鼓室副神经节瘤的诊断与治疗

目的：探讨鼓室副神经节瘤的临床和病理特征。方法：复习临床病历资料,采用HE和免疫组化方法研究鼓室副神经节瘤的病理特征。结果：肿瘤实质由上皮样主细胞和短梭形支持细胞组成。主细胞中CgA、NSE和Syn呈阳性表达,支持细胞中S-100蛋白阳性表达。病理诊断为鼓室副神经节瘤,随访2年未见复发征象。结论：鼓室副神经节瘤十分罕见,临床和病理诊断困难,常需借助免疫组化协助诊断。治疗以手术切除为主。     

副神经节瘤伴腰椎转移一例报道并文献复习

目的:探讨腹膜后非嗜铬副神经节瘤(副节瘤)的诊断与治疗方法.方法:诊断为肾上腺癌并腰椎转移的患者,女,38岁;手术采用经胸腹联合切口,切除第9肋,打开膈肌,由于肾脏和肿瘤粘连紧密,行腹膜后肿瘤及左肾联合切除术.结果:肿瘤完整切除,肿瘤10cm× 9cm× 7cm.病理诊断为倾向来源于肾上腺的副神经节瘤.腰椎手术后,病检证实是副神经节瘤转移.结论:恶性副神经节瘤对化疗和放疗不敏感,手术是唯一有效的治疗方法.     

原发性腹膜后副神经节瘤临床诊疗分析

目的:探讨原发性腹膜后副神经节瘤的手术治疗效果,复发及死亡的影响因素。方法:回顾性分析1985年1月至2015年1月30年间于我院治疗的91例原发性腹膜后副神经节瘤的手术患者的临床资料,统计学方法分析腹原发性腹膜后副神经节瘤手术的治疗效果,预后及复发和死亡的相关因素。结果:77例原发性腹膜后良性副神经节瘤患者,l、3、5年总生存率均为98.5%,复发率分别为2%,4.5%,16%。手术根治度与复发相关(X~2=10.368,P=0.01),手术未完整切除复发率高。性别、年龄、肿瘤部位、肿瘤直径与复发无关(P0.05)。14例原发性腹膜后恶性副神经节瘤患者,1、3、5年总生存率分别为78.5%、50%,41.5%。14例恶性副神经节瘤复发率分别为71%,85%,100%。肿瘤级别与腹膜后恶性副神经节瘤预后(X~2=5.536,P=0.019)和复发相关(X~2=5.734,P=0.017),肿瘤级别低,死亡率高,复发率高;远处转移与复发相关(X~2=4.067,P=0.044),远处转移患者复发率高;性别、年龄、肿瘤部位、肿瘤直径、手术根治度与预后及复发无关(P0.05)。结论:良性腹膜后副神经节瘤患者预后较好,手术根治度与复发相关,根治性手术是其主要治疗方式;恶性副神经节瘤预后差,肿瘤分级与其复发及死亡相关,肿瘤分级低复发及死亡率高,远处转移与复发相关,远处转移患者复发率高。     

膀胱平滑肌瘤合并子宫多发性平滑肌瘤一例报道并文献复习

目的对一例膀胱平滑肌瘤合并子宫多发性平滑肌瘤患者诊疗进行回顾性分析。方法回顾分析一例膀胱平滑肌瘤合并子宫多发性平滑肌瘤患者临床资料,并结合相关文献进行复习。结果膀胱平滑肌瘤行局部切除,子宫多发性平滑肌瘤行全子宫切除,术后随访5年,未见肿瘤复发、恶变、侵袭转移及盆腔其他并发症。结论膀胱平滑肌瘤是一种少见的良性肿瘤,术前诊断主要依赖彩超、CT等影像学检查。手术探查能明确肿瘤部位,确诊依赖病理。手术治疗为主,预后良好。     

