目的 比较超声联合神经刺激仪引导下经腹股沟远端入路闭孔神经阻滞(ONB)和传统体表标志定位联合神经刺激仪引导下ONB在经尿道膀胱肿瘤电切术(TURBT)中预防闭孔神经反射的效果差异.方法 收集2019年3月至2021年12月在华润武钢总医院行TURBT的患者共32例,术前影像学或内镜检查评估膀胱肿瘤均位于膀胱侧壁单侧或双侧闭孔神经支配区域,将其随机分为超声引导组(U组)18例和体表标志定位组(S组)14例.对比两组患者每侧ONB的穿刺次数、操作时间、ONB成功率、术中ONB的效果及并发症发生情况等.结果 U组患者均为1次穿刺成功;S组患者有8侧为1次穿刺成功,10侧为2次及以上穿刺成功,其中1例失败,两组穿刺成功率比较差异无统计学意义(P>0.05).U组ONB操作时间显著低于S组(P<0.05).U组有1例术中出现轻度闭孔神经反射;S组有8例术中出现轻度闭孔神经反射,两组比较差异有统计学意义(P<0.05).所有患者均未出现局麻药中毒、术后闭孔神经支配区域痛性感觉异常及闭孔神经损伤等情况.结论 与传统体表标志定位联合神经刺激仪引导下ONB比较,超声联合神经刺激仪引导下经腹股沟远端入路ONB定位更准确、穿刺次数少、操作时间短且阻滞效果好,值得临床推广使用.

目的 探讨硕通镜钬激光碎石术治疗上尿路结石患者的清石率及安全性.方法 选取2016年6月至2019年11月北京市隆福医院收治的74例上尿路结石患者为研究对象,按照患者病床单双号分为两组,分别为观察组、对照组.观察组实施硕通镜下钬激光碎石术治疗,对照组实施微创经皮肾镜碎石术治疗,对比两组患者的各项围手术期指标.结果 观察组患者的手术时间、术中出血量及住院时间与对照组比较,均优于对照组(P<0.05);观察组结石清除率为94.59％,与对照组的89.19％对比,差异无统计学意义(P>0.05).手术前,两组患者疼痛程度比较,差异有统计学意义(P<0.05);手术后,观察组疼痛评分要显著低于对照组(P<0.05).观察组术后并发症发生率为5.41％,显著低于对照组的21.62％(P<0.05).结论 硕通镜下钬激光碎石术治疗上尿路结石患者的临床价值显著,清石率高,且术后疼痛轻,并发症发生率低.

目的 分析用自行研制的等离子"V"型电极行经尿道膀胱肿瘤整块切除的可行性及临床疗效.方法 选取2015年4月至2016年10月华润武钢总医院收治的膀胱癌患者29例作为研究对象,其中男20例,女9例,平均年龄41岁.肿瘤单发11例、多发18例.用5％葡萄糖将吡柔比星20 mg稀释至20 ml作为标记及填充液,用于膀胱肿瘤基底部注射.用自行研制的等离子体"V"型电极行经尿道膀胱肿瘤整块切除.观察肿瘤整块切除的完整性、膀胱闭孔神经反射发生的频次和幅度及肿瘤局部复发等临床效果.结果 29例患者合计切除肿瘤数66枚,均整块切除,每例分别有1～5枚瘤体,均带蒂,肿瘤大小为0.5～2.0 cm.肿瘤病理分期:T123例、T2a 3例、T2b 3例;病理分级:Ⅰ级5例、Ⅱ级22例、Ⅲ级2例.66枚肿瘤中位于膀胱侧壁的有39枚.术中发生闭孔神经反射12次,无膀胱穿孔及术后膀胱出血等并发症.随访时间10～17个月,未见肿瘤术后原位复发.结论 经尿道等离子体"V"型电极膀胱肿瘤整块切除术疗效确切,安全可行.

Urinary tract infection complicated with urinary tract calculi( lithangiuria)is one of the most common diseases causing serious urinary sepsis and septic shock. Recent studies show that the accurate diagnosis,rational use of antibiotics and timely treatment of complications are the key to treatment success. In this article,the latest progress and the treatment strategies for urinary tract infections complicated with lithangiuria are explored.

