抗原(PSA)、游离前列腺特异性抗原(fPSA)/PSA、甘油三脂(TG)、总胆固醇(TC)水平有关(P＜0.05);经非条件Logistic回归分析结果得出,BMI、HbA1c、PSA、fPSA/PSA、TG、TC均是前列腺癌发生的危险因素(OR＞1,P＜0.05);经非条件Logistic回归分析结果得出,HbA1c、PSA、fPSA、fPSA/PSA、TG、TC、PI-RADS评分均是高危前列腺癌发生的危险因素(OR＞1,P＜0.05).结论:BMI、HbA1c、PSA、fPSA/PSA、TG、TC均是前列腺癌的独立危险因素;HbA1c、PSA、fPSA、fPSA/PSA、TG、TC、PI-RADS评分均是高危前列腺癌的独立危险因素.

Objective To retrospectively study the patients with benign prostatic hyperplasia（BPH） who still needed surgical treatment after taking α-receptor blocker, and analyze the risk factors. Methods A total of 209 cases of benign prostatic hyperplasia hospitalized in our hospital from January 2016 to July 2021 were retrospectively analyzed, patients who still needed surgical treatment after taking medicine were divided into the surgical group（n=95） and patients who continued oral drug therapy were divided into the drug group（n=114）, patients’ age, duration of continuous medication, history of hypertension, history of diabetes, history of smoking, history of urinary retention, history of alcohol consumption, BMI, total prostate volume（TPV）, intravesical prostatic protrusion（IPP）, international prostate symptom Score（I-PSS）, residual urine volume（PVR）, prostate specific antigen（PSA）,bladder detrusor muscle thickness（DWT）,maximum urine flow rate（Qamx） and other factors with statistical differences were first univariate analysis, followed by multivariate Logistic regression analysisand other factors. Results BMI, IPP, TPV, I-PSS, PVR, PSA, DWT and Qamx were statistically different between the two groups（P＜0.05）. Multivariate Logistic regression analysis showed that IPP, PVR and PSA were the main risk factors for BPH patients who still needed surgical treatment after taking α-receptor blocker. Conclusions IPP, PVR and PSA are the main risk factors for BPH patients who still need surgical treatment after taking α-receptor blocker, which is of great significance for predicting the efficacy of oral ɑ-receptor blocker in BPH patients.

Objective To explore the impact of preoperative CT urography（CTU） three-dimensional imaging on the effect and safety of flexible ureteroscopy in the treatment of lower calyceal calculus. Methods 64 patients with lower calyceal calculus were divided into CTU group（n = 26） and IVP group（n = 38） according to preoperative examination methods. CTU group received CTU three-dimensional imaging before operation, and IVP group received intravenous pyelography（IVP） before operation. The preoperative examination indicators,operation time, stone clearance rate, postoperative complications and laboratory indicators of the two groups were compared. Results No statistical difference was found in stone diameter, IPA and IW between the two groups（P ＞0.05）. The operation time of CTU group was shorter than that of IVP group, and the stone clearance rate was higher than that of IVP group（P ＜0.05）. No statistical difference was found in the incidence of postoperative complications between the two groups（P ＞0.05）. The leukocyte and CRP levels of CTU group were lower than those of IVP group（P ＜0.05）. Conclusions Preoperative CTU three-dimensional imaging for flexible ureteroscopy in the treatment of lower calyceal calculus has significant effect, which can shorten the operation time, improve the stone clearance rate and reduce the postoperative inflammatory reaction.

目的:评价超细肾镜治疗1～2 cm肾下盏结石的有效性和安全性.方法:纳入2018年3月-2021年6月于河南中医药大学第一附属医院住院治疗的67例1～2 cm肾下盏结石患者,根据不同手术方式分成超细肾镜组37例和输尿管软镜组30例.比较两组术后3 d结石清除率、术后并发症发生率、手术时间、术后住院时间、术后1 h血红蛋白下降量和术后12 h不同疼痛程度例数.结果:超细肾镜组和输尿管软镜组术后3 d结石清除率分别为91.9％和70.0％,差异有统计学意义(P＜0.05);超细肾镜组和输尿管软镜组术后并发症发生率分别为16.2％和26.7％,手术时间分别为(54.43±12.02)min和(59.23±12.00)min,术后住院时间分别为(6.51±1.26)d和(6.30±1.53)d,术后1 h血红蛋白下降量分别为(10.95±3.64)mL和(11.40±3.31)mL,术后不同程度疼痛例数比较,差异无统计学意义(P＞0.05).结论:超细肾镜治疗1～2 cm肾下盏结石是安全、高效的.

