尿道损伤的诊断治疗现状

尿道损伤一直是个棘手的泌尿外科常见疾病。逆行尿道造影是评价尿道损伤的金标准。尿道损伤的治疗方法的选择在泌尿系创伤中是争议最多的。目前没有一种方法是最简单有效的处理方法。组织工程技术的诞生和发展,给尿道损伤的处理带来了新的希望,有望为尿道损伤的修复提供新的材料。本文仅就尿道损伤疾病的基本概况及国内外在诊断和治疗方面的的研究现状作简要综述。     

绿激光水下汽化生物组织的实验及临床应用

应用自制的KTP.Nd3 :YAG绿激光治疗机进行了水下汽化离体动物组织实验并对15名前列腺增生患者和3名尿道狭窄患者进行临床治疗。结果发现水下汽化离体动物组织汽化速度快,热损伤区小。临床结果表明此方法手术时间短,不出血,导尿管时间短,只需3 d左右,未发现副作用和不良反映。经水下汽化离体生物组织和经尿道镜治疗的临床实验,可以得出以下结论:本单位研制的KTP.Nd3 :YAG绿激光治疗机经尿道镜汽化术治疗前列腺增生、尿道狭窄等泌尿科疾病疗效确切,是一种特别适用于高危患者的微创介入的治疗手段,可以作为泌尿科的一线治疗方法。     

脊髓损伤再生修复的临床研究进展

创伤性脊髓损伤会导致患者感觉运动功能的严重缺失,严重影响生活质量,给社会和家庭带来沉重负担.针对创伤性脊髓损伤目前主要集中于处理原发性创伤损伤以及通过康复训练提高生活自理能力等方法,而对于神经再生及运动功能恢复却未有有效方法.以干细胞及生物材料为核心的再生医学技术的发展,为创伤性脊髓损伤的再生修复提供了新的治疗的可能.再生医学修复脊髓损伤的研究已逐渐进入临床试验阶段,为脊髓损伤患者的治疗带来了希望.本文对干细胞或功能细胞以及生物材料治疗创伤性脊髓损伤的临床研究现状进行了综述.     

阴囊纵隔血管蒂皮瓣尿道成形Ⅰ期治疗尿道下裂26例

目的:介绍阴囊纵隔皮瓣尿道成形术Ⅰ期修复尿道下裂的方法.方法:于阴囊纵隔部设计以纵隔血管为蒂,宽1.5～2cm,长等于尿道外口至冠状沟距离的皮瓣,切取后成形尿道,修复下裂.结果:本组26例皮瓣全部成活,成形尿道排尿通畅.术后6例出现尿漏,4例换药治疗后自行愈合,2例半年后行瘘修补.随访6月至2年,无尿瘘及尿道狭窄.阴茎功能及外形满意.结论:阴囊纵隔皮瓣尿道成形术是Ⅰ期治疗尿道下裂的良好方法.     

脊髓损伤后神经环路重建的研究进展

成年哺乳类脊髓损伤后的修复与再生是一项复杂且尚未解决的挑战.随着全球经济的增长,脊髓损伤的发生率呈上升趋势.脊髓损伤可能导致永久性的运动功能障碍和感觉丧失,给患者及其家属带来极大的经济压力和心理负担.因此,迫切需要开发有效的治疗脊髓损伤的新策略.近年来,应用外源性或内源性神经元中继的治疗手段为脊髓损伤后环路重建提供了新的思路.将干细胞或生物材料等移植物作用于脊髓损伤区,可改善损伤区局部微环境,诱导神经干细胞定向分化为神经元,促进脊髓环路重建和功能恢复,因此成为较有临床应用前景的方法.本综述主要介绍细胞移植治疗、组织工程策略和基因调控等方法在修复受损脊髓的神经网络中的应用,并讨论了脊髓损伤后新生神经元是否具有潜在的功能整合,重建受损神经环路,并恢复其运动和感觉功能等问题.     

