INTRODUCTION:The safety and effectiveness of percutaneous nephroscopic surgery without artificial hydronephrosis remain controversial, and there are few relevant studies. This retrospective study aimed to compare the efficacy of two different methods of eliminating and creating artificial hydronephrosis in percutaneous nephrolithotomy (PCNL) in the oblique supine position. METHODS:This is a retrospective study. A total of 162 patients who underwent PCNL in an oblique supine position at our hospital were divided into two groups according to the surgical method: the free artificial hydronephrosis group (group A) and the artificial hydronephrosis group (group B). Group A was directly treated with PCNL under ultrasound guidance, and group B was treated with artificial hydronephrosis before PCNL. Several outcomes were measured, including procedure time, stone clearance rate, and incidence of complications. RESULTS:The procedure time in group A lower than that in group B, and the incidence of sepsis was significantly lower in group A than in group B (p < 0.05). There was no statistical difference in stone clearance rate, success rate of primary establishment of puncture channel, unilateral change in perioperative red blood cell count, change in perioperative renal function, and perioperative complications (except sepsis) between the two groups (p > 0.05). CONCLUSION:For experienced physicians, PCNL without artificial hydronephrosis in an oblique supine position can be attempted to reduce the number of surgical steps without affecting the stone clearance rate and increasing the occurrence of complications.

目的 观察前列欣胶囊治疗湿热下注型慢性前列腺炎伴勃起功能障碍的临床效果.方法 将104 例湿热下注型慢性前列腺炎伴勃起功能障碍患者按照随机数字表法以1∶1的比例分为治疗组(n =52,脱落4 例)和对照组(n = 52,脱落5 例).对照组予左氧氟沙星联合坦索罗欣治疗,治疗组在对照组的基础上加前列欣胶囊治疗,连续服用 4 周.比较2 组治疗前后美国国立卫生研究院慢性前列腺炎症状评分量表(NIH-CPSI)评分、国际勃起功能指数-5(IIEF-5)评分、蒙哥马利-艾森贝格抑郁量表(MADRS)评分及前列腺小体外泄蛋白水平变化,比较 2 组勃起功能障碍疗效和中医证候疗效、不良反应发生率.结果 治疗后2 组NIH-CPSI各项评分均较本组治疗前降低,且治疗组疼痛症状、生活质量评分及总分均低于对照组,比较差异均有统计学意义(P<0.05).治疗后,2 组IIEF-5 评分均较本组治疗前升高(P<0.05),MADRS评分及前列腺小体外泄蛋白水平均较本组治疗前降低(P<0.05),且治疗组IIEF-5 评分高于对照组(P<0.05),前列腺小体外泄蛋白水平低于对照组(P<0.05).治疗组勃起功能障碍总有效率89.58％(43/48),中医证候总有效率68.75％(33/48),对照组分别为70.21％(33/47)、46.81％(22/47),治疗组均高于对照组(P<0.05).治疗组不良反应总发生率为12.50％(6/48),对照组为10.64％(5/47),2 组比较差异无统计学意义(P>0.05).结论前列欣胶囊联合左氧氟沙星、坦索罗欣治疗湿热下注型慢性前列腺炎伴勃起功能障碍患者的治疗效果更佳,能有效缓解患者临床症状,提升生活质量,且不会增加不良反应.

