目的 探讨5 F输尿管导管负压吸引辅助6/7.5 F输尿管镜碎石术,治疗输尿管结石合并感染的安全性和有效性.方法 回顾性分析该院2020年7月-2021年12月67例采用旁置5 F输尿管导管负压吸引辅助6/7.5 F输尿管镜碎石术治疗输尿管结石合并感染的患者的临床资料,67例患者术前均有发热,入院后抗感染对症治疗,体温正常3 d后,行输尿管镜碎石治疗.术中输尿管镜下留置5 F输尿管导管并越过结石上方,输尿管导管末端连接负压吸引,并在输尿管镜下应用200 μm钬激光碎石.结果 术后6例患者出现发热.其中,低热(<38.5℃)4例,高热(38.9℃和39.4℃)2例,术后感染率为9.0%,术后2～4周拔除输尿管双J管,术后清石率为83.6%.所有病例均未发生输尿管穿孔、黏膜撕脱和感染性休克等严重并发症.结论 5 F输尿管导管负压吸引辅助6/7.5 F输尿管镜碎石术治疗输尿管结石合并感染,安全、有效,可操作性强,可降低术后感染和尿脓毒血症的发生率.

上尿路尿路上皮癌（upper tract urothelial carcinoma，UTUC）包括肾盂癌和输尿管癌，在欧美国家其发病率较低，约占尿路上皮癌的5%~10%[1-2]，在我国其发病率较高，占尿路上皮癌的18%[3]。UTUC标准手术方法是根治性肾输尿管全长切除加膀胱袖套状切除术（radical nephrourotertectomy，RNU），但术后常出现膀胱肿瘤复发，影响预后。膀胱灌注化疗对减少膀胱肿瘤复发具有重要作用，但灌注方案尚未达成统一意见，本文就其研究进展综述如下。

Wernicke's encephalopathy (WE) is a condition caused by a deficiency of vitamin B1. While there have been many reported cases of WE in the literature, there are few reports on the early stages of the disorder. In this report, we present a case of WE with urinary incontinence as the main clinical manifestation. A 62-year-old female patient was admitted to the hospital due to intestinal obstruction and did not receive vitamin B1 supplements for 10 days. Three days after her operation, she developed urinary incontinence. She also had mild mental symptoms, such as a little indifference. After consultation with a urologist and neurologist, the patient was immediately given intramuscular vitamin B1 at a dosage of 200 mg/day. After 3 days of supplementing with vitamin B1, her urinary incontinence and mental symptoms improved and were completely resolved after 7 days of treatment. Surgeons should be aware that when long-term fasting patients have urinary incontinence, it may be a symptom of WE, and they should be supplied with vitamin B1 in a timely manner without extensive examination.

Background: The incidence of prostate cancer (PC) exhibits geographical heterogeneity. However, the metabolic mechanisms underlying this geographic heterogeneity remain unclear. This study aimed to reveal the metabolic mechanism of the geographic heterogeneity in the incidence of PC. This study aimed to investigate the anti-cancer effects of different gum extracts on metabolic changes and their impact on gene expression in HT-29 cell.Methods: Transcriptomic data from public databases were obtained and analyzed to screen geographic-differentially expressed genes and metabolic pathways. Associations between these differentially expressed genes and the incidence of PC were determined to identify genes that were highly associated with PC incidence. A co-expression network analysis was performed to identify geographic-specific regulatory pathways.Results: A total of 175 differentially expressed genes were identified in four countries and were associated with the regulation of DNA replication and the metabolism of pyrimidine, nucleotides, purines, and galactose. Additionally, the expression of the genes CLVS2, SCGB1A1, KCNK3, HHIPL2, MMP26, KCNJ15, and PNMT was highly correlated with the incidence of PC. Geographicspecific differentially expressed genes in low-incidence areas were highly correlated with KCNJ15, MMP26, KCNK3, and SCCB1A1, which play a major role in ion channel-related functions.Conclusions: This study suggests that geographic heterogeneity in PC incidence is associated with the expression levels of genes associated with amino acid metabolism, lipid metabolism, and ion channels.

目的 探究母系表达基因3(MEG3)在前列腺癌(PCa)中的表达及其分子调控网络.方法 选取2019年7月至2020年5月深圳市前海蛇口自贸区医院收治的20例PCa患者的癌组织样本作为Tumor组;20例经尿道前列腺剜除术的良性前列腺增生组织标本作为Normal组.采用实时荧光定量PCR检测两组患者的MEG3基因表达水平.采用UCSC数据库、PROMO数据库、DIANA生物学软件和miRTarBase软件等预测分析MEG3的上游转录因子、下游靶miRNA及靶miRNA的靶基因,并绘制MEG3的分子调控网络.结果 Tumor组患者的MEG3表达水平为2.64±0.305,明显低于Normal组的8.23±0.759,差异有统计学意义(P<0.05);MEG3的主要上游转录因子有YY1、C/EBPβ、GR-α;MEG3靶向调控hsa-miR-877-3p;与PCa发生相关的SUMO1、FLRT2、HIVEP3则受hsa-miR-877-3p所调控.结论 MEG3在PCa组织中低表达,可以推测MEG3的表达缺失可能参与PCa的发生过程.经生物信息学分析预测出其分子调控网络,为进一步研究MEG3在PCa发生中的分子生物学机制提供了新线索.