23例输尿管子宫内膜异位症患者诊断和治疗的临床分析

目的:总结23例输尿管子宫内膜异位症患者的临床诊断和治疗经验.方法:回顾性分析23例病理证实为输尿管子宫内膜异位症患者的临床诊治以及术后随访资料,并对结果进行对比分析.结果:23例患者均接受了超声检查,其中21例接受了静脉肾盂造影检查,11例接受了逆行肾盂造影检查,16例接受了CT检查,8例接受了MRI检查;23例均行手术治疗,其中3例接受了输尿管粘连松解术治疗,6例接受了输尿管狭窄段切除+输尿管膀胱再吻合术治疗,12例接受了输尿管狭窄段切除+输尿管端端吻合术治疗,2例接受了输尿管内镜下子宫内膜异位病损电灼术治疗.23例患者均为单侧发病,左侧14例,右侧9例.术后病理检查证实为子宫内膜异位症,异位病灶均位于输尿管下段.结论:输尿管子宫内膜异位症是一种泌尿外科罕见的疾病,早期诊断难度较大,影像学检查在输尿管子宫内膜异位症的诊断中起着重要作用.对于轻度的输尿管梗阻患者,推荐行输尿管粘连松解术治疗;对于中、重度输尿管梗阻患者,推荐行输尿管狭窄段切除术治疗;对于病变程度严重的病例,推荐术后应用激素类药物治疗降低术后的复发率.     

输尿管子宫内膜异位症伴肾积水1 例报告并文献复习

目的:探讨子宫内膜异位症累及输尿管的诊断和治疗方法。方法:术前诊断为右侧输尿管下段占位病变伴右肾积水的42岁女性患者,行下腹正中切口,探查右侧输尿管开口处可见淡黄色息肉样病变,突入膀胱,输尿管下段增粗并全程扩张积水,行输尿管下段并膀胱袖式切除,输尿管膀胱再植术。术后病理报告为输尿管子宫内膜异位症。结果:术后复查B超示右肾积水较术前恢复,术后予抑那通3.75mg/28d,随访6个月未见复发。结论:对于输尿管占位并上尿路积水的女性患者,除考虑肿瘤外还应考虑子宫内膜异位症可能。手术联合内分泌治疗是治疗输尿管子宫内膜异位伴肾积水的有效方法。     

副神经切断联合远端毁损术治疗痉挛性斜颈的临床疗效分析

目的:探讨副神经切断联合远端毁损术治疗痉挛性斜颈的临床疗效。方法:选择2011年1月至2014年1月我院采用两种手术方法治疗的痉挛性斜颈患者100例,其中单纯副神经切断组30例,副神经切断+神经远端毁损组70例。所有患者术前、术后2周、术后3月、术后6月均行Tsui评分评估治疗疗效,同时术后观察是否出现吞咽困难、呼吸困难及发音障碍等严重并发症。结果:单纯副神经切断组患者术前Tsui评分平均为(22.14±2.19),术后2周为(15.23±1.28),手术前后比较差异有统计学意义(P0.05)。副神经切断+神经远端毁损组患者术前Tsui评分平均为(23.09±1.23),术后2周为(8.23±0.98),手术前后比较差异有统计学意义(P0.05)。单纯副神经切断组术后3月和术后6月的Tsui评分分别为(13.03±1.11)和(11.34±1.02),副神经切断+神经远端毁损组Tsui评分分别为(6.09±0.25)和(4.41±0.29),组间比较差异均有统计学意义(P0.05)。术后副神经切断+神经远端毁损组出现1例切口感染的患者,予以相应处理后好转,均为出现吞咽困难、呼吸困难及发音障碍等严重并发症,两组患者术后并发症的比较差异无统计学意义(P0.05)。结论:副神经切断联合远端毁损术治疗痉挛性斜颈疗效较单纯副神经切断术好,术后并发症少,安全性高。     

膀胱再生技术改进及并发症预防和处理的临床分析(附161例报告)

目的:改进膀胱再生方法,预防并发症产生,提高膀胱再生临床治疗效果.方法:膀胱全切除行膀胱再生术66例,大部切除膀胱再生术70例,结核性挛缩膀胱再生扩大术25例.结果:不全随访膀胱全切除者其中1例无瘤生存16年,另1例现已无瘤生存10年.膀胱大部切除无瘤生存10年以上者12例.结核性挛缩膀胱再生扩大术6例死于其它疾病,19例生存.结论:膀胱再生术,可应用于治疗膀胱各种疾病.对膀胱肿瘤切除部位和范围不受限,对病人打击小,年老体弱者可接受.     