线粒体移植在治疗线粒体缺陷疾病中的研究进展

线粒体是真核细胞中重要的细胞器,是高等生命体赖以生存的能量来源.线粒体异常可引起细胞甚至器官发生病变,越来越多的疾病被证实与线粒体功能障碍有关.线粒体移植是从患者正常组织分离线粒体然后注入线粒体损伤或缺失的部位,使损伤细胞得到救治、器官功能得以恢复的全新干预技术.线粒体移植作为一种新兴治疗方案在一些疾病干预的基础研究中崭露头角,尤其是在保护心脏缺血再灌注损伤领域已经发展到临床试验阶段.本文从线粒体起源出发,总结了仍处于实验阶段的几种线粒体移植方法,概述了线粒体移植在脑缺血引起神经元损伤保护领域、心肌缺血再灌注损伤保护领域和肿瘤治疗领域的研究进展,从分子层面探讨了线粒体损伤及线粒体移植修复的机理,并提出研发患者专属的"线粒体移植治疗生物制剂"的设想,旨在为线粒体缺陷有关疾病的治疗研究提供新的视角.     

Ⅰ期尿道成形术治疗尿道下裂(附126例报告)

目的:总结Ⅰ期手术治疗尿道下裂的方法及疗效.方法:分析本科室2008年9月至2010年3月期间收治的尿道下裂126例患者,其中98例为采用侧背侧皮瓣的OUPFⅡ法;另28例阴茎下弯畸形较严重,采用切除尿道板加尿道口旁皮瓣的OUPFⅣ法的治疗方法和效果等临床资料.结果:126例中115例病例得到治愈,治愈率为91.3%.11例出现术后并发症:10例术后并发尿瘘,均为针尖样尿道皮肤瘘口,其中3例多发瘘口,7例单发瘘口,均已行补瘘术.另1例为尿道外口狭窄,定期行尿道扩张术可获得满意疗效.结论:OUPF法尿道成形手术适合于几乎所有尿道下裂患者,是一种很好的手术方法,具有手术时间短,取材方便,术后恢复快,阴茎外观满意,尿道狭窄、尿瘘、阴茎下弯畸形等并发症少等优点.     

经尿道推注利多卡因治疗男性拔管后排尿困难的临床研究

目的：探究一种新的男性导尿管拔出后排尿障碍的治疗方法。方法：选择肝胆外科利用腰麻联合硬膜外麻醉术后拔尿管后 排尿障碍的60 例患者,随机分治疗组（30 例）：用10 mL注射器经尿道给予2%的利多卡因和0.9%的生理盐水各5 mL混合液,并 保留5 min;对照组（30 例）：施行常规腹部热敷治疗。结果：治疗组所有患者在2-5 小时内排尿,对照组16 例在2-5 小时内排尿, 14 例尿潴留,最终应用治疗组方法后全部排尿。结论：经尿道给予利多卡因推注治疗男性术后排尿障碍具有很好的临床效果,值 得临床推广应用。     

获得多能性干细胞的方法

胚胎干细胞系的获得为细胞和器官损伤及病变的治疗提供了新的途径,但是治疗用细胞和受体病人之间免疫不相容问题妨碍了干细胞临床应用.近年来对分化细胞重编程研究使研究人员可以获得多能性干细胞,这为解决这一难题带来了新的希望.对获得多能性干细胞所涉及的机制以及方法进行了综述.     

采用质粒DNA研究人结缔组织生长因子（hCTGF）对骨损伤修复作用的研究

摘要：目的 研究人结缔组织生长因子（hCTGF）对细胞的增殖作用及其骨损伤促愈合的生物学作用。方法 利用真核基因导入系统,转染具有分化潜能的成纤维细胞,并导入骨折实验动物模型,利用分子生物学和临床骨科技术检测分析,获得数据。结果 明确了hCTGF对细胞的增殖作用,表明了hCTGF以基因治疗为手段具有修复骨损伤的生物学活性,为该因子在临床上治疗骨损伤提供新的活性因子和新的治疗方法。     

Les traumatismes de la verge: à propos de 23 cas

The authors report 23 cases of penile injuries based on a retrospective study of their urological practice in Senegal. The various cases were distributed as follows: fracture of the penis (19 cases), corpora cavernosa and urethral gunshot injuries (2 cases), rupture of the superficial dorsal vein of the penis (1 case) and laceration of the penile skin (1 case). The mean age of these patients was 32.4 years. Early surgical treatment of all penile fractures reduces the complication rate.     

