目的:探讨机器人辅助后腹腔入路肾部分切除术联合腔内B超治疗完全内生型肾肿瘤的有效性和安全性.方法:整理2016年4月至2019年4月我院23例机器人辅助后腹腔入路肾部分切除术治疗的cT1a期完全内生型肾肿瘤患者的临床资料,将同期机器人辅助后腹腔入路肾部分切除术治疗cT1 a期外生型肾肿瘤40例患者作为对照组,比较两组患者之间的手术情况、术后观察指标及随访情况.结果:两组患者中山评分(Z=313.00,P=0.024)、手术时间(Z=182.00,P<0.001)、热缺血时间(t=5.04,P<0.001)等差异有统计学意义,但术中出血量、中转肾切术例数、切缘阳性率、术后估算肾小球滤过率、伤口引流管带管时间及术后住院时间、术后并发症之间的差异无统计学意义(均P>0.05).23例完全内生型肾肿瘤中,成功切除22例,中转肾根治性切除1例.在中位随访9个月(四分位间距:6～12月)后,患者术后均无复发.结论:机器人辅助后腹腔入路肾部分切除术联合术中腔内B超治疗完全内生型肾肿瘤安全可行,其中术中B超定位是切除肿瘤的关键.

目的 探讨腺性膀胱炎(CG)患者经尿道病损电切术(TUR)后复发的独立危险因素.方法 回顾性分析2011年1月-2020年12月西京医院泌尿外科230例行T U R术CG患者的临床病理资料,所有患者术后规律来院随访.使用单因素及多因素logistic回归分析探索影响术后复发的危险因素.结果 本组53例患者(23.0％)术后复发,中位复发时间6(1～36)个月,平均7.1个月.多因素logistic回归分析结果显示,年龄(P=0.001)、合并盆腔脂肪增多症(PL)(P<0.001)、肠化生型CG(P=0.008)、膀胱镜下形态(P=0.024)以及中性粒细胞绝对值/淋巴细胞绝对值(NLR)(P<0.001)是术后复发的独立危险因素.结论 年龄、合并PL、病理类型、膀胱镜下形态以及术前NLR是CG患者TUR术后复发的独立危险因素,而膀胱化疗药物灌注并不能使患者显著获益.

目的 探讨微通道经皮肾镜碎石术(mPCNL)后结石清除率(SFR)的独立预测因素,并建立相应列线图进行风险评估.方法 回顾性分析2018年1月-2021年6月西京医院泌尿外科170例行mPCNL患者的临床资料.术后1个月行B超检查评估结石清除情况.使用logistic回归分析探索影响SFR的术前因素,运用RStudio软件建立列线图.采用Bootstrap法对模型的预测性能进行内部验证,模型的区分度根据受试者工作特征曲线(ROC)下面积(AUC)评价,并通过绘制校准图以检验模型的一致性.进行决策曲线分析(DCA)评估其临床适用性.结果 本组一期SFR为77.6％.单因素及多因素logistic回归分析结果显示,结石位置(P=0.033)、直径(P<0.001)、平均CT值(P=0.001)以及结石距皮肤的距离(SSD)(P=0.012)是SFR的独立预测因素.列线图的区分度为0.909(95％CI:0.863～0.956),且其预测概率与实际SFR之间具有良好的一致性.DCA显示模型在几乎所有的决策阈值概率中都有正的净收益,具有显著的临床意义.结论 结石位置、直径、平均CT值以及SSD是肾结石患者mPCNL术后SFR的独立预测因素.本研究建立的列线图具有良好的预测性能,有助于临床医生制定术前治疗方案.