腹腔镜探查并治疗腹部恶性肿瘤术后肠梗阻的临床研究

目的:探讨腹腔镜辅助探查并治疗腹部恶性肿瘤术后肠梗阻患者的可行性及安全性。方法:应用腹腔镜技术对我院42例腹部恶性肿瘤术后患者行手术治疗,其中包括良性粘连性肠梗阻14例、肿瘤复发16例、原发性结肠癌1例、恶性肠粘连11例。结果:42例患者均在腹腔镜下明确诊断,其中18例患者在完全腹腔镜下手术治疗,13例患者在腹腔镜辅助下行手术治疗,6例患者腹腔严重粘连中转开腹手术治疗,5例患者腹腔广泛转移行保守治疗。腹腔镜手术时间为35~290min,平均住院日9.2±1.7d。患者术后疼痛较轻、下床活动时间及肠道功能恢复时间短、术后并发症少。结论:恶性肿瘤术后肠梗阻患者仍需手术治疗,在严格掌握手术适应症下,应用腹腔镜技术对恶性肿瘤术后肠梗阻病人的治疗是安全、可行的。     

动脉插管化疗配合膀胱灌注治疗复发性、多发性、表浅性膀胱癌

目的:探讨腹壁下动脉插管化疗(inferior-epigastric artery chemotherapy,IAC)配合吡柔比星(THP)膀胱灌注治疗复发性、多发性和表浅性膀胱癌的疗效。方法:对12例复发性、多发性和表浅性膀胱移行细胞癌患者术后行腹壁下动脉插管化疗3个疗程后,开始行吡柔比星膀胱灌注,每次30 mg,每周1次共12次,以后每2周1次共6次,以后每月1次共6次,第二年重复,第三年每月一次。定期膀胱镜检查,进行随访。结果:12例复发性、多发性、浅表性膀胱移行细胞癌患者,术后随访时间24-48个月,肿瘤复发1例,复发率8.3%。不良反应主要为术后小膀胱,尿路刺激症状和尿常规异常。结论:腹壁下动脉插管化疗配合吡柔比星膀胱灌注治疗复发性、多发性和表浅性膀胱癌的效果明确,疗效满意,患者耐受性好,值得临床推广应用。     

Urine cytology evaluation in cases of uretero-ileal cutaneous diversion

Cytological examination of urine from the ileal conduit in cases of bladder cancer treated by radical surgery can be an important and effective follow-up procedure. A total of 19 patients (18 males and one female) on whom radical cystectomy for cancer was performed were studied. Three urine specimens were examined in each case using routine cytological methods. Three cases of recurrent carcinoma (mainly of papillary type) were diagnosed cytologically before any clinical evidence of disease. the cytological examination of urine at 3-6 month intervals after cystectomy for bladder carcinoma is considered advisable in all cases, since the recurrence rate of transitional cell neoplasms in the upper urinary tract after cystectomy for transitional carcinoma is quite high.     

室间隔缺损介入封堵和外科手术对瓣膜功能影响的对比研究

目的:通过对介入封堵治疗的室间隔缺损患者进行中长期临床随访,并和同期行外科修补手术的室间隔缺损患者进行对比,分析两种术式对心脏瓣膜功能的影响。方法:选择行介入封堵治疗患者279例(介入组),行外科手术修补治疗患者243例(手术组)。利用超声心动图检查瓣膜反流发生情况及随访转归情况,并对两组瓣膜反流的发生率进行对比研究。结果:术后短期介入组二尖瓣反流发生率较手术组高(P0.05),三尖瓣和主动脉瓣反流发生率两组相比无统计学差异。中长期随访中,三尖瓣反流、主动脉瓣反流以及二尖瓣反流两组相比均无统计学差异。结论:室间隔缺损介入封堵治疗疗效确切,安全性高,创伤较小。术前利用超声心动图对患者的严格筛选,术中熟练轻柔稳定的操作和适合封堵器的选择是减少介入封堵术后发生瓣膜反流最重要的因素。     

Carcinoma in situ of the urinary bladder. Clinical presentation, cytologic pattern and stromal changes

