目的观察肾细胞癌组织中KISS-1、基质金属蛋白酶-9(MMP-9)蛋白的表达变化,并探讨其临床意义。方法采用免疫组化方法检测50例肾细胞癌组织、15例癌旁肾组织、15例正常肾组织中的KISS-1和MMP-9蛋白。结果肾细胞癌组织、癌旁肾组织及正常肾组织中KISS-1蛋白呈阳性表达者分别为16(32.00%)、11(73.00%)、10(66.67%)例,三者相比,P<0.05;KISS-1蛋白的表达与肾细胞癌的临床分期、淋巴结转移及肿瘤分化程度有关(P均<0.05)。肾细胞癌组织、癌旁肾组织及正常肾组织中MMP-9蛋白呈阳性表达者分别为32(64.00%)、6(40.00%)、1(6.67%)例,三者相比,P<0.05;MMP-9蛋白的表达与肾细胞癌的临床分期、淋巴结转移及肿瘤分化程度有关(P均<0.05)。肾细胞癌组织中KISS-1及MMP-9蛋白的表达呈负相关(rs=-0.468,P<0.01)。结论肾细胞癌组织中KISS-1蛋白低表达、MMP-9蛋白过表达,可能与肾癌的发生及侵袭转移有关,而且KISS-1基因可能抑制MMP-9蛋白的表达,二者有望成为判断肾细胞癌侵袭和转移能力的生物学指标。

Objective To observe the expression of metastasis suppressor gene KISS-1 in renal cell carcinoma(RCC),and explore its clinical significance.Method The expressions of KISS-1 protein were detected by the immunohistochemical method in 50 cases of RCC tissue,15 cases of paracarcinoma tissue and 15 cases of normal renal tissue.Results The positive rate of KISS-1 protein in RCC tissue was 32.00%,significantly lower than 73.00% in paracarcinoma tissue and 66.67%in normal renal tissue(all P 0.05);the expression of KISS-1 protein was correlated with clinical stage,lymph node metastasis and RCC differentiation in the RCC(all P0.05),and the positive rate of KISS-1 protein was negatively correlated with RCC differentiation(rs=-0.481,P=0.000).Conclusions The expression of KISS-1 protein is visibly decreased in RCC tissue,and it plays a certain inhibitory role in the occurrence and development of RCC.KISS-1 protein may become a new biological indicators of RCC which predicted the malignant level.

Objective To explore the diagnosis and treatment of renal trauma.Methods One hundred and two cases of renal trauma were treated with conservative procedure,renal repair,nephrectomy and super selected renal artery embolization,respectively.The curative effects were observed.Results Among the 102 cases,conservative procedure was performed in 72,renal repair in 5,nephrectomy in 13 and super selected renal artery embolization in 12.Ninety-nine patients were cured and 3 patients died of the injury.Conclusion Hematuria and flank pain are the main clinical symptoms of renal trauma.Urine examination and B-ultrasonography should be the routine methods and CT examination has important diagnosis value for the diagnosis of renal trauma.The therapies mainly depend on the types and extent of renal trauma and the condition of compound wound.

Objective:To appraise the clinical outcome in localized renal cell carcinoma(RCC) of patients who undergoing retroperitoneal laparoscopic radical nephrectomy.Methods:70 patients underwent radical nephrectomy for localized RCC,and all operation completed by the same platoon doctors.30 by retroperitoneal laparoscopic radical nephrectomy and 40 by open radical nephrectomy through an extraperitoneal 11th rib flank incision.There is no statistically significant difference in the 2 groups' data.The operation time,blood loss during operation,hospital stay and complication after surgery were analyzed and compared.All the cases were followed up for 5-40 months(mean times 23 months) and the survival rates,wound healing,and carcinoma metastasis were recorded. Results:compared retroperitoneal laparoscopic radical nephrectomy with open radical nephrectomy;operation time 90-360 min(mean 110±11.3 min) vs.100-150 min(mean 100±10.5 min)(P0.05).Blood loss 50-1 600 ml (mean 108.6±28.3 ml) vs.70-1 100 ml(mean 162.8±40.1 ml P0.05);total narcotic requirement after surgery 8 vs.32(P0.05).fasting period 1-2 day(mean 1.3±0.5d) vs.3-5 day(mean 3.1±1.1d,P0.05);length of hospital stay 3-7 day(mean 4.5±1.3d) vs.7-13 day(mean 8.8±1.7d.P0.05).Conclusions:compared with open radical nephrectomy,retroperitoneal laparoscopic radical nephrectomy is associated with lower blood loss, narcotic requirement and complications,a shorter hospital stay and earlier resumption of routine activities.Retroperitoneal laparoscopic radical nephrectomy has become the first therapy in localized renal cell carcinoma.