目的 探讨石淋清颗粒预防大鼠草酸钙肾结石形成的作用机制.方法 将60只大鼠随机分为空白组、模型组和石淋清颗粒低、中、高剂量组(6.5、13、26 g/kg)及去乙酰化酶3(SIRT3)抑制剂组(石淋清颗粒26 g/kg+SIRT3抑制剂25 mg/kg),每组10只.除空白组外,其余各组大鼠将饮水更换为1％乙二醇溶液,并每天灌胃2％氯化铵溶液2 mL,连续4周,以复制肾结石大鼠模型.造模同时,给药组灌胃相应药物,空白组和模型组灌胃等体积生理盐水.测定大鼠24 h尿量、尿液pH值和尿液中Ca2+、草酸(Ox)含量及血清中肌酐(Cr)、血尿素氮(BUN)、Ca2+含量;观察大鼠肾组织病理学形态、草酸钙肾结晶情况和超微结构;检测大鼠肾组织中丙二醛(MDA)、超氧化物歧化酶(SOD)、活性氧(ROS)、骨桥蛋白(OPN)水平;检测大鼠肾组织中SIRT3、叉头框蛋白O3a(FOXO3a)、SOD2 mRNA和蛋白的表达水平.结果 与空白组比较,模型组大鼠24 h尿量、尿液pH值、肾组织中SOD水平,以及SIRT3、FOXO3a、SOD2 mRNA和蛋白表达水平均显著降低(P<0.05或P<0.01);尿液中Ca2+、Ox含量,血清中Cr、BUN、Ca2+含量,肾组织中ROS、MDA、OPN水平均显著升高(P<0.01);肾组织病理损伤严重,可见大量弥漫性分布的黑色结晶,肾小球基膜增厚,足突细胞和肾小管上皮细胞中的线粒体水肿.与模型组比较,石淋清颗粒各剂量组大鼠上述指标含量/水平(低剂量组血清中Ca2+含量除外)均显著逆转(P<0.05或P<0.01),肾组织病理损伤、草酸钙肾结晶、肾小球足突细胞和肾小管上皮细胞中的线粒体损伤均明显改善;而SIRT3抑制剂组上述指标变化差异无统计学意义(P>0.05).结论 石淋清颗粒可有效抑制大鼠草酸钙肾结石的形成,改善肾损伤,其作用机制可能与提高抗氧化作用和激活SIRT3/FOXO3a信号通路有关.

目的 评价在经尿道等离子前列腺剜除术(TUKEP)手术过程中采用保留前列腺尖部的手术方式治疗良性前列腺增生的临床疗效.方法 通过回顾性分析,选择2017年01月至2021年06月于我院收治的良性前列腺增生124例患者,将其中行保留前列腺尖部的TUKEP的患者60例纳入观察组,而接受传统前列腺电切术的患者64例归于对照组;比较两组年龄、前列腺体积、术前I-PSS评分、术后第3个月I-PSS评分、最大自由尿流率(Qmax)、残余尿量(PVR)、手术时长、导尿管留置时长、术后住院总天数(HOD)、手术并发症、术后血红蛋白(HGB)下降量、短期(术后一周)及长期(术后3个月)尿失禁(UI)发生率.结果 两组年龄、前列腺体积、术前I-PSS评分、手术时长、手术并发症、术后HGB下降量,第3个月UI发生率的差异无统计学意义(P>0.05),但观察组导尿管留置时长、术后HOD、短期UI发生率、术后第3个月I-PSS、PVR等均低于对照组,差异有统计学意义(P<0.05),Qmax高于对照组,差异有统计学意义(P<0.05).结论 保留前列腺尖部的TUKEP较传统前列腺电切术治疗BPH的效果更加明显,能降低UI发生率,改善患者术后生活质量.

肾结石可导致新发高血压的形成,并且可加速高血压的发展;而高血压又是肾结石的危险因素.两者发生发展存在共同途径以及一定的联系,因此本文从高尿钙、胰岛素抵抗、炎症和细胞因子以及氧化应激和手术等方面对两者可能存在的联系进行综述,以便为更好的预防疾病的发生发展和未来的研究提供一些可行的思路.

