Objective To investigate the expressions of metallothionein-2A (MT-2A), E-cadherin, interleukin-6 (IL-6), cyclin E, proliferating cell nuclear antigen (PCNA) and bcl-2 in prostate cancer tissues and their correlation with biochemical recurrence of prostate cancer. Methods Tissue specimens from 128 cases of prostate cancer who underwent radical prostatectomy in Shanxi Dayi Hospital from October 2012 to October 2017 were processed and transferred into tissue microarrays, the clinicopathological parameters of patients were also recorded. The expression levels of MT-2A, E-cadherin, IL-6, cyclin E, PCNA and bcl-2 were detected by immunohistochemical avidin-biotin complex (ABC) staining. The correlation between different molecular markers and biochemical recurrence of prostate cancer was analyzed. Results The biochemical recurrence rate of 128 patients with prostate cancer was 30.5％ (39/128). The biochemical recurrence rates of low-risk, intermediate-risk and high-risk prostate cancer patients were 14.8％(8/54), 38.7％(24/62) and 58.3％ (7/12), respectively. The risk classification and pathological T stage of patients with prostate cancer were associated with the expressions of MT-2A, cyclin E, IL-6 and E-cadherin (all P< 0.05). Multivariate Cox risk model showed that the high risk classification (HR= 1.81, 95％CI 1.56-2.19, P=0.042), MT-2A positive expression (HR= 2.01, 95％CI 1.08-3.15, P= 0.005), cyclin E positive expression (HR= 1.79, 95％CI 1.08-2.21, P= 0.042) and E-cadherin negative expression (HR= 1.92, 95％ CI 1.22-2.45, P= 0.020) were the independent risk factors for biochemical recurrence of prostate cancer. Conclusion The expression of MT-2A, cyclin E and E-cadherin may serve as independent predictors for biochemical recurrence of prostate cancer.

膀胱肿瘤是泌尿外科最常见的恶性肿瘤之一.随着生活水平提高,越来越多的早期无血尿等症状的膀胱肿瘤在体检中被发现.在膀胱肿瘤TNM分期中,非肌层浸润性膀胱癌约占80％,其中约90％为尿路上皮癌. 经尿道膀胱肿瘤电切术(TURBT)是治疗非肌层浸润性膀胱癌的"金标准"[1].2μm激光和钬激光是近年来发展的治疗膀胱肿瘤的微创技术,具有操作精细、出血少、术后恢复快等优点[2].本研究将比较2μm激光和钬激光在治疗非肌层浸润性膀胱癌上的安全性和有效性,现报告如下.

目的:良性前列腺增生(BPH)是一种临床进展性疾病,本研究观察了富半胱氨酸61(CYR61)、血管内皮生长因子-C (VEGF-C)、IL-6、细胞色素C(cytochrome c)、凋亡蛋白caspase-3及细胞核增殖指数Ki-67在BPH组织中的表达,并分析与BPH临床进展危险因素之间的相关性,探讨预测BPH临床进展的分子标志物.方法:收集BPH患者前列腺标本288例,记录所有患者的年龄、前列腺体积、血清PSA水平及国际前列腺症状评分(IPSS).明确前列腺组织中BPH病理学改变后将所有标本制作为BPH组织芯片.采用免疫组化ABC法对CYR61、VEGF-C、IL-6、cytochrome c、caspase-3和Ki-67的表达水平进行检测,并对不同分子标记物与BPH临床进展危险因素之间的相关性进行分析.利用免疫荧光双染技术检测BPH组织中CYR61和VEGF-C的同步表达和定位.结果:288例BPH标本中CYR61、VEGF-C、IL-6、cytochrome c、caspase-3和Ki-67的阳性表达例数分别为1 98例、221例、1 35例、76例、109例和102例,其阳性表达率分别为68.8％、76.7％、46.9％、26.4％、37.8％和35.4％.CYR61和VEGF-C表达与患者年龄、前列腺体积、血清PSA水平呈正相关(P＜0.05).cytochromec和caspase-3表达与前列腺体积呈负相关(P＜0.05).CYR61和VEGF-C的免疫荧光双染结果证实了BPH组织中CYR61和VEGF-C的同步表达.结论:CYR61和VEGF-C的高表达对BPH的临床进展可能具有预测作用.