Objective:To investigate the clinical features of leiomyosarcoma of the kidney(LMSK) and the methods of diagnosis and treatment.Methods:1 case of LMSK confirmed by surgery and pathology was analyzed. and the clinical presentations,pathologic characteristics,the diagnosis,treatment and prognosis of LMSK were discussed with review of the literature.The patient was a female,presented with complaint of intermittent lumbago in left side for 8 days.Ultrasound-B and CT scan of the abdomen revealed a space-occupying lesion arising from the left kidney.Results:The patient underwent radical nephrectomy.The tumor was 6 cm in diameter,The pathology showed alternating fascicles of spindle cells with blunt-ended non-tapering nuclei and eosinophilic cytoplasm.Immunohistochemistry showed tumor cells with diffuse cytoplasmic positivity forα-smooth muscle actin(α-SMA) and desmin(Des).They were negative for cytokeratin(CK) and HMB-45.By TNM staging:T_(2b)N_0M_0,G_2,stage:ⅡA.The patient died of local recurrence and lung metastasis 5 months after operation.Conclusions:LMSK is an extremely rare and highly malignant with poor prognosis.clinical presentations and radiologic features are nonspecific and diagnosis is usually made postoperatively.Surgical excision being the primary treatment,the efficacy of adjuvant chemotherapy and irradiation remains debatable.

【Objective】To summarize the experience of diagnosis and minimally invasive treatment on acute anuria caused by bilateral ureteral obstruction due to medicine crystal deposition.【Methods】Two patients with acute anuria caused by bilateral ureteral obstruction due to medicine crystal deposition were treated,and the clinical data were reviewed.【Results】The main clinical manifestations consisted of anuria after injection of antibiotic,pain in renal region,high levels of creatinine.The main adjuvant examinations included B-ultrasound,X-ray (KUB) and noncontrast 64-row helical CT.The upper urinary tract obstructions were detected by B-ultrasound and CT.Neither were diagnosed definitively by B-Ultrasound and X-ray (KUB).CT detected the slightly-high density image in the lower ureter.Maximum intensity projections (MIP) showed the slightly-high density image in the lower ureter clearly,and their CT values were 30～128 Hu;upper urinary tract obstructions were removed in both cases by ureteroscopic or cytoscopic part medical crystal removal and being placed double J stents,renal function recoved to normal rapidly postoperative in both cases and were normal two monthes later.【Conclusions】In patients with obstructive anuria caused by bilateral ureteral obstruction due to medicine crystal deposition,conventional KUB and US could not identify the cause of ureteral obstruction,but noncontrast 64-row helical CT MIP reconstruction could produce clear and comprehensive images of medicine crystal in the lower uerter,and could provide the diagnosis.The minimally invasive treatments including ureteroscopic or cytoscopic part medical crystal removal and placing double J stent are active treating methods.

目的分析因膀胱肿瘤行根治性膀胱全切后的尿流改道手术方式的选择标准及临床效果。方法选择2001年6月～2008年1月我院因膀胱肿瘤行根治性膀胱全切术后并尿流改道的病例共69例,其中回肠膀胱术37例,回肠新膀胱术32例。就两种尿流改道的术式的手术适应证和并发症进行分析。结果69例手术患者均无围手术期死亡。回肠膀胱术者出现酸中毒、电解质紊乱、肠梗阻近期并发症7例;回肠新膀胱出现近期并发症共6例。回肠新膀胱其中3例需压腹排尿或间断导尿,2例女性出现夜间尿失禁,其余术后能自行排尿。术后复查膀胱镜均未见尿道肿瘤复发。结论接受原位新膀胱患者的生活质量要优于接受非可控性尿流改道的患者,但应根据患者的具体情况来选择合适的尿流改道方式,以减少术后并发症的发生。