原发输尿管尿路上皮癌是临床上相对少见的尿路上皮恶性肿瘤,约占整个尿路上皮肿瘤的5％[1],其中以移行细胞癌最为常见,约占原发性输尿管癌的95％以上.由于输尿管尿路上皮肿瘤不易直接观察,不易进行局部治疗,发现时较膀胱尿路上皮肿瘤有更高的肿瘤分期[1-2],且输尿管肌层薄,而淋巴丰富,故输尿管尿路上皮癌更早出现转移或更易穿透至输尿管周围,最为常见的远处转移是肝脏、骨骼及肺[3],预后差,故早期诊断、早期治疗是提高原发输尿管尿路上皮癌治疗效果的关键.

Objective:To discuss the etiology diagnosis and treatment of cryptorchidism malignant abdominal type of germ cell tumor.Methods:One case of bilateral cryptorchidism and unilateral malignant huge germ cell tumor was reported and review the literature.Results:The incidence rate of bilateral cryptorchidism and unilateral malignant germ cell tumor is low,and founded in late stages.Treatment protocols of abdominal type of germ cell tumor should be different from groin type and scrotum type.Postoperative radiotherapy,chemotherapy and follow-up should be actively proceeded,the result was eusemia.Conclusion:The germ cell tumor is relatively uncommon.The cryptorchidism is the high risk factor.The patient of cryptorchidism should be treated by surgery actively.Adjuvant chemotherapy is the key to improve the survival rate.

目的:对经直肠前列腺穿刺活检病例的临床资料、病理形态学及免疫组化进行分析,以提高对前列腺癌的临床及病理诊断准确率.方法:回顾性分析我院2006年1月~2011年6月间153例行前列腺穿刺活检病人的临床及病理资料,研究其血清PSA、病理形态学特点,并将其中确诊为前列腺癌患者50例与良性前列腺病变患者103例进行对比分析.结果:前列腺癌50例,血清PSA平均值为(84.54±32.99)ng/ml,免疫组化显示,PSA阳性率为96%.P504s阳性率为94%,CK34βE12和P63阳性率分别为33.3%和20.4%;良性前列腺病变103例,其中良性前列腺增生96例,血清PSA平均值为(11.29±1.086)ng/ml,免疫组化显示,PSA阳性率为100%,CK34βE12和P63阳性率分别为99%和98.9%,P504s局灶性弱阳性率为1%;前列腺上皮内瘤变(PIN)7例,血清平均PSA为(20.314±10.10)ng/ml,免疫组织化学显示,PSA阳性率为100%,CK34βE12和P63阳性率分别为85.7%和85.7%,P504s局灶性弱阳性率为42.9%.结论:结合临床资料、病理形态学改变及免疫组化进行综合分析,能够提高前列腺癌诊断和鉴别诊断的准确率.

Objective To improve the accuracy of the clinical and pathological diagnosis in prostate carcinoma by analysing clinical date,pathomorphology and immunohistochemical staining of biopsy specimen acquired by prostate paracentesis through rectum.Methods retrospectively analysed the clinical and pathological date of 153patients in our hospital from January 2006 to June 2011,and investigated the information about PSA and pathology.Finally,50 patients with prostate carcinoma and 103cases of benign prostate lesions were analyzed contrastively in these patients.Result In the 50 cases with prostate carcinoma,the serum PSA mean of patients was(84.54±132.99)ng/ml,the immunohistochemistry showed PSA positive rate was 96%.P504s positive rate was 94%,CK34βE12and P63positive rate was 33.3% and 20.4%.103 cases of benign prostate disease,96 cases of these patients were diagnosed benign prostatic hyperplasia,the serum PSA mean of them was(84.54±32.99)ng/ml.The immunohistochemistry showed that: PSA positive rate was 100%,CK34βE12and P63positive rate was 99% and 98.9%,P504sfocal weak positive rate of 1%.Other seven cases were diagnosed prostatic intraepithelial neoplasia(PIN),the serum PSA mean of patients was(20.314±10.10)ng/ml,the immunohistochemistry showed PSA positive rate was 100%,CK34βE12and P63positive rate was 85.7% and 85.7%,P504spositive rate was 42.9%.Conclusion Combined with clinical date,pathomorphology change and immunohistochemical index,the accuracy rate of diagnosis and differential diagnosis in prostate carcinoma was improved remarkably.