Objective:To investigate the risk factors for biochemical recurrence after radical prostatectomy.Methods:The clinical data of 558 radical prostatectomy patients admitted to the First Affiliated Hospital of Air Force Military Medical University from January 2010 to December 2020 were retrospectively analyzed. The average age was 67.9 (40-87) years old, and the average body mass index was 24.56 (15.12-35.94) kg/m 2. The average PSA was 41.07 ng/ml, including 48 cases<10 ng/ml, 98 cases 10-20 ng/ml, and 412 cases>20 ng/ml. There were 123, 214, 118, 89, and 14 cases with biopsy Gleason 6-10 score, respectively. The clinical stage : 90 cases in ≤T 2b, 273 cases in T 2c, and 195 cases in ≥T 3 . 558 cases underwent radical prostatectomy, including 528 robotic-assisted laparoscopic surgery, 25 laparoscopic surgery, and 5 open-surgery. The risk factors for postoperative biochemical recurrence were analyzed by Cox regression. Results:A total of 63 patients had postoperative pathological stage pT 2a, 32 patients had pT 2b, 241 patients had pT 2c, and 222 patients had ≥pT 3. A total of 210 cases developed biochemical recurrence after surgery, and the mean time to biochemical recurrence was 33.3 (3-127) months after the radical prostatectomy. The biochemical recurrence rates at 1, 3, and 5 years were 9.7% (54/558), 21.5% (120/558), and 31.7% (177/558), respectively. Among pT 2a and pT 2b patients, 7 (11.1%) and 4 (12.5%) cases developed biochemical recurrence, respectively. Among pT 2c stage patients, 145 (60.17%) cases had positive cut margins, treated with androgen-deprivation therapy (ADT) after surgery. 68 (28.21%) cases of pT 2c stage patients had biochemical recurrence at mean 36.1 (3-106)months after the radical prostatectomy. Among ≥pT 3 patients, 147 patients with positive margins, perineural invasion, seminal vesicle invasion and positive pelvic lymph nodes were treated with postoperative androgen deprivation therapy (ADT) + radiotherapy. 98 of 147 patients (66.67%) had biochemical recurrence, and the average time to biochemical recurrence was 30.6 (24-98) months.75 patients of ≥pT 3 without positive margins, perineural invasion, seminal vesicle invasion or positive pelvic lymph nodes, were treated with postoperative ADT. 33 of them (44%) had biochemical recurrence, and the average time to biochemical recurrence was 32.5 (21-106) months. 5-and 10-year survival rates of 210 patients with biochemical recurrence were 89.05% (187/210) and 78.09% (164/210) respectively, 5- and 10-year tumor-specific survival rates were 92.57% and 87.69%, respectively. 46 of 210 cases died, of which 31 (67.39%) died from prostate cancer, and 15 cases (32.61%) died from cardiovascular and cerebrovascular diseases. Multifactorial Cox regression analysis showed that patient's age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7 were independent risk factors for biochemical recurrence. Conclusions:After radical prostatectomy, patients were treated according to their pathological stage and surgical margins. Patients with positive margins have a higher risk of biochemical recurrence. The independent risk factors for biochemical recurrence included age ≥70 years, initial PSA > 20ng/ml, ≥pT 3 and Gleason score ≥7.