The clinical presentation, cytologic pattern and stromal changes in the cystectomy specimen were studied in a group of 26 patients with carcinoma in situ of the urinary bladder who underwent cystectomy. Only cases in which the nuclear area of the carcinoma in situ cells was over 80 sq micron (large-cell type) were included in this study. The results indicate that the cells from large-cell carcinoma in situ of the bladder exfoliate easily, resulting in a cytologic pattern of predominantly single, highly abnormal cancer cells. Due to the increased exfoliation of the affected epithelium, the bladder stroma is focally denuded; therefore, while cytology may be strongly positive for malignancy in these cases, the histologic diagnosis can be falsely negative when only denuded stroma is biopsied. The edematous stroma causes complaints of "cystitis." The neoplastic urothelium may involve contiguously related epithelial surfaces. When the lesion extends into the prostatic ducts, the patient can have "pseudoprostatitis" complaints. Urethral extension may give penile voiding pain. In one female patient, involvement of the vagina and vulva was found. Carcinoma in situ may develop in patients with papillary low-grade bladder carcinoma during follow-up, with a concomitant shift in the cytologic and clinical patterns; this deserves the consideration and attention of the cytologist and the clinician due to its serious clinical implications.     

细胞角蛋白20在膀胱癌中的研究进展

膀胱肿瘤是最常见的泌尿系统肿瘤,其中上皮性肿瘤占95％以上,绝大多数为尿路移行上皮细胞癌。膀胱癌的早期症状不明显,复发率较高,早期诊断和治疗对提高其疗效非常重要。近年来,诊断膀胱肿瘤的新方法不断出现,显著提高了膀胱肿瘤诊断及预后预测水平。其中,膀胱肿瘤标记物检测已成为膀胱肿瘤的诊断新方法,具有十分重要的临床意义。研究发现,细胞角蛋白20fcytokeratin20,CK20）是中间纤维家族成员之一,在正常膀胱组织中特异性表达于伞细胞,在膀胱癌中特异性表达于膀胱移行细胞癌,其诊断膀胱肿瘤的特异性和灵敏性均较高,且与膀胱肿瘤的临床分级、病理分期和转移均密切相关,因此可作为辅助诊断膀胱肿瘤的检测标志物及治疗和预后评估指标。本文将就其在膀胱癌中的研究进展综述如下。     

细胞角蛋白20 在膀胱癌中的研究进展

膀胱肿瘤是最常见的泌尿系统肿瘤,其中上皮性肿瘤占95%以上,绝大多数为尿路移行上皮细胞癌。膀胱癌的早期症状不 明显,复发率较高,早期诊断和治疗对提高其疗效非常重要。近年来,诊断膀胱肿瘤的新方法不断出现,显著提高了膀胱肿瘤诊断 及预后预测水平。其中,膀胱肿瘤标记物检测已成为膀胱肿瘤的诊断新方法,具有十分重要的临床意义。研究发现,细胞角蛋白20 (cytokeratin 20,CK20)是中间纤维家族成员之一,在正常膀胱组织中特异性表达于伞细胞,在膀胱癌中特异性表达于膀胱移行细 胞癌,其诊断膀胱肿瘤的特异性和灵敏性均较高,且与膀胱肿瘤的临床分级、病理分期和转移均密切相关,因此可作为辅助诊断 膀胱肿瘤的检测标志物及治疗和预后评估指标。本文将就其在膀胱癌中的研究进展综述如下。     

荧光原位杂交应用于尿路上皮癌尿液早期诊断的研究进展

尿路上皮癌(urothelial carcinoma,UC)是泌尿系统最常见恶性肿瘤之一,早期诊断是提高该类疾病疗效的关键所在,荧光原位杂交(fluorescence in situ hybridization,FISH)通过尿液来检测UC,具有快速、无创伤性、敏感度高和特异性强等优点。FISH提高了尿细胞学在低级别或浅表性膀胱UC诊断的敏感性,且减少了血尿、尿路感染及膀胱内灌注治疗等对细胞形态的影响而引起的假阳性,提高检测的特异性。对于诊断上尿路UC,FISH的敏感性与特异性更高。膀胱UC患者9号染色体p16抑癌基因丢失与复发明显相关,FISH既能预测膀胱UC的复发性,更能监测UC的复发,但仍需大样本、多中心的前瞻性研究。本文将FISH在膀胱UC、上尿路UC早期诊断以及膀胱UC术后监测等方面的临床应用研究报道进行综述。     