目的 探讨肾脏原始神经外胚层肿瘤(PNET)的临床病理特征.方法 回顾性分析山西大医院收治的1例肾脏PNET患者的临床病理资料,并进行文献复习.结果 该患者临床表现和影像学检查无特异性,行根治性肾切除术,过程顺利.肉眼可见肿瘤切面呈灰红色,可区别于肾脏透明细胞癌;术后免疫组织化学提示为PNET、Vimentin(+)、CD99(+)、NSE(部分+)、CD117(部分+)、CD56(+)、Syn(+)、Fli-1(+)、Ki-67(30％+).术后21个月患者无复发及转移征象.结论 肾脏PNET临床罕见,预后相对较好,诊断依赖于组织病理学,早期手术治疗对改善预后有重要意义.

阴茎折断也称为阴茎白膜及海绵体破裂或阴茎骨折,是阴茎闭合性损伤中的一种,更是泌尿外科急症的泌尿系损伤患者中的一种病种之一,临床少见. 部分患者在阴茎损伤轻微时羞于就诊或者在不正规医院就诊,造成阴茎纤维瘢痕形成、硬结、勃起疼痛、性功能不全等不良后果. 现将2013年7月至2017年5月收治的17例患者病例资料进行分析,总结阴茎诊断的临床诊治体会,以期提高对阴茎折断疾病诊断及治疗水平.

尿路上皮癌是泌尿系统常见的肿瘤之一,上尿路癌占原发性尿路上皮癌的5％～6％,其中原发性输尿管癌占尿路上皮肿瘤的1％[1].对于原发性输尿管癌,标准治疗是将肾输尿管膀胱袖套状切除.有报道对于低级别低分期的输尿管肿瘤或对于孤立肾输尿管癌、双侧尿路上皮癌,肾功不全患者,合并内科疾患难以承受标准手术患者,可行保肾手术治疗[2],目前仍有争议[3].2011-2014年本院共实施176例输尿管肿瘤手术,其中151例行标准术式,25例行保肾手术治疗,效果满意,现将保肾治疗病例及临床资料报告如下.

目的:许多分子标记物的表达异常与前列腺癌(PCa)发生密切相关,本次研究观察了细胞色素C(cytochrome c)、凋亡蛋白caspase-3、p21、p27及增殖细胞核抗原(PCNA)在PCa、癌旁前列腺增生(BPH)组织及BPH组织中的表达,并分析与PCa临床进展危险因素之间的相关性.方法:分别收集PCa组织标本32例和BPH组织标本64例,记录PCa患者的血清PSA水平、Gleason评分及病理学TNM分期.采用免疫组化ABC法对cytochrome c、凋亡蛋白caspase-3、p21、p27及PCNA的表达水平进行检测,并对不同分子标记物与PCa临床进展危险因素之间的相关性进行分析.结果:与BPH组织相比,cytochrome c和caspase-3在PCa组织中的表达水平增高(P＜0.01),p21在PCa和BPH组织中的表达差异无统计学意义(P＞0.05),p27在癌旁BPH组织中的表达显著增高(P＜0.01),PCNA在PCa及癌旁BPH组织中的表达显著增高(P＜0.01,P＜o.05).cytochrome c和caspase-3表达与PCa患者的Gleason评分及病理学TNM分期之间呈负相关(P＜0.05).p21和p27表达与Gleason评分之间呈负相关(P＜0.05),然而PCNA表达与Gleason评分、血清PSA水平呈正相关(P＜0.05).结论:通过组织芯片技术,研究细胞凋亡与增殖因子在PCa组织中的表达对进一步明确PCa发生及临床进展的分子机制具有重要作用.