Objective:To investigate the clinical effect of early cluster therapy on septic shock after minimally invasive urological surgery.Methods:A total of 40 patients with septic shock after minimally invasive surgery in the Department of Urology of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from July 2017 to April 2022 were selected as the research objects. The patients were divided into control group (hospitalized from July 2017 to August 2019) and observation group (hospitalized from September 2019 to April 2022) according to the length of hospital stay, with 20 cases in each group. The control group treated by the conventional plan, the observation group treated by the bundled strategy in the early stage, and the related treatment was completed within 6 hours of the onset. The vital signs, inflammatory indexes and shock disease-related scales of patients in the two groups at different time points were evaluated.Results:After 6 hours of treatment, the vital signs including heart rate, mean arterial pressure (MAP), central venous pressure (CVP) and blood oxygen saturation (SaO 2) were significantly improved in both groups, and the MAP, CVP and SaO 2 of the observation group were higher than those of the control group, and the differences were significant ( t=3.74, 8.79, 5.83; all P<0.05). After 24 hours of treatment, the inflammatory indexes including neutrophils and procalcitonin of the two groups were significantly improved, and the procalcitonin of the observation group was lower than that of the control group, and the difference was significant ( Z=2.24, P<0.05). After 6 and 24 hours of treatment, the Apache II and sequential organ failure assessment scores in the two groups showed a downward trend, and the above scores of the observation group were lower than those of the control group, and the differences were significant ( F=550.85, 417.58; all P<0.05). Conclusions:The early bundle strategy has a significant effect on the treatment of septic shock after urological surgery, which can stabilize the patient’s vital signs as soon as possible, relieve the symptoms of infection, and effectively avoid further damage to the organ function.

目的 探讨不同数量经皮肾镜通道对肾结石患者术后早期肾功能的影响.方法 选取2017年7月至2021年8月河南中医药大学第一附属医院接收的60例复杂肾结石患者作为研究对象,按照经皮肾镜碎石取石术(PCNL)通道数量分为3组,分别为A组(单通道PCNL组)、B组(双通道PCNL组)及C组(多通道PCNL组),比较术后第2天3组肾功能指标变化情况.结果 3组手术时间、住院时间比较,差异无统计学意义(P>0.05).A组术中出血量最少,随着通道的增加,出血量增多,差异有统计学意义(P<0.05).B组与C组血肌酐(SCr)水平变化高于A组,差异有统计学意义(P<0.05),B组与C组SCr水平比较,差异无统计学意义(P>0.05).3组血中尿素氮(BUN)水平变化比较,差异无统计学意义(P>0.05).结论 复杂肾结石患者应用经皮肾镜单通道、双通道及多通道治疗后均会损伤早期肾功能,与单通道相比双通道术后早期肾功能下降明显,双通道与多通道对肾功能损害无明显差异.因此,对于复杂肾结石患者,临床可根据其具体病情选择合适的治疗方案.

Objective:To compare the efficacy of transurethral resection of the prostate and holmium laser enucleation of the prostate in the treatment of benign prostatic hyperplasia.Methods:The clinical data of patients with benign prostatic hyperplasia treated in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2018 to January 2022 were retrospectively. According to surgical methods, patients were divided into control group and study group, with 50 cases in each group. The control group was treated by transurethral resection of the prostate, and the study group was treated by holmium laser enucleation of the prostate. The perioperative operation indexes, urodynamic indicators, prostate symptoms score, quality of life score, sexual function and complications were compared between the two groups.Results:The intraoperative blood loss, bladder flushing time, indwelling time of the catheter, and hospital stay in the study group were less than those in the control group (all P<0.05). Before operation, there was no significant difference in urodynamic indexes, prostate symptom scores, and quality of life scores between the two groups ( P>0.05). The maximum urinary flow in the study group was higher than that in the control group, while the residual urine volume, prostate symptom score, quality of life score were lower than those in the control group ( P<0.05). The erectile function index score in the study group was higher than that in the control group, while erectile dysfunction score and incidence of retrograde ejaculation were lower than those in the control group ( P<0.05); the incidence of complications in the study group (28.00%, 14/50) was higher than that in the control group (8.00%, 4/50), P<0.05. Conclusions:Holmium laser enucleation of the prostate has more prominent effects in the treament of benign prostatic hyperplasia, which can shorten the hospital stay, facilitate the recovery of postoperative sexual function, and have a lower complication rate.