Objectives:To evaluate the clinical efficacy of standard channel percutaneous nephroscope combined with flexible ureteroscope and traditional standard channel combined with microchannel percutaneous nephrolithotomy in the treatment of multiple renal calculi without hydronephrosis.Methods:Eighty patients with multiple renal calculi without hydronephrosis treated in Shijiazhuang People's Hospital from January 2020 to October 2021 were randomly divided into two groups: the experimental group and the control group, with 40 cases in each group. Patients in the experimental group were treated with standard channel percutaneous nephroscope combined with flexible ureteroscopy lithotripsy, while those in the control group were treated with standard channel combined with microchannel percutaneous nephrolithotomy. The differences in operative time, postoperative hospital stay, intraoperative blood loss, calculus clearance rate, and number of channels between the two groups were compared and analyzed. Moreover, the changes of renal function indexes such as serum creatinine, urea nitrogen, blood β 2-microglobulin and blood uric acid were compared and analyzed between the two groups postoperatively; Renal static imaging technology was utilized to compare and analyze the renal parenchymal injury of the two groups postoperatively. The incidence of surgical complications such as pain, fever, urine leakage at the incision, chest tightness and chest pain within 72h postoperatively was compared and analyzed between the two groups.Results:The operative time, postoperative hospital stay and intraoperative blood loss in the experimental group were significantly lower than those in the control group, with statistically significant differences (P=0.00). The number of percutaneous renal channels established in the experimental group was significantly superior to that of the control group (P=0.00); No statistically significant difference can be seen in the calculus clearance rate between the two groups (P=0.17); Postoperative TNF-a, CRP, IL-6 and other inflammatory factors in the experimental group were significantly lower than those in the control group (TNF-a, CRP, P=0.00; Il-6, P=0.01), and cortisol level in the experimental group was significantly lower than that in the control group, which was statistically significant (P=0.00). Postoperative renal static imaging showed that the degree of renal injury in the experimental group was lower than that in the control group (P=0.00). No statistically significant difference was observed in renal function indexes such as serum creatinine, urea nitrogen, blood β2-microglobulin and blood uric acid between the two groups (P>0.05).Conclusion:Standard channel percutaneous nephroscope combined with flexible ureteroscope is a safe and effective treatment regimen for the treatment of multiple renal calculi without hydronephrosis, boasting of numerous advantages such as reduced number of channels, less bleeding, short operative time, low kidney injury, low impact on internal environmental factors such as inflammation and stress in the patients, short postoperative hospital stay, and low incidence of complications.

目的 探讨不同时间介入栓塞术在经皮肾镜碎石取石术(PCNL)后肾出血治疗中的疗效.方法 选取2010年1月至2020年12月在石家庄市人民医院行PCNL后肾出血60例患者的临床资料,根据出血后行介入栓塞术时间的不同分为A组(n=33)和B组(n=27),统计并比较两组患者的栓塞成功率和围手术期结果;治疗前和治疗后7 d血液学指标(血肌酐、尿素氮、血红蛋白和红细胞计数).结果 两组患者栓塞成功率和手术时间比较,差异无统计学意义(P>0.05);A组患者血尿消失时间、住院时间短于B组患者,住院期间输血量低于B组患者,差异有统计学意义(P<0.05).治疗后7 d,两组患者血红蛋白水平和红细胞计数高于治疗前,差异有统计学意义(P<0.05);尿素氮和血肌酐水平与治疗前比较,差异均无统计学意义(P>0.05).结论 介入栓塞术在PCNL术后肾出血治疗中有较好的疗效,早期介入栓塞术可以减少输血量及缩短住院时间,介入栓塞时间对患者预后无明显影响.

目的 研究"两减一免"经皮肾镜技术治疗输尿管上段结石的有效性和安全性.方法 选择2017年8月—2019年12月在石家庄市人民医院接受经皮肾镜手术治疗的输尿管上段结石患者82例,根据手术类型将患者分为2组:治疗组41例采用"两减一免"法经皮肾镜手术治疗,对照组41例采用传统经皮肾镜技术治疗,比较2组穿刺通道建立时间、手术时间、手术出血量(根据血红蛋白下降幅度评估)、留置肾造瘘管例数、Ⅰ期手术清石率、住院时间及不良事件发生情况.结果 治疗组穿刺通道建立时间、手术时间、术后住院时间均明显短于对照组(P均<0.05),留置肾造瘘管例数明显少于对照组(P<0.05),Ⅰ期结石清除率明显高于对照组(P<0.05),2组术后血红蛋白下降幅度和术后不良事件发生率比较差异均无统计学意义(P均>0.05).结论 "两减一免"经皮肾镜技术治疗输尿管上段结石效果更好且安全,操作更加简便易行.

目的 探讨超声引导下斜仰卧截石位经皮肾镜取石术免除输尿管逆行插管制造人工肾积水的可行性和安全性.方法 回顾性研究2018年1月～2019年12月在石家庄市人民医院接受经皮肾镜手术治疗的肾、输尿管上段结石伴肾积水患者247例,按手术方法将患者分为观察组(免人工肾积水)140例及对照组(人工肾积水)107例.将两组的结石清除率、围手术期参数及术后并发症进行分析、比较.结果 两组患者年龄、性别、结石位置和结石负荷、肾积水直径等差异无统计学意义(P＞0.05);所有病例均成功建立经皮肾通道,观察组在穿刺通道建立时间、术后血红蛋白下降幅度、一期手术清石率、术后住院天数与对照组比较,差异均无统计学意义(P＞0.05);观察组一次穿刺成功率低于对照组,但手术时间明显短于对照组,差异有统计学意义(P=0.002);两组并发症发生率差异无统计学意义(P＞0.05).结论 超声引导下斜仰卧截石位经皮肾镜取石术中免除人工肾积水治疗合并肾积水的肾、输尿管上段结石安全有效,方法更加简便易行.