Objective To evaluated the clinical efficacy of transurethral en bloc resection of bladder tumor with 2 μm laser in the high-risk elderly patients with bladder cancer under local anesthesia. Methods All of 64 high-risk elderly patients having underwent surgical treatment from April 2015 to October 2016 were divided into 2 groups,2 μm laser group(30 patients)and transurethral resection of bladder tumor(TURBT)group(34 group)according to surgical methods.The area and degree of pain was observed and recorded using visual analogue scales(VAS)during the 2 μm laser operation. The operation time,bladder irrigation time,catheter indwelling time,hospital stay,complications and 1-year cumulative recurrence rate were compared between 2 groups. Results The ASA grade in 2 μm laser group was higher than that in TURBT group and there was significant difference(P<0.05).During the 2 μm laser operation,the urethra pain was 53.33%(16/30),bladder pain was 20.00%(6/30), both urethra and bladder pain was 26.67%(8/30).The VAS scores were(2.50 ± 1.38)points,all the patients tolerated the pain in the 2 μm laser group.There was no significant difference in operation time between 2 groups(P>0.05).The bladder irrigation time,catheter indwelling time and hospital stay were shorter in 2 μm laser group than those in TURBT group:(40.00 ± 19.06)h vs.(56.47 ± 14.55)h,(4.33 ± 1.40)d vs. (5.65 ± 0.93) d,(4.13 ± 1.51) d vs. (6.24 ± 0.75) d,P<0.05 or<0.01. The overall incidence of complications was lower in 2 μm laser group than that in TURBT group:13.33%(4/30) vs. 64.71% (22/34),χ2=8.719,P=0.003.Compared with that of pre-treatment,the quality of life was higher after treatment in two groups,but there were no significant differences between the two groups.There were no significant differences in 1-year cumulative recurrence rate between the two groups after treatment (χ2= 0.496,P = 0.481). Conclusions Transurethral 2 μm laser treatment in bladder cancer under urethral surface anesthesia is safe and reliable for the high-risk elderly patients and complications are fewer than TURBT.The recent curative effect is satisfied.

Objective:To explore the minimally invasive treatment of acute renal failure associated with ceftri-axone sodium-related drug calculi.Methods:Thirteen cases of acute renal failure caused by deftriaxone sodium-re-lated drug calculi were retrospectively analyzed in our hospital from October 2013 to October 2016.There were 5 males and 8 females with mean age of 34 years.The mean serum creatinine level was 384 μmol/L and mean urea nitrogen was 12.3 mmol/L.Indwelling of ureteral stents by bladder scope was done.Results:All 13 patients were successfully subjected to indwelling of ureteral stents.Thirty min to 1 h after operation,the average urine was 1 500 mL.After 2-3 days,renal function was normal.Conclusions:In acute renal failure caused by ceftriaxone so-dium-related drug calculi,ureteral obstruction should be relieved as soon as possible,renal function recovers,and simultaneously,ceftriaxone sodium should be used normatively.

Objective To investigate the safety and effectiveness of 2 μm laser resection of transurethral bladder tumor under urethral surface anesthesia.Methods Clinical data of 13 elderly patients with high-risk bladder tumor who underwent 2 μm laser resection of bladder tumor under urethral surface anesthesia in our hospital from January 2015 to January 2017 were retrospectively analyzed.Results Thirteen cases of bladder tumor were successfully operated,and the average operation time was 30 min,none appeared obturator nerve reflex,uncontrollable bleeding and bladder perforation.There was no need for continuous bladder flushing,the average indwelling catheter 1 d,no seeondary hematuria or massive bleeding occurred after the operation.The specimen of bladder tumor sent to pathological sections of the pathological section can correctly determine the depth and staging of the tumor invasion.Conclusions Urethral surface anesthesia in transurethral resection of bladder tumor 2 μm laser surgery is safe and effective and time-saving,the advantages of small trauma,fewer complications,faster postoperative recovery,does not affect postoperative pathological examination,more important is this operation can solve the intolerable requirements of superficial bladder tumor patients of other anesthesia operation,worthy of promotion.