Objective:To explore the preoperative 68Ga-PSMA PET/CT examination on the guidance of surgical strategies for high-risk prostate cancer patients and the influence of positive surgical margins after surgery. Methods:The clinical data of 118 patients with high-risk prostate cancer who underwent robot-assisted laparoscopic radical prostatectomy from June 2019 to December 2020 in Xijing Hospital of Air Force Military Medical University was retrospectively analyzed. 47 patients received 68Ga-PSMA PET/CT examination before surgery (study group), and 71 cases without 68Ga-PSMA PET/CT examination before operation ( control group). There was no statistically significant difference in the age [69 (63, 76) vs. 67 (64, 74) years], PSA [PSA≤20ng/ml: 9.91 (6.00, 13.67) vs. 11.64 (8.15, 15.44) ng/ ml, PSA> 20ng/ml: 66.53 (53.66, 195.30) vs. 63.18 (30.08, 148.05) ng/ml], preoperative clinical staging (T 2/≥T 3: 21/26 cases vs. 34/37 cases), and Gleason score [8 (7, 9) vs. 8 (7, 9) points] (all P>0.05) between study group and control group. Both groups underwent robot-assisted laparoscopic radical prostatectomy. The surgical plan was based on the PSMA PET/CT and MRI results in study group and control group respectively. First, ensure that all tumors are removed, and secondly, preserve the patient's urethral length as much as possible to ensure postoperative urinary control.If there is seminal vesicle invasion, expand the scope of resection as needed. If lymph node metastasis is shown, lymph node dissection is performed. For those with negative lymph nodes in imaging studies, if enlarged lymph nodes are found during the operation, lymph node dissection is also performed. After the operation, the perioperative results and surgical margins of the two groups were compared, and the correlation between the PSA value and the SUVmax value of prostate cancer tissue was analyzed. Results:The operations of the two groups were successfully completed, and there was no transfer to open surgery. The operation time of the study group was shorter than that of the control group [175 (155, 205) min vs. 205 (155, 235) min, P=0.003], and the positive rate of resection margin was significantly lower than that of the control group [23.40% (11/47) vs. 45.07%(32/71), P=0.017]. For patients with pathological stage ≥pT 3, the positive rate of surgical margins in the study group was significantly lower than that in the control group [30.77%(8/26) vs. 62.16%(23/37), P=0.014]. In the study group, 11 cases of PSMA-PET showed positive lymph nodes before operation, 10 cases were pathologically positive after operation (90.91%). PSMA-PET showed negative lymph nodes in 1 case, which was pathologically positive after operation. In the control group, 26 cases underwent lymph node dissection, and 16 cases (61.54%) were pathologically positive after operation. The preoperative PSA value of 47 cases in the study group was positively correlated with the SUVmax value of prostate cancer tissue ( r=0.579, P<0.01). Conclusions:Preoperative 68Ga-PSMA PET/CT for high-risk prostate cancer patients can guide the surgeon to optimize the surgical plan, reduce the positive rate of resection margins, and effectively remove the metastatic lymph nodes, which will benefit the patients.

There is still a lack of competing risk analysis of patients with papillary renal cell carcinoma (pRCC) following surgery. We performed the cumulative incidence function (CIF) to estimate the absolute risks of cancer-specific mortality (CSM) and other-cause mortality (OCM) of pRCC over time, and constructed a nomogram predicting the probability of 2-, 3- and 5-year CSM based on competing risk regression. A total of 5993 pRCC patients who underwent nephrectomy between 2010 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The 2-, 3-, 5-year CSM rates were 3.2%, 4.4% and 6.5%, respectively, and that of OCM were 3.2%, 5.0% and 9.3%, respectively. The estimates of 5-year cumulative mortality were most pronounced among patients aged > 75 years in OCM (17.0%). On multivariable analyses, age, tumor grade, T stage, N stage, and with or without bone, liver and lung metastases were identified as independent predictors of CSM following surgery and were integrated to generate the nomogram. The nomogram achieved a satisfactory discrimination with the AUC t of 0.730 at 5-year, and the calibration curves presented impressive agreements. Taken together, age-related OCM is a significant portion of all-cause mortality in elderly patients and our nomogram can be used for decision-making and patient counselling.

目的 探讨微创经皮肾镜碎石取石术(minimally invasive percutaneous nephrolithotomy,mPCNL)治疗肾结石一期清石的影响因素.方法 回顾性分析2014年1月～2020年12月664例肾结石采用mPCNL治疗的资料,全麻,单通道碎石,手术均由同等资历的术者完成.术后7～10天行KUB或泌尿系CT检查,未见明显结石残留,或结石最大径≤0.4 cm为一期清石.采用单因素和多因素logistic回归分析术后一期清石的影响因素.结果 664例中123例(18.5％)未能一期清石.单因素分析显示,结石大小、结石CT值、结石数量、结石分布及术前肾积水与一期清石有关(P<0.05).多因素logistic回归分析结果显示,结石最大径>2 cm(OR=5.444,95％CI:3.313～8.945,P=0.000),结石CT值>1000 HU(OR=4.200,95％CI:2.581～6.835,P=0.000),多发结石(OR=2.439,95％CI:1.154～5.153,P=0.019),鹿角形结石(OR=15.487,95％CI:6.483～36.997,P=0.000)是mPCNL未能一期清石的独立预后因素.结论 结石最大径>2 cm、结石CT值>1000 HU、多发结石及鹿角形结石是mPCNL未能一期清石的独立预后因素,术前可据此预测一期清石效果.

Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery procedure. High rates of operative complications and mortality are usually associated with an open surgery procedure. The recently emerged robot-assisted laparoscopic radical nephrectomy (RAL-RN) and IVC tumor thrombectomy have shown to reduce operative related complications in patients with renal cell carcinoma. This case series study aimed to summarize technical utilization, perioperative outcomes, and efficacies of RAL-RN and IVC tumor thrombectomy in our hospital. A retrospective analysis was performed on clinical data from 20 patients who underwent RAL-RN and IVC tumor thrombectomy from January 2017 to December 2019 in our department. Patients had a median age of 59 years (interquartile range [IQR], 46-68). Four patients had renal neoplasm on left side and 16 on right side. Nineteen patients underwent RAL-RN (level 0: n = 2) or RAL-RN with IVC thrombectomy (n = 17) (level I: n = 3; level II: n = 12; and level III: n = 3) and 1 patient was converted into an open surgery. The median operative time was 328 minutes (IQR, 221-453). The estimated median blood loss was 500 mL (IQR, 200-1200). The median size of removed renal carcinoma was 67 cm(2) (IQR, 40-91); the length of IVC tumor thrombus was 5 cm (IQR, 3-7). The postsurgery hospital length of stay was 6 days (IQR, 5-7). The complications included intestinal obstruction (n = 1), lymphatic fistula (n = 1), heart failure (n = 1), and low hemoglobin level (n = 1). The outcomes for patients after 16 months (IQR, 11-21) follow-up were tumor-free (n = 10), tumor progression (n = 4), loss of contact (n = 1), and death (n = 5). We concluded that RAL-RN and IVC thrombectomy renders good safety profiles including minimal invasiveness, low estimated median blood loss, short hospitalization, low morbidity, and quick renal function recovery. The long-term efficacy needs a further investigation.

目的 探讨20例膀胱子宫内膜异位症患者的临床诊断和治疗.方法 回顾性分析2016年1月至2019年12月西京医院泌尿外科收治的20例膀胱子宫内膜异位症患者的临床诊疗资料和随访结果.结果 20例患者术后病理均确诊为膀胱子宫内膜异位症,平均年龄(31.41±6.50)岁;肿瘤平均直径(3.87±1.33)cm;妇科手术史17例,其中剖宫产15例、子宫肌瘤手术2例;行开放性膀胱部分切除术17例,行经尿道膀胱电切术3例.术后随访8～48个月,术后复发2例,无复发18例.结论 膀胱子宫内膜异位症的确诊需病理学诊断,治疗方法以膀胱部分切除术为主,同时辅助药物治疗,但仍有复发概率.

目的 探讨阴囊及双侧睾丸离断伤患者的治疗方法及效果.方法 分析2019年空军军医大学附属西京医院收治的1例阴囊及双侧睾丸离断伤患者的诊疗过程和术后随访情况,并回顾相关文献.结果 阴囊及双侧睾丸离断伤患者在热缺血+冷缺血14h ～ 18h后,在显微镜下行双侧睾丸动脉(各2支)、双侧精索内静脉(各4支)和双侧输精管(各1支)吻合术,阴囊原位缝合.术后2d复查B超显示,左侧睾丸可见血流信号,右侧睾丸未见血流信号.术后7d行超声造影显示,右侧睾丸无灌注,左侧睾丸灌注正常,大部分阴囊皮下软组织开始显影,右侧阴囊局部未见造影剂灌注.术后21d行右侧睾丸切除+右侧阴囊坏死组织清创术.结论 显微镜下行双侧睾丸再植术是治疗双侧睾丸离断伤最有效的方法,至少单侧睾丸再植成功是维持男性生育和男性体症的基础.而再植阴囊的存活是保证睾丸低温环境生精的必要条件,否则将给患者带来终身遗憾.

