現(xiàn)有預(yù)防非妊娠期婦女膀胱炎復(fù)發(fā)的臨床證據(jù)如下:①連續(xù)預(yù)防性使用抗生素:一系列隨機(jī)對(duì)照試驗(yàn)研究表明,連續(xù)預(yù)防性使用抗生素(甲氧芐氨嘧啶、復(fù)方磺胺甲噁唑、呋喃妥英、頭孢克洛或一種喹啉)6～12個(gè)月可以減少?gòu)?fù)發(fā)性膀胱炎的發(fā)生率,但各種不同用藥方案間未發(fā)現(xiàn)感染率有差異.一個(gè)比較持續(xù)性每日使用抗生素與性交后使用抗生素的隨機(jī)對(duì)照試驗(yàn)表明,1年后尿培養(yǎng)陽(yáng)性率差異無(wú)統(tǒng)計(jì)學(xué)意義.②性交后預(yù)防性使用抗生素(復(fù)方磺胺甲噁唑、呋喃妥英或一種喹啉):4個(gè)隨機(jī)對(duì)照試驗(yàn)研究表明,性交后2 h內(nèi)使用復(fù)方磺胺甲噁唑、呋喃妥英或喹啉較安慰劑能顯著降低膀胱炎發(fā)生率.一個(gè)關(guān)于性交后預(yù)防性使用抗生素和每日連續(xù)使用抗生素的隨機(jī)對(duì)照試驗(yàn)發(fā)現(xiàn),1年后二者的膀胱炎發(fā)生率的差異無(wú)統(tǒng)計(jì)學(xué)意義.③一次性使用復(fù)方磺胺甲噁唑:一個(gè)小樣本隨機(jī)對(duì)照試驗(yàn)發(fā)現(xiàn),連續(xù)每日預(yù)防性使用復(fù)方磺胺甲噁唑與在膀胱炎癥狀出現(xiàn)后一次性使用復(fù)方磺胺甲噁唑相比,前者能顯著降低膀胱炎發(fā)生率.但由于證據(jù)太有限,不能得出肯定結(jié)論.④酸果蔓汁(cranberry juice)和酸果蔓制品:一個(gè)系統(tǒng)評(píng)價(jià)發(fā)現(xiàn),酸果蔓汁及其制品能預(yù)防復(fù)發(fā)性膀胱炎的證據(jù)不足.⑤用馬尿酸烏洛托品預(yù)防:缺乏研究馬尿酸烏洛托品的可靠的隨機(jī)對(duì)照試驗(yàn).
目的 探討彩色多普勒超聲診斷膀胱破裂的診斷價(jià)值,以提高膀胱破裂的超聲診斷水平。 方法 回顧性分析2002年1月－2011年9月術(shù)前行彩色超聲檢查診斷膀胱破裂并經(jīng)手術(shù)證實(shí)的5例患者資料，下腹加壓檢查和經(jīng)導(dǎo)尿管注水試驗(yàn)檢查作為超聲判斷有無(wú)膀胱破裂的重要檢查方法。 結(jié)果 5例均為腹膜外型膀胱破裂,彩色多普勒血流顯像明確診斷4例，漏診1例，超聲檢查是診斷膀胱破裂的有效方法。 結(jié)論 彩色多普勒超聲可以作為膀胱破裂的首選檢查技術(shù)。Objective To investigate the value of color doppler flow image (CDFI) in diagnosing bladder rupture, in order to promote the ultrasound diagnosis for the disease. Methods We retrospectively analyzed the medical data of 5 patients with bladder rupture diagnosed by CDFI before operation and confirmed by surgery. Pressing the lower abdomen and injecting water through catheter were the main examination methods for CDFI in diagnosing bladder rupture. Results All the 5 cases were bladder rupture of extraperitoneal type. Four were diagnosed with CDFI, and 1 was misdiagnosed. The ultrasonic examination was an effective technology in diagnosing bladder rupture. Conclusion CDFI may be regarded as the first diagnostic technology for bladder rupture.