Objective To explore the effective methods of preventing recurrence of bladder carcinoma.Methods 82 patients were treated with preventative urinary bladder irrigation chemotherapy after transurethral resection of bladder tumor(TUR-BT),including pirarubicin (THP) in 48 cases (THP group) and hydroxycamptothecin (HCPT) in 34 cases (HCPT group).Follow-up was performed to compare the efficiency difference between the two groups.Results The postoperative tumor recurrence rate of THP group was significantly lower than that of HCPT group (10.42% vs 26.47%,P<0.05).Furthermore THP group had fewer side effects than HCPT group(14.58% vs 23.53%,P<0.05).Conclusion Both THP and HCPT can reduce the postoperative recurrence rate of bladder tumor,of which THP is more effective and safer.

1 临床资料 患者,男,72岁,于2009年2月25日在南昌大学第二附属医院体检时行B超检查发现右侧肾囊实性混合性团块,考虑为囊肿.行双肾CT平扫加增强扫描示:双肾不均匀强化囊实性占位,考虑为恶性病变,以转移性肿瘤可能性大.

Objective To evaluation the curative effect of transurethral resection of prostate(TURP)and transurethral plasmakinetic vaporize resection of prostate(PKRP)for the treatment of symptomatic benign prostatic hyperplasia(BPH)in the near future.Methods From March 2008 to November in the Urology Second Affiliated Hospital of Nanchang University,73 patients who were diagnosised BPH served as control group,line TURP treatment;and in December 2008 to June 2009 in the same unit,61 patient with BPH as a treatment group,line PKRP treatment.Observed two groups of patients with operative time,bleeding volume,preoperative and postoperative 15 days of IPSS,RUV,Qmax,QOL and postoperative complications.Results The treatment group the average operative time is a slightly longer than that in the control group,but the difference was not statistically significant(P0.05);treatment group,bleeding volume,postoperative complications occurrence were significantly lower than the control group(P0.05 or P0.01);two groups postoperative 15 days of IPSS,RUV,Qmax,QOL compared with the preoperative value differences were statistically significant(all P0.01),the treatment group after 15 days of IPSS,RUV,Qmax,QOL values compared with the control group had no statistically significant difference(all P0.05).Conclusion PKRP treatment is superior to TURP at present,is the ideal treatment of BPH.

Objective To report the efficacy of lithotripsy with laser U100 on treatment of ureteric calculi,and discuss the failure reasons and complications.Methods To summarize and analyze 541 cases in the urological department of the second affiliated hospital of Nanchang University between February 2003 and October 2006.Results The success rate of U100 laserlithotripsy on treatment of ureteric calculi was 91.3%(494/541),and the success rates of upper and mid-lower ureter were 85.1%(177/208)and 95.2%(317/333)respectively,and the rate of upper ureter was higher than mid-lower obviously(P0.005).In one week,the total stone-free rate was 86.0%(425/494),and stone-free rate of upper,mid-lower ureter was 78.0%(138/177),90.5%(287/317)respectively and the rate of upper ureter was higher than mid-lower evidently(P0.005).Three patients had ureter perforation,but no more complications appeared including ureter segmentation or inner membrane avulsion,and no post operation complication like ureterostenosis.Conclusion Ureteroscope U100 laser lithotripsy is a safe and effective endourological approach,because of high lithotripsy efficacy,satisfactory stone-free rate,low complications and minimal invasion,short hospital stay and fast recovery.

Objective To study and evaluate the diagnosis and treatment strategy of Pheochromocytoma.Methods The clinical data of 38 cases of patients with adrenal gland pheochromocytoma were reviewed retrospectively.Results all the 38 cases gained definitive diagnose.Among them 32 cases received surgical treatment and was conformed by pathologic studies with 29 of benign and 3 of malignant. Their hypertension and other symptoms were effectively controlled and the patients resumed satisfactively.Conclusion The procedures of the qualitative and locative diagnosis of adrenal gland pheochromocytoma included clinical manifestation,urinary VMA assessment and imaging investigation. Surgical management was the only means for curing the disease.The three important steps were surfficient preoperative preparation.Carefully operation and control of blood presure between interdicting blood supply of tumors.laparoscopic adrenalectomy is a therapeutic tool which has great future.