目的 探讨经尿道2μm激光膀胱部分切除术联合髂内动脉栓塞化疗对高危浸润性膀胱癌的疗效.方法 对收治的18例高危浸润性膀胱癌患者经尿道行2μm激光膀胱部分切除术,术后加用髂内动脉栓塞化疗.结果 18例患者经动脉栓塞化疗后,16例发生恶心、食欲不振,5例发生呕吐,3例发热,经对症处理后缓解.外周血血红细胞、白细胞减少5例,经对症处理1周后恢复正常.随访6~42个月,平均24个月.3例患者术后6个月复发,1例术后12个月复发,其余14例无瘤生存.结论 经尿道2μm激光膀胱部分切除术联合髂内动脉栓塞化疗治疗高危浸润性膀胱癌复发率较低,不良反应少,安全有效.

目的 探讨电子输尿管镜联合2μm激光治疗尿道狭窄的疗效.方法山西大医院2012年1月至2014年8月采用电子输尿管镜联合2μm激光治疗尿道狭窄30例(长度1.0～2.5cm,平均1.3±0.4 cm),术后6周拔除尿管,定期尿道扩张4～6次.结果 本组30例,1次手术成功率100％,手术时间20～60 min,平均(34±9) min,拔除尿管后最大尿流率(Qmax)为15.9～25.5 ml/s,平均(21.2±3.2) ml/s.全部病例均未出现严重出血、尿道穿孔、假道形成、尿瘘、直肠损伤、尿失禁等并发症.随访4～12个月,29例术后无复发和再狭窄,最大尿流率(Qmax)均＞15 ml/s,膀胱残余尿量＜50 ml,1例术后3个月尿线变细,行膀胱镜下尿道扩张后治愈.结论 电子输尿管镜联合2μm激光治疗尿道狭窄,手术视野清晰、创伤小、并发症少、效果明显、安全可靠,近期疗效满意.

目的:评价TURBt联合术前髂内动脉化疗栓塞术治疗直径≥3 cm的肌层浸润性膀胱癌的临床效果.方法:将45例直径≥3 cm的肌层浸润性膀胱癌患者(分期:T2-3N0M0)分为A、B两组,A组23例,单纯行TURBt,B组22例,行TURBt联合术前髂内动脉化疗栓塞.统计分析比较两组手术时间、出血量、生存率、复发率、不良反应发生率,并绘制生存曲线及复发率曲线.结果:A组手术时间为(61.2±8.3)min,出血量(55.8±3.7)ml,B组手术时间为(30±8.4)min,出血量(20.3±5.4)ml,两组比较差异有统计学意义(P＜0.05).3年生存率,A组为86.36％,B组为95.00％,两组比较差异无统计学意义(P＞0.05).3年复发率,A组为54.55％,B组为45％,两组比较差异有统计学意义(P＜0.05).两组不良反应发生率比较差异无统计学意义(P＞0.05).结论:TURBt术前髂内动脉化疗栓塞治疗直径≥3 cm的肌层浸润性膀胱癌有效降低了手术难度及术后复发率,近期效果满意.

Objective To study the expression and clinical significance of matrix metalloproteinase 2 (MMP-2) in chinese patients with bladder cancer. Methods The relevant original articles published in journals from 1998 to 2014 were selected. The ratio of the case group and the control group (OR value) regarded as an effect index. Then the original data were analyzed using Meta analysis software RevMan 5.0, the combined OR values and 95%confidence interval were calculated, and the forest map was draw. Results 13 studies involving 692 patients that met the inclusion criteria were included in the Meta analysis. The OR values of bladder cancer tissue group and normal bladder tissue group, superficial bladder cancer group and invasive bladder cancer group, and low grade bladder cancer group and senior bladder cancer group were 45.83, 0.22 and 0.31, respectively. The positive rates of MMP-2 in bladder cancer tissue group, invasive bladder cancer group and advanced bladder cancer group were significantly higher than those in normal bladder tissue group, superficial bladder cancer group and low grade bladder cancer group (all P< 0.05). Conclusions The high expression of MMP-2 has a certain effect in bladder cancer. The detection of MMP-2 contributes to the understanding of the biology of bladder cancer, and provides information for clinical treatment and prognosis.