目的 探讨超细肾镜治疗肾结石的临床疗效.方法 选取2018年1月至2021年4月于河南中医药大学第一附属医院泌尿外科住院治疗的68例肾结石患者,依照手术方式不同分为超细肾镜组(肾镜组)32例,输尿管软镜组(软镜组)36例.比较两组患者的结石清除率、手术时间、术后住院时间、并发症发生率、术中出血量(术后1 h血红蛋白下降量)、术后C反应蛋白(C-reaction protein,CRP)及降钙素原(procalcitonin,PCT)水平.结果 肾镜组较软镜组清石率明显增高,差异有统计学意义(P<0.05);肾镜组术后CRP及PCT水平较软镜组明显降低,差异有统计学意义(P<0.05);两组术中出血量、手术时间、术后住院时间、并发症发生率比较,差异无统计学意义(P>0.05).结论 超细肾镜治疗肾结石的效果显著优于输尿管软镜,炎性反应较输尿管软镜轻,与输尿管软镜比,未增加手术出血量及住院时间和手术时间、并发症.

目的 观察平片式无张力疝修补术治疗成人腹股沟疝患者的疗效.方法 选取2017年1月至2018年12月该院收治的86例成人腹股沟疝患者作为研究对象,根据不同手术方案将其分为对照组和研究组,各43例.对照组行传统疝修补术,研究组行平片式无张力疝修补术.对比分析两组手术时间、术后72 h疼痛视觉模拟评分法(VAS)、住院时间、住院费用、下床活动时间、并发症发生情况,并于术后3个月随访两组复发情况.结果 与对照组比较,研究组住院费用少,住院时间、下床活动时间均较短,术后72 h VAS评分低,差异均有统计学意义(P＜0.05);两组手术时间比较,差异无统计学意义(P＞0.05);研究组血清肿、异物感、慢性疼痛、切口感染等并发症发生率均低于对照组,差异均有统计学意义(P＜0.05);术后3个月随访,两组均无一例脱落,研究组复发率为0,对照组为4.65％ (2/43),两组复发率比较,差异无统计学意义(P=0.494).结论 平片式无张力疝修补术应用于成人腹股沟疝患者,有助于降低并发症发生率,缩短住院时间,减少住院费用,值得临床推广应用.

目的:分析前列舒通(QS)与喹诺酮类抗菌药物(QNs)治疗细菌性前列腺炎(BP)的效果.方法:本研究为2017年3月至2019年3月间来太康县第二人民医院治疗的182例BP患者.按治疗方式不同分为观察组(行QS+QNs治疗)和对照组(常规治疗),均91例,对比两组患者疗效.结果:观察组患者的疗效为96.70％,优于对照组87.91％;慢性前列腺症状指数(NIH-CPSI)评分均低于对照组;不良反应率为4.40％低于对照组13.19％,组间比较,差异均具有统计学意义(P＜0.05).结论:为BP患者行QS+QNs治疗可改善临床症状,减少不良反应.

目的:分析B超引导下微通道经皮肾镜钬激光碎石术在复杂性肾结石中的应用价值.方法:选取2015年1月—2016年12月入院的肾结石患者120例进行回顾性分析,据术式分为激光组(65例)和超声组(55例).激光组行微通道经皮肾镜钬激光碎石术,超声组行经皮肾镜超声碎石术.比较两组手术时长、术中出血量、肾造瘘管拔除时间、住院时间;比较两组首次、2次结石清除率及术后并发症的发生率;随访1年,比较两组结石复发率.结果:激光组术中出血量少于超声组(P<0.05),肾造瘘管拔除时间和住院时间均短于超声组(P<0.05),但手术时间长于超声组(P<0.05);激光组首次结石清除率(89.23％)明显高于超声组(72.73％),差异有统计学意义(P<0.05),但2次结石清除率比较,差异无统计学意义(P>0.05);激光组术后病并发症发生率(3.08％)低于超声组(16.36％),差异有统计学意义(P<0.05);随访1年后,两组结石复发率比较,差异无统计学意义(P>0.05).结论:B超引导下微通道经皮肾镜钬激光碎石术可显著减少复杂性肾结石患者术中出血量,缩短患者的住院时间,提高结石清除率.

目的:探讨经皮肾通道顺行输尿管软镜治疗输尿管中下段结石合并远端输尿管狭窄、扭曲患者的有效性及安全性.方法:回顾性分析2014年6月～2018年11月在我院行输尿管硬镜碎石术(URL)的27例输尿管中下段结石的临床资料,术中发现输尿管狭窄及扭曲严重,输尿管镜难以上行至结石处,改行俯卧位建立F24皮肾镜通道后,顺行置入输尿管导引鞘及输尿管软镜,处理结石.结果:手术时间46～139 min,平均(67±15) min,26例采用顺行输尿管软镜将输尿管结石全部清除(残石颗粒冲入膀胱),术后1～3 d拔除尿管,后自行排出,均未出现气胸、肠道损伤、严重出血及输尿管脱套等严重并发症.1例改行开放取石.结论:顺行输尿管软镜在URL治疗失败的输尿管中下段结石合并远端输尿管狭窄、扭曲的治疗中,具有安全、有效、并发症少等优点.