目的 探讨双侧肾癌的诊治及预后.方法 回顾性分析2006年至2019年我科收治的27例双侧肾癌患者的临床诊治资料、家族史及预后随访资料.结果 27例患者均经影像学检查明确诊断,21例患者行手术治疗(12例患者一侧行肾根治性切除术、对侧行肾部分切除术,9例患者行双侧肾部分切除术,其中5例患者行机器人辅助腹腔镜下双侧肾部分切除术),1例患者行冷冻消融术,5例患者未行手术治疗.手术均成功,术后病理证实均为肾癌,并根据个体情况给予相应治疗及随访.结论 临床上双侧肾癌少见,治疗以手术为主,术后治疗应该个体化.患者的预后主要受肿瘤临床和病理分期的影响,术后个体化的治疗和随访也起到重要的作用.

目的 探讨男性尿道异物的急诊处理.方法 回顾性分析2019年我院急诊治疗的7例男性尿道异物患者的临床资料,并回顾相关文献.结果 7例尿道异物患者中,玻璃试管2例,直线缝针3例,实心塑料棒1例,温度计1例.异物远端位于前尿道6例,位于后尿道1例.徒手取出2例,膀胱镜下取出4例,开放手术取出1例.徒手取出异物患者术后即刻离院,膀胱镜下取出异物患者在急诊留观室观察2h后离院.膀胱切开取出异物患者术后留置尿管,未行膀胱造瘘,术后10 d拔除尿管出院.随访1～3个月,平均随访(1.6±0.7)个月,均无并发症发生.结论 针对男性尿道异物,应根据异物位置、材质、数量、置入时间等选择恰当的取出方法,解除尿道损伤和梗阻,取出过程中避免二次损伤.

目的 探讨微通道经皮肾镜联合输尿管软镜治疗马蹄肾下盏结石的临床疗效.方法 回顾性分析2017至2019年西京医院收治的40例马蹄肾下盏结石患者的临床资料,根据手术方式分为微通道经皮肾镜组、微通道经皮肾镜联合输尿管软镜组,比较两组患者年龄、性别、左右侧结石、结石大小、手术时间、术中出血、一期清石率、术后并发症等临床资料.结果 两组患者的年龄、性别、左右侧结石、结石大小、术中出血、术后感染、二次手术、住院时间相比差异无统计学意义(P>0.05).微创经皮肾镜联合输尿管软镜手术时间、清石率与微通道经皮肾镜相比差异有统计学意义(P<0.05).结论 微通道经皮肾镜联合输尿管软镜治疗马蹄肾下盏结石较微创经皮肾镜手术时间延长,但术后清石率较单一微通道经皮肾镜增高.

目的 比较两种输尿管支架管临床应用及带管期间相关症状.方法 收集空军军医大学附属西京医院2018年至2019年经输尿管硬镜治疗的输尿管中下段结石患者216例的临床资料,比较术中置管情况、带管期间相关症状如肉眼血尿、腰部或下腹部疼痛、泌尿系感染、膀胱刺激症状、尿失禁、膀胱端附管结石、支架管移位等指标.结果 216例患者中,术中置入双线圈输尿管支架管97例,术中置入双J输尿管支架管119例.两组患者肉眼血尿、泌尿系感染、疼痛、支架管下移、膀胱端附管结石差异无统计学意义(P>0.05),而膀胱刺激症状、女性尿失禁、支架管上移差异有统计学意义(P<0.05).双线圈输尿管支架管膀胱刺激症状和上移明显减少,但尿失禁增多,尤其是女性患者.结论 两种支架管各有利弊,临床医师可合理选择.