Lésions des organes génitaux externes par arme a feu: a propos de six observations

Patients and Methods

This is a retrospective study of patients admitted with gunshot injuries to the external genital organs to the urology departments of Aristide Le Dantec Hospital, Grand Yoff General Hospital and Dakar Principal Hospital, between January 1998 and January 2003. The following parameters were studied: patients’ age and gender, interval between accident and admission, clinical features, complementary investigations and treatment, and early and late outcomes.

Results

Only males were observed and the mean age of these patients was 37.7 years (range: 22–52 years). Lesions were accidental in five cases. Two cases of testicular wounds, two cases of corpus cavernosum injuries, two cases of urethral injury, and one case of perineal wound were observed. After excision of the lesions, complementary procedures consisted of: orchidectomy in two cases, corpus cavernosum — albuginea suture in two cases and end-to-end urethral suture in one case. Perineoscrotal wounds were sutured three days after debridement. All patients received antibiotics and antitetanus serum. No death was observed during the immediate follow-up. No case of urethral stricture or erectile dysfunction was observed with a follow-up of 18 months. Semen analysis was normal in the two cases of orchidectomy.     

Contemporary Management of Bulbar Urethral Strictures

Urethral stricture disease (USD) is a progressive scar-forming disease commonly encountered by urologists and is challenging to manage. USD most frequently occurs in the bulbar urethra. Patients typically present with chronic obstructive voiding symptoms but may develop recurrent urinary tract infections, detrusor failure, or renal disease. The authors review the pathophysiology, diagnostic workup, and evidence-based management of bulbar urethral strictures (BUS). There are multiple surgical options to treat BUS. Endoscopic techniques (eg, dilation and urethrotomy) are suitable for the initial management of short strictures but new evidence-based guidelines recommend against repeated endoscopic treatment. Urethroplasty is the gold standard treatment for BUS of all lengths, with anastomotic techniques appropriate for strictures <2 cm and tissue substitution performed for longer strictures. New techniques, such as non-transecting urethroplasty, lack long-term data but may represent a paradigm shift in the field. Future treatments may utilize tissue-engineered grafts and agents that inhibit inflammation and scar formation.     

Les lésions de l’urètre associées à une fracture des corps caverneux. A propos d’une série de 4 cas et revue de la littérature

Introduction

Urethral injury associated with corpora cavernosa fracture is a relatively uncommon form of urological trauma. Early diagnosis and immediate surgical repair are essential.

Patients and methods

Between January 1990 and December 2004, a total of 4 male patients with urethral injury associated with fracture of the corpora cavernosa were retrospectively studied from a series of 96 cases of penile fracture.

Results

The mean age of the patients was 36.5 years (range: 27–45 years). Urethral bleeding was noted in all patients. Immediate surgical repair via a penile circular subcoronal incision was performed in all cases. Two partial urethral injuries associated with a unilateral corpus cavernosum lesion were identified. In the other cases, total urethral injury was associated with bilateral rupture of the corpora cavernosa. The tunica albuginea defect was closed and the urethral laceration repaired over a urethral catheter. With a mean follow-up of 2.5 years, 2 short urethral strictures were observed and were managed non-operatively with good outcome.