目的:探讨前列腺平滑肌肉瘤的临床诊治和预后特点.方法:汇报1例39岁前列腺平滑肌肉瘤患者,以“进行性排尿困难2个月余,不能自主排尿15天”入院.超声检查提示:考虑为脓肿可能;前列腺MRI检查提示:前列腺异常信号,考虑为占位病变;膀胱镜检查示:前列腺不规则增生.于2013年3月18日在腰硬联合麻醉下行“经尿道前列腺诊断性电切术”,手术顺利.查阅相关文献复习讨论.结果:病理报告示:组织呈灰白、灰红色,HE染色可见短梭形细胞、核大小差异较大,细胞丰富、密集、呈浸润性生长、核异型性明显、可见核分裂象;免疫组化示:Vimentin(+++)、Desmin(+)、SMA(+)、Caldesmon(+++),病理诊断:低分化平滑肌肉瘤.结论:前列腺平滑肌肉瘤是一种罕见的前列腺肿瘤,其发病机制目前还不清楚,临床诊断常较为困难,确诊需依靠病理学组织学及免疫组化染色检查.治疗以手术切除联合放化疗为主,但其病情进展迅速,预后不佳.

Objective To explore the protective role of tea polyphenol on the oxidative stress and cellular apoptosis of testicular tissues in experimentally-induced varicocele rat models .Methods A total of 32 male prepubertal Wistar rats were randomly divided into 4 groups ,with 8 rats in each group .Group I was the sham operation group .Group Ⅱ was the varicocele model group .Group Ⅲ and Ⅳ were the tea polyphenol groups ,in which the varicocele models were treated with tea polyphe-nol of different concentrations .Four weeks after the models were established ,group I and Ⅱ were fed with 1 mL/100 g nor-mal saline ,group Ⅲ and Ⅳ were fed with 10 mg/kg and 40 mg/kg tea polyphenol respectively .After being fed once every day for 4 weeks ,all rats were executed and the left testes were collected to detect the vitality of superoxide dismutase (SOD) ,con-tent of malondialdehyde (MDA) ,and the apoptosis index (AI) .Results Group I showed the highest vitality of SOD ,fol-lowed by group Ⅱ ,Ⅲ and Ⅳ (P<0 .05) .Group II had the highest measurement of MDA and AI ,followed by group Ⅲ ,Ⅳ andⅠ (P<0 .05) .Conclusion Tea polyphenol can significantly reduce the oxidative stress and cellular apoptosis of testicular tis-sues ,indirectly improving the spermatogenesis in rats .

Objective To systematically evaluate the efficacy and safety of solifenacin versus tolterodine, for treatment of overactive bladder (OAB). Methods Chinese and English literatures of randomized controlled trials us-ing solifenacin versus tolterodine for treatment of OAB were collected, and the references included in the literatures were searched. Statistical software, RevMan 5.0 was used for the meta-analysis. Results Eight studies, involving a to-tal sample size of 832 cases, were included for the meta-analysis, with the same examined baseline. By comparing five common parameters and adverse reactions after medication, meta-analysis found that there were no statistical differ-ences in improving OAB daily frequency of urgent urination, urinary incontinence, and nocturia between using solife-nacin and tolterodine. However, the effect of using solifenacin in improving daily frequency of urination and micturi-tion volume per voiding were better than those of using tolterodine, with statistically significant differences ( P<0.05). For adverse reactions, the dry mouth incidence of using solifenacin was 50%lower than that of using tolterodine, with statistically significant difference (P<0.05). There were no statistical differences in constipation, blurred vision, and dyspepsia between using solifenacin and tolterodine. Conclusion Both of solifenacin and tolterodine can improve symptoms of OAB, whereas the effects of using solifenacin in improving daily frequency of urination, micturition vol-ume per voiding, and dry mouth are better than those of using tolterodine. As the included literatures and sample size were limited, large sample size and long-term follow-up of high-quality clinical trial can provide better evidence-based findings.