The Expression Patterns of p53 and p16 and an Analysis of a Possible Role of HPV in Primary Adenocarcinoma of the Urinary Bladder

Background

Primary adenocarcinoma of the urinary bladder is rare. The molecular and cellular events leading to its pathogenesis are not well delineated. The goal of this study was to investigate p53 and p16 expression, as well as HPV status, in a relatively large series of primary bladder adenocarcinomas.

Materials and Methods

Thirty six cases of urinary bladder adenocarcinoma were chosen from participating institutions. The diagnosis and available clinical history were reviewed in each case. Immunostains for p53, p16 and HPV and high-risk and low-risk HPV-ISH were performed on all tumors.

Results

Patients had an average age of 61 years with a male predominance (1.5∶1 male∶female ratio). The average tumor size in cystectomy specimens was 4.3 cm. Of the cases managed by transurethral resection, 40% were pT2 at the time of diagnosis. In cystectomy specimens, 77% were either pT3 or pT4. Strong nuclear p16 expression was seen in 67% of all cases and p53 expression was present in 58% of the cases. Expression of both markers was seen in 33% of cases. Expression of p16 or p53 alone was present in 12 (33%) and 9 (25%) cases, respectively. Neither marker was expressed in only 3 (8%) of the tumors. No significant correlation between clinical variables and any of the markers we studied was identified. No HPV infection was detected in any case.

Conclusions

Expression of p53 and/or p16 is very common in urinary bladder adenocarcinoma. These findings implicate a high likelihood that alterations in these cell cycle proteins contribute to the pathogenesis of these tumors. Despite frequent immunohistochemical labeling for p16, no evidence of HPV infection was found.     

Site of Action of Nitrofurantoin in Experimental Urinary Tract Infection

The effectiveness of nitrofurantoin in suppressing bacterial growth in the urinary tract was evaluated by using two different experimental models. Pyelonephritis was produced in rats by direct inoculation of 10(4)Escherichia coli in the medulla of left kidney. Ascending urinary tract infection was induced by inoculation into the urinary bladder of 10(7)Proteus mirabilis, after a partial cystectomy. Nitrofurantoin was shown to be effective in suppressing bladder bacteriuria, in preventing ascending pyelonephritis, and also in preventing bacterial multiplication in kidney tissue following direct inoculation.     

帕金森病的尿动力学表现及临床意义

为了评估有持久膀胱排尿障碍的帕金森氏病患者的尿动力学表现及其临床意义,对25例帕金森氏病患者行尿动力检查,并要求记录并回收24小时排尿日记.结果显示,1)有18例患者出现膀胱过度活动,逼尿肌收缩力低下或无反射4例,膀胱出口梗阻6例,另3例检查结果正常,无一例出现逼尿肌-括约肌协同失调; 2)患者所返回的排尿日记显示帕金森氏病患者普遍出现日排尿次数增加及每次排尿量的减少.由此可以得出结论:逼尿肌反射亢进是帕金森氏病患者尿动力学检查的最常见类型;尿动力学检查对正确处理帕金森氏病患者的排尿障碍有指导意义.     

Metatarsal metastasis from transitional cell cancer of the urinary bladder

Urinary bladder cancers can be grouped into three general categories: superficial, invasive and metastatic. Approximately 90% of malignant tumors of the urinary bladder are of epithelial origin and the majority of them are transitional cell carcinomas (TCC). Metastatic spread of urinary bladder cancers usually includes regional lymph nodes, the lung, the liver and the bones. The presence of metastasis tends to correlate with muscular wall invasion as often demonstrated at the initial diagnosis; consequently clinical bladder cancer represents a late phase of the disease. Although skeletal metastases of bladder cancers are rather common, they have been rarely described to occur in distal bones. For that reason, we report metatarsal metastasis from transitional cell cancer of the urinary bladder in a 59-year-old woman.