Background Lymph node invasion (LNI) is a strong adverse prognostic factor in prostate cancer (PCa). The purpose of this study was to evaluate the role of Prostate Imaging Reporting and Data System version 2 (PI-RADSv2) scores for estimating the risk of LN metastasis. The study also aimed to investigate the additional value of PI-RADSv2 scores when used in combination with clinical nomograms for the prediction of LNI in patients with PCa. Methods We retrospectively identified 308 patients who underwent multiparametric magnetic resonance imaging (mpMRI) and RP with pelvic lymph node dissection (PLND). Clinicopathological parameters and PI-RADSv2 scores were assessed. Univariate and multivariate logistic analyses were performed. The area under the receiver operating characteristic curves (AUCs) and decision curve analysis (DCA) were generated for assessing the incremental value of PI-RADSv2 scores combined with the Briganti and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms. Results Overall, 20 (6.5%) patients had LNI. At univariate analysis, all clinicopathological characteristics and PI-RADSv2 scores were significantly associated to LNI ( p < 0.04). However, multivariate analysis revealed that only PI-RADSv2 scores and percentage of positive cores were independently significant ( p ≤ 0.006). The PI-RADSv2 score was the most accurate predictor (AUC, 80.2%). The threshold of PI-RADSv2 score was 5, which provided high sensitivity (18/20, 90.0%) and negative predictive value (203/205, 99.0%). When PI-RADSv2 scores were combined with Briganti and MSKCC nomograms, the AUC value increased from 75.1 to 86.3% and from 79.2 to 87.9%, respectively ( p ≤ 0.001). The DCA also demonstrated that the two nomograms plus PI-RADSv2 scores improved clinical risk prediction of LNI. Conclusions The patients with a PI-RADSv2 score <5 were associated with a very low risk of LNI in PCa. Preoperative PI-RADSv2 scores could help improve the accuracy of clinical nomograms for predicting pelvic LN metastasis at radical prostatectomy.

Objective To investigate the role of cancerous inhibitor of protein phosphatase 2A (CIP2A) in proliferation,apoptosis and invasion of prostate cancer cells.Methods In this study,the expression level of CIP2A in tissues of prostate cancer (n =83) and benign prostatic hyperplasia (n =67)diagnosed in our hospital from May 2012 to September 2014 was detected,thereafter,the relationship between CIP2A expression level and clinicopathological features in prostate cancer tissues was analyzed.The human prostate cancer cell line LNCaP were divided into study group (silencing the CIP2A gene) and control group (no treatment) according to the different treatment methods.Then various indexes were detected by various methods,including expression levels of CIP2A protein and mRNA by Western blotting and reverse transcriptase-polymerase chain reaction (RT-PCR),cell proliferation by methyl thiazol tetrazolium(MTT) colorimetry,cell cycle distribution by flow cytometry,and cell invasion ability by Transwell TM assay,Results The positive expression rate of CIP2A protein in prostate cancer tissues was significantly higher than that in benign prostatic hyperplasia tissues (65.06％ vs.26.87％,P ＜ 0.01).The expression level of CIP2A protein was not correlated with the age (P ＞ 0.05),but was correlated with the postoperative-1-year recurrence rate,pathological differentiation,TNM staging and preoperative prostate specific antigen (PSA) levels (P ＜0.05);The relative expression level of CIP2A protein and mRNA in the study group was significantly lower than that in the control group (P ＜ 0.05).The proliferation rate of prostate cancer cells in the study group was significantly lower than that in the control group [(93.37 ± 4.23) ％ vs.(137.56 ± 4.19) ％,P ＜ 0.01];The proportion of cells in G1 phase of the study group was significantly higher than that of the control group [(58.74 ± 2.68) ％ vs.(49.82 ± 2.70) ％,P ＜ 0.01];The proportion of cells in S phase of the study group was significantly lower than that of the control group [(11.93 ± 1.41) ％ vs.(22.06 ± 2.13) ％,P ＜ 0.01];The number of transmembrane cells in the prostate cancer cells of the study group was significantly lower than that of the control group [(92.83 ± 8.50)vs.(142.69 ± 16.08),P ＜ 0.01].Conclusion CIP2A is highly expressed in prostate cancer tissues,and is related to postoperative recurrence,pathological differentiation,TNM staging and preoperative PSA levels;The study shows that CIP2A can promote prostate cancer cell proliferation,and invasion,as well as plays an important role in the process of apoptosis.