OBJECTIVE:To study the effect of tea polyphenols (TP) on the apoptosis of germ cells in rats with experimental varicocele.METHODS:Thirty-two adolescent male Wistar rats were randomly and equally divided into groups A (sham-operation), B (high-dose TP), C (low-dose TP), and D (experimental left varicocele). Experimental varicocele was induced by partial ligation of the left renal vein in the latter three groups of rats. The animals in groups A and D were fed with normal saline, while those in B and C with TP at 40 and 10 mg per kg per d, respectively, all for 4 weeks. Then, all the rats were sacrificed and the left testes harvested for determination of the expression of HIF-1, Bcl-2, Bax, CytC, and caspase-3 by immunohistochemistry and measurement of the apoptosis index (AI) of spermatogenic cells.RESULTS:The expression of Bcl-2 was higher in groups B and C than in D but lower than in A (P < 0.05), and lower in C than in B (P < 0.05). However, the expressions of HIF-1, Bax, CytC, and caspase-3 were lower in groups B and C than in D but higher than in A (P < 0.05), and higher in C than in B (P < 0.05). The AI of spermatogenic cells was the lowest in group A, higher in D than in the other groups but lower in B than in C (P < 0.05).CONCLUSION:TP can reduce the apoptosis of spermatogenic cells in a dose-dependent manner in varicocele rats.

肾结石的传统治疗方法主要是冲击波碎石和经皮肾镜碎石，但其碎石效果和安全性一直难以令人满意，而输尿管软镜利用人体的自然解剖通道进入肾盂治疗肾结石具有微创和安全等优点，使用输尿管软镜成为处理上尿路结石的新趋势［1］。新型组合式输尿管软镜是一种可拆卸组合式输尿管软镜，在一定程度上弥补了传统的一体式输尿管软镜价格昂贵、易损坏、维修成本高等不足，大大推动了该项技术在临床上的应用。但组合式输尿管软镜由于分体组合的特点，因而存在视野不够清晰和只能单向操作等缺点，如何联合钬激光准确定位和有效碎石成为技术难点。我院自2012年4月至2013年10月应用组合式输尿管软镜联合钬激光治疗98例肾结石患者，疗效满意，现报告如下。

患者男，29岁，因车祸致胸腹部联合损伤，腹壁破裂，部分肠管外露，无意识，后就诊于当地医院，考虑腹部开放性损伤、左侧胸腔积液，急诊行剖腹探查术，术中发现膈肌撕裂、部分小肠坏死、部分降结肠坏死，行膈疝修补术＋肠部分切除术＋结肠造瘘术＋左侧胸腔闭式引流术，术中输浓缩红细胞及血浆，因病情危重，术后3d 转入我院进一步治疗。平素体健，无食物、药物过敏史，无肝炎、结核等传染病病史。入院查体：结肠造瘘口排便通畅，全身多处瘀斑、瘀点，多处皮肤软组织擦伤，左腰背部皮下血肿，可及肿块，伴有波动感。入院查泌尿系CT （图1）：考虑有左肾挫伤。入院后给予监测生命体征、抗感染、保肝、补液、纠正电解质紊乱及酸碱失衡等对症支持治疗；因左腰背部皮下血肿积液行切开引流，持续有脓液渗出，并坏死组织脱出（图2），给予定期换药期间腹部伤口不愈合，遂行清创缝合术。入院2个月后病情平稳复查 CT （图3）示左肾缺如，肾窝局部有渗出。建议行肾动态显像检查，患者及家属不同意行该检查。同时，本例患者左腰背部瘘口间断仍有脓液渗出，不愈合，行造影检查（图4）考虑与后腹腔行通，建议行探查或清创术，患者及家属暂不同意。目前患者病情平稳，肾功能正常，已办理出院。