Objective:To explore the safety and effectiveness of 6/7.5 F ureteroscope combined with ureteral catheter negative pressure suction for treatment of upper ureteral calculi.Methods:The data of 216 patients with upper ureteral calculi were treated with 6/7.5 F ureteroscope combined with ureteral catheter negative pressure suction and holmium laser lithotripsy in Qianhai Shekou Free Trade Zone Hospital from January 2019 to December 2020 were analyzed retrospectively. 5 F ureteral catheter was placed through the stone and connected to negative pressure suction. 200 μm holmium laser was used to crush the stone.Results:Among the 216 patients, 209 cases were successfully reached the position below the stone during the operation, the success rate was 96.8%. 18 cases were treated with flexible ureteroscopic lithotripsy because the whole or most of the stones returned to the renal pelvis, the stones migration rate was 8.3%. There were 5 cases of low fever and 1 case of high fever after operation, and the infection rate was 2.7%. After extubation, KUB showed residual stones larger than 4 mm in 20 cases, the stone clearing rate was 90.7%. No serious complications such as ureteral perforation, mucosal avulsion, and septic shock occurred.Conclusion:6/7.5 F ureteroscope combined with ureteral catheter negative pressure suction to treat upper ureteral calculi is safe and effective. It can reduce the rate of stone migration, increase the rate of postoperative stone clearance and reduce postoperative infection.

钬激光（Holmium:YAG laser）是一种多用途、安全高效的脉冲式激光,具有组织穿透度浅（0.4 mm）、脉冲持续时间短（0.25 ms）、瞬时峰值功率高（10 kW）等特点,加之波长（2 140 nm）接近水的吸收峰值,其使用安全,具有对软组织极佳的切割效果以及强大的碎石功能。自从1996年Gilling等 [1] 首次报道使用钬激光行前列腺切除术（holmium laser resection of the prostate,HoLRP）以来,逐渐广泛应用于临床,随着组织粉碎器技术的发展,1998年Gilling等 [2] 再次提出钬激光前列腺剜除术（holmium laser enucleation of the prostate,HoLEP）。

目的:分析前列腺增生体积超过80mL的患者分别施予经尿道双极等离子前列腺剜除术(PKEP)与经尿道前列腺电切术(TURP)治疗的效果.方法:将本院2016-06～2018-06接受并施予TURP治疗的40例超过80mL前列腺增生患者作为A组,另选取同期接受并施予PKEP治疗的40例同病患者作为B组,观察两组手术时间、术中出血量、增生组织切割量、术后留置尿管时间以及住院时间,比较两组手术前后国际前列腺症状评分(IPSS)和残余尿量(PVR).结果:B组患者的手术时间为(60.16±8.45)min1,少于A组的(82.38±15.27)min1,术中出血量为(72.44±13.69)mL,少于A组的(98.66±22.34)mL,术后留置尿管时长为(58.66±3.58)h,短于A组的(80.44±6.82)h,住院时间为(5.00±0.6)d,短于A组的(6.45±1.20)d,增生组织切割量为(93.46±18.84)g,多于A组的(79.55±17.20)g,差异均有统计学意义(P＜0.05).两组术前IPSS评分与PVR比较差异无统计学意义(P＞0.05),B组患者术后IPSS评分为(4.55±1.48)分,少于A组的(5.20±1.39)分,PVR为(7.51±0.77)mL,少于A组的(9.40±1.27)mL,差异有统计学意义(P＜0.05).结论:前列腺增生体积超过80mL的患者施予PKEP具有切除腺体彻底,出血少,安全性高,疗效确切的优点.

目的 探讨分腿俯卧位下可视化穿刺联合超微通道经皮肾镜取石术治疗肾下盏结石的有效性及安全性.方法 回顾性分析2018年3月至2021年5月因肾下盏结石实施腔内手术治疗的患者的临床资料,其中分腿俯卧位改良法可视化穿刺组(下文简称"改良组")62例,输尿管软镜组(下文简称"软镜组")64例.比较两组手术时间、结石清除率、住院时间、术后血红蛋白下降值、术后VAS评分和并发症发生率.结果 改良组与软镜组的手术时间为(36.47±8.43)min vs.(41.20±12.82)min(P=0.000),一期结石清除率为95.2％vs.79.7％(P=0.009),改良组明显优于软镜组;但两组在住院时间[(3.14±0.39)d vs.(3.15±0.39)d]、并发症发生率[术后发热4.84％vs.6.25％、肾周积液4.84％vs.4.69％]、血红蛋白下降值[(5.52±2.65)g/L vs.(5.46±2.67)g/L]、术后VAS评分[2.31±0.46 vs.2.29±0.45]等方面均无统计学差异(P>0.05).结论 分腿俯卧位下,采用可视化穿刺超微通道经皮肾镜取石术治疗肾下盏结石,可缩短手术时间、提高结石清除率,并不增加并发症,安全、高效、快速,值得推广.