Comments

Secondary urethral lesions associated with corpora cavernosa fracture most frequently affect young adults. In North African countries, forced self-manipulation of an erect penis is the most frequent cause, but the associated urethral lesion is usually related to vaginal intercourse. The diagnosis can generally be made on the basis of history and physical examination alone. Blood at the meatus or haematuria or voiding difficulties suggest associated trauma to the urethra [4]. Additional imaging examinations are rarely required. The standard treatment is prompt surgical exploration, evacuation of haematoma, and primary repair of the urethral and corpora cavernosa defects. Late complications after surgical repair are penile curvature and pain during coitus. They are usually attributable to a residual fibrotic area.

Conclusion

Urethral injury associated with corpora cavernosa fracture usually has typical signs. The mechanism of trauma is very suggestive. Early surgical treatment is the only guarantee of a satisfactory functional result.     

Joint arthritis and soft-tissue problems of the hand

The hand, by virtue of its position in space, complex anatomical composition, and characteristic biomechanical properties, is subject to a host of disease processes and traumatic injuries. This article reviews the presentation, evaluation, treatment, and outcomes of treatment in hand infections, high-pressure injection injuries, Dupuytren disease, and arthritis.     

Human dental mesenchymal stem cells and neural regeneration

Nerve tissue presents inherent difficulties for its effective regeneration. Stem cell transplantation is considered an auspicious treatment for neuronal injuries. Recently, human dental mesenchymal stem cells (DMSCs) have received extensive attention in the field of regenerative medicine due to their accessibility and multipotency. Since their origin is within the neural crest, they can be differentiated into neural crest-derived cells including neuron and glia cells both in vitro and in vivo. DMSCs are also able to secrete a wide variety of neurotrophins and chemokines, which promote neuronal cells to survival and differentiation. Experimental evidence has shown that human DMSCs engraftment recovered neuronal tissue damage in animal models of central nervous system injuries. Human DMSCs can be a new hope for treatment of nervous system diseases and deficits such as spinal cord injury, stroke and Parkinson’s disease.     

Stenosis of the urethral meatus in boys; surgical correction

Stenosis of the external urethral meatus in boys is not an uncommon developmental defect. It may cause disease higher in the urinary tract and unless corrected may lead to permanent damage. The most effective treatment is meatotomy, which can be carried out in a physician's office by a method described.     

入伍新训中膝关节损伤的特点与防治研究

目的：通过对某部新入伍官兵训练中膝关节损伤发生原因、特点进行流行性病学调查和分析,为合理训练,预防损伤发生和 治疗相关伤病提供指导依据。方法：对某部2013 年度450 名新入伍官兵的训练伤发病情况进行统计分析,重点分析膝关节损伤 发生率、伤病类型和致伤原因,并对其严重者进行关节镜治疗,观察和分析术后随访效果。结果：某部新兵的训练伤发生率为 20.0%。以关节急性扭伤最为多见,占81.1%。其中膝关节损伤共发生32 例,占训练伤发病率为7.1%,占训练伤发病率43.8%,其 中膝关节周围肌肉损伤20 例、交叉韧带损伤1 例、半月板损伤9 例、侧副韧带损伤2 例。致伤率最高的前3 位科目是5000 米负 重跑、跨越障碍训练、格斗训练,共27 例,占膝关节训练伤总数的84.4%。所有受伤患者中,12 例行手术治疗,20 例给予石膏、支具 固定、休息等保守治疗。经随访所有患者均得到较好的功能恢复。结论：对于新兵膝关节训练伤预防工作非常重要,避免致残;关 节镜手术技术的进步对于膝关节军事训练伤治疗有良好的效果。     

6. Changing concepts in the diagnosis and treatment of closed renal injuries.

Direct force is responsible for all closed kidney injuries except those involving the pedicle. Underlying parenchymal disease strongly predisposes the kidney to injury. Accurate diagnosis is crucial to rational treatment, and this is accomplished by infusion pyelography, angiography, retrograde pyelography and scanning. Treatment of kidney injuries has classically been conservatives, except when the clinical course or the nature of pre-existing diseases make an operation essential, but the current trend is towards more aggressive surgical treatment. This applies not only to pedicle injuries but also to major parenchymal trauma, and it is rendered feasible by precise diagnosis and improved surgical technique.