目的 探讨间苯三酚联合山莨菪碱对下尿路微创手术术后膀胱痉挛的治疗效果及安全性.方法 收集2014年3月—2017年5月于太康县第二人民医院泌尿外科接受下尿路微创手术的128例患者为观察对象,随机分为两组,间苯三酚+山莨菪碱(观察组)和山莨菪碱(对照组),每组各64例.比较两组患者术后72 h内膀胱痉挛次数、膀胱痉挛持续时间、膀胱冲洗转清时间等指标变化.结果 观察组患者下尿路微创手术后膀胱痉挛次数为24 h内(4.3±0.5)次、24～48 h(3.8±0.4)次以及48～72 h(2.8±0.4)次,显著少于对照组,差异有统计学意义(P<0.05);观察组患者下尿路微创手术后膀胱痉挛持续时间为24 h内(7.8±1.5)min、24～48 h(6.8±0.4)min以及48～72 h(4.9±0.3)min显著低于对照组,差异有统计学意义(P<0.05);观察组患者膀胱冲洗时间和尿管拔除时间分别为(3.2±1.2)d和(4.1±1.3)d均显著低于对照组,差异有统计学意义(P<0.05);疼痛视觉模拟评分为(3.1±0.3)分显著低于对照组,差异有统计学意义(P<0.05).结论间苯三酚联合山莨菪碱对于下尿路微创手术术后膀胱痉挛的治疗效果显著,安全性高,值得临床推广.

肾盏憩室是肾实质内覆盖移行上皮细胞的囊腔,经狭窄的盏颈与肾盂或肾盏相通,憩室无分泌功能,但尿液可反流入憩室内。肾盏憩室结石首先由Rayer于1841年描述,可为多发性,位于肾的任何部位,但肾上盏更易受累及。常规治疗方式包括开放手术、体外冲击波碎石术、经皮肾镜取石术（percutaneous nephrolithotom,PCNL）及腹腔镜肾楔形切除术 [1] 。随着输尿管软镜在上尿路结石治疗中的增

随着输尿管软镜技术应用的增多,手术体位常规采用截石位,特殊病例可采用仰卧位[1],对于关节强直、畸形、和无法行截石位的患者,手术变得尤为困难。对于特殊体位的选择,国内少有报道。我院于2013年6月至2015年6月应用输尿管软镜治疗上尿路结石患者761例,其中对27例（约占35.5‰）特殊上尿路结石患者采用完全平卧位（2例）、完全平卧位双下肢稍外展（11例）、健侧截石位患侧平卧

Objective:To evaluate the clinical effects of Ho∶YAG laser lithotriptor with flexible ureteroscope in the treatment of upper urinary tract calculi.Method:Three hundred and nine cases of upper urinary tract calculi were treated with Ho∶YAG laser lithotriptor through flexible ureteroscope.Among them were 228patients with renal calculi and 81patients with upper ureteral calculi.Stone diameter was 0.8-3.0cm,averaging 1.6cm.Re- sult:All the operative procedures were successful.The stone-free rate was 83.5%(258/309).Mean operation du- ration was 50(range,30-90)mins.Mean postoperative hospital stay was 5(range,2-8)days.The stone-free rate was 91.9%(284/309)two weeks later on KUB.No ureteral perforations or pyonephrosis occurred.Conclusion: Ho∶YAG laser lithotripsy through flexible ureteroscope is a safe,effective treatment for upper urinary tract cal- culi.

目的对周口地区尿路结石成分进行分析,为临床治疗及预防提供参考。方法对临床资料进行整理分析,并采用泌尿结石成分分析试剂盒对229例尿路结石标本进行化学成分定性研究。结果尿路结石男性发病多于女性,男女比例为2.5:1,18～52岁为高发年龄。结石成分以混合结石占多数,为182例(79%),其中以草酸钙,磷酸钙与尿酸的混合结石为主。对比混合性结石及单纯性结石发现,各成分所占比例基本一致。结论结石成分分析对于了解结石性质,预防结石复发具有重要意义。