目的:比较输尿管镜尿道会师术与开放尿道吻合术治疗早期男性前尿道损伤的临床疗效与安全性.方法:回顾性分析2010年8月～2018年12月间深圳市南山区蛇口人民医院收治的86例前尿道损伤患者的临床资料,根据手术方式分为内镜组56例和开放组30例,比较两组手术时间、术中出血量、住院时间以及术后并发症发生情况.结果:内镜组患者手术时间为(16.15±5.40)min,明显少于开放组的(75.20±12.81)min,术中出血量为(35.25±11.36)ml,明显少于开放组的(115.6±33.65)ml,住院时间为显著低于开放组的(14.28±3.10)d和(20.16±4.79)d,差异有统计学意义(P<0.01).结论:输尿管镜尿道会师术治疗前尿道损伤具有创伤小、出血少,手术时间短、并发症少等优点,在临床治疗早期男性前尿道损伤时可作为优先选择方案.

目的 比较内镜下肾内联合手术(endoscopic combined intra-renal surgery,ECIRS)与多通道经皮肾镜碎石术(multi-tract percutaneous nephrolithotomy,MPCNL)治疗复杂性肾结石的有效性和安全性.方法 选取我院2018年10月～2019年9月收治的复杂性肾结石患者300例行前瞻性随机对照研究,随机分为ECIRS和MPCNL组,每组150例.比较两组患者手术时间、术后住院时间、术后血红蛋白下降程度、C反应蛋白升高值、并发症发生率及术后一期净石率.结果 ECIRS组与MPCNL的手术时间分别为(124.31±22.61)min VS(121.45±25.52)min,两组比较无统计学差异(P=0.30).但与MPCNL组相比,ECIRS组的碎石清除率较高[88.7％(133/150)VS 80％(120/150)],术后住院时间较短[(4.29±1.22)d VS(7.46±1.28)d],术后血红蛋白下降值较低[(10.84±2.53)g/L VS(18.43±6.55)g/L],C反应蛋白升高值较小[(11.74±1.14)mg/L VS(14.42±3.09)mg/L],经皮肾通道数量较少,并发症发生率较低[27.3％(41/150)VS 62％(93/150)],差异具有显著性(P<0.05).结论 ECIRS在斜仰卧截石位取石治疗复杂性肾结石,结合了PCNL和输尿管软镜碎石术(flexible ureteroscopy lithotripsy,FURL)的优势,能有效减少经皮肾通道的数目,减少出血量,降低潜在并发症发生率,并能保持较高的结石清除率,具有良好的有效性和安全性,因此值得临床应用.

目的 探讨应用旁置输尿管导管负压吸引的输尿管硬镜钬激光碎石治疗输尿管上段结石的临床疗效.方法 选取2018年1月-2019年3月该科行输尿管硬镜治疗的输尿管上段结石患者83例,随机分为实验组42例(应用旁置输尿管导管负压吸引的输尿管硬镜钬激光碎石)和对照组41例(旁置输尿管导管的输尿管硬镜钬激光碎石).比较两组碎石时间、结石上移率、术后结石清除率、术后感染发生率和其他并发症(术后输尿管穿孔、黏膜撕脱等)发生率的差异.对于结石上移至肾盂的病例均一期给予输尿管软镜碎石治疗.结果 两组一般情况[性别、年龄、结石侧别、体质指数(BMI)]、结石最大长径、结石CT值、结石与肾盂输尿管连接处距离比较,差异均无统计学意义(P>0.05).实验组术中结石上移病例9例,对照组术中结石上移病例16例.两组碎石时间、结石清除率、其他并发症发生率比较,差异均无统计学意义(P>0.05);两组结石上移率、术后发热率比较,差异均有统计学意义(P<0.05).结论 应用旁置输尿管导管负压吸引的输尿管硬镜钬激光碎石治疗输尿管上段结石具有一定的应用价值,特别适用于没有输尿管软镜及封堵器、套石篮等手术器械的基层医院.

目的 探讨雷公藤甲素负载外泌体的抗小鼠前列腺癌作用.方法 实验分为对照组、TPL组和exo-TPL纳米粒组三组,MTT法观察细胞增殖抑制率,qPCR方法检测NF-κB和p53表达情况.构建小鼠前列腺癌模型,从接种第8天开始,每周第1～2天给药,共给药2周,观察肿瘤体积和质量,记录小鼠的荷瘤生存期.观察不同组雷公藤甲素的血液药物浓度和组织分布情况.结果 与TPL组相比,exo-TPL纳米粒组对RM-1小鼠前列腺癌细胞的增殖抑制率明显提高,其NF-κB mRNA表达水平显著降低,p53 mRNA表达水平显著升高.exo-TPL纳米粒组肿瘤体积和质量明显小于TPL组,生存期延长.与TPL组相比,exo-TPL纳米粒组可在血液和组织中保持更高的雷公藤甲素浓度.结论 与TPL组相比,exo-TPL纳米粒组可产生更强的抑制前列腺癌小鼠皮下瘤生长的作用.