Objective It is to observe the curative effect of vardenafil,acipimox combined with traditional Chinese medicine in the treatment of diabetic erectile dysfunction.Methods One hundred and eighty cases of diabetic erectile dysfunction patients with kidney deficiency and blood stasis type were randomly divided into observation group and control group,there was 90 cases in each group.The patients were treated with vardenafil and acipimox in the control group,and with traditional Chinese medicine warming kidney,activating blood circulation and dredging collaterals decoction on the basis of the treatment of the control group in the observation group.The two groups were treated continuously for 12 weeks,then the clinical efficacy,IIEF-5 score before and after treatment,and safety of the two groups were observed.Results The total effective rate of the observation group was significantly higher than that of the control group (P ＜ 0.05);the IIEF-5 score in the observation group was significantly higher than that in the control group (P ＜ 0.05);there was no significant difference in the incidence of adverse reactions between the 2 groups (P ＞ 0.05).Conclusion The effect of vardenafil,and acipimox combined with warming kidney,activating blood circulation and dredging collaterals decoction on the treatment of kidney deficiency and blood stasis type diabetes erectile dysfunction is remarkable,the penis erectile function can be improved,and the safety of the medicine is higher.

Objective To investigate the synergistic efect of scopadulciol (SDC) on the killing effect on antitumor actions by Ad-hTERT-HSV-tk/ganciclovir (GCV) suicide gene system on prostate cancer cells in vitro.Methods To clarify the mechanism of enhanced effect of SDC in the gene therapy of human prostate cancer by TK-dependent GCV in molecular level,the TK enzyme activity and the concentration of GCV-TP in the tumor cells were measured by using high performance liquid chromatography (HPLC).The prostate cancer cells,respectively,were treated with Ad-hTERT-HSV-tk or GCV in combination with SDC with different doses and different concentrations.The killing effect and the bystander effect of these drugs in the therapy of human prostate cancer cells were observed.Results SDC had slightly effect on the TK enzyme activity of LNCaP and PC3 cells that were transduced by Ad-hTERT-HSV-tk.The GCV-TP concentration in the GCV treatment group was 100％.The GCV-TP concentration was ( 101.0 ± 1.5) ％ when 0.04 μmol/L SDC was added,but there was no significant difference.The GCV-TP concentration was up to ( 106.0 ± 4.5) ％ when adding 0.20 μmol/L SDC that was 5-fold higher for the dose of the therapy,and there was significant difference campared to the GCV treatment group (P＜0.05).It was confirmed that SDC had strong bystander effect and weak killing effect on the prostate cancer cells by conbination of Ad-hTERT-HSV-tk and GCV.Conclusion The synergistic effect of SDC is significantly shown in the therapy of human prostate cancer cells by TK-dependent GCV.SDC is effective in the Ad-hTERT-HSV-tk/GCV administration system in killing prostate cancer cells.

近年来,儿童外伤性尿道断裂的数量呈上升趋势,尿道闭锁由于病变部位深,传统开放手术损伤大,术野小,操作困难.随着腔内技术的发展,泌尿外科的大部分手术都可以通过腔内手术解决,也包括尿道狭窄及尿道闭锁.为探讨女童创伤性尿道闭锁的治疗方法,我院自2007年1月至2011年1月采用小儿膀胱镜结合尿道内切开镜辅助下行尿道会师术方法探通尿道7例,疗效满意,现总结分析如下.

新生儿期性别畸形的60％～70％是女性假两性畸形,最常见的原因为先天性肾上腺皮质增生( congenital adrenal hyperplasia,CAH)[1],临床并不多见,且常延迟诊治.2007年7月至2010年3月,我们共收治3例CAH所致女性假两性畸形,经手术矫治结合糖皮质激素替代治疗,效果满意。