【摘要】 目的 分析異基因造血干細(xì)胞移植術(shù)（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后出血性膀胱炎（hemorrhagic cystitis，HC）相關(guān)的危險(xiǎn)因素，動(dòng)態(tài)監(jiān)測(cè)受者尿BK病毒（BK virus，BKV），分析其與HC發(fā)病的關(guān)系?！》椒ā』仡櫺苑治?003年3月-2008年1月期間接受allo-HSCT的121例患者的資料，選擇8個(gè)臨床參數(shù)[年齡、性別、疾病類(lèi)型、移植時(shí)疾病狀態(tài)、供者類(lèi)型、預(yù)處理方案、急性移植物抗宿主?。╝cute graft-versus-host disease，aGVHD）、aGVHD的預(yù)防方案]作COX回歸分析。采用SYBR Green染料實(shí)時(shí)熒光定量聚合酶鏈反應(yīng)法對(duì)2006年9月-2008年1月42例allo-HSCT患者尿BKV載量進(jìn)行動(dòng)態(tài)監(jiān)測(cè)，分析被檢查者尿液BKV基因載量與HC發(fā)生以及嚴(yán)重程度的關(guān)系?！〗Y(jié)果 121例患者中有24例發(fā)生HC，發(fā)病時(shí)間為術(shù)后0~63 d，中位時(shí)間40 d；持續(xù)時(shí)間7~150 d，中位時(shí)間22 d。Ⅱ~Ⅳ度aGVHD為HC的獨(dú)立危險(xiǎn)因素[RR=8.304，95%CI（1.223，56.396），P=0.030]。allo-HSCT受者尿液中BKV檢出率為100%（42/42）。與正常人及未發(fā)生HC的allo-HSCT受者相比，HC患者尿中BKV基因載量具有更高平均峰值。 結(jié)論?、騸Ⅳ度aGVHD，尿中BKV DNA高載量與HC的發(fā)生有相關(guān)性?！続bstract】 Objective To identify the risk factors for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and define the quantitative relationship between BK virus (BKV) DNA load with HC. Methods The medical records of 121 patients undergoing allo-HSCT from March 2003 to January 2008 were retrospectively analyzed. Eight clinical parameters were selected for COX regression analysis, including age, sex, underlying disease, disease status at transplant, donor type, conditioning regimen, acute graft-versus-host disease (aGVHD), and GVHD prophylaxis. From September 2006 to January 2008, mid-stream urine samples were continuously collected from 42 patients with allo-HSCT. SYBR green real-time polymerase chain reaction, technique was utilized to define the quantitative relationship between BKV DNA load and HC. Results Twenty-four out of 121 patients developed HC. The median time of onset was 40 days after HSCT, ranged from 0 to 63 days. The disease lasted for 7 to 150 days, with a median duration of 22 days. Grade Ⅱ-Ⅳ aGVHD [RR=8.304, 95% CI (1.223,56.396); P=0.030] was identified as an independent risk factor for the occurrence of HC. BKV excretion was detected in 100% (42/42) of the recipients of allo-HSCT. When compared with asymptomatic patients and allo-HSCT recipients without HC, patients with HC had a significantly higher mean peak BKV DNA load. Conclusions Patients are at an increased risk of developing HC if they have grade Ⅱ-Ⅳ aGVHD. A correlation between the load of BKV and incidence of HC may exist.
【摘要】 目的 分析超聲對(duì)腺性膀胱炎的誤、漏診原因，探討減少其誤、漏診的方法。 方法 回顧性分析2006年1月-2010年2月經(jīng)病理證實(shí)的135例腺性膀胱炎的聲像圖表現(xiàn)?！〗Y(jié)果 135例腺性膀胱炎患者中，超聲誤診26例，誤診率19.3%，漏診11例，漏診率8.2%。誤診的主要原因：乳頭結(jié)節(jié)型和團(tuán)塊型與膀胱腫瘤聲像圖極為相似、容易混淆，超聲醫(yī)師對(duì)膀胱壁各層次的觀察不仔細(xì)，對(duì)病史重視不夠；漏診的主要原因：膀胱充盈不佳或不充盈，病變體積太小、位于前壁或頂部，或病變位于膀胱后壁及頸部被明顯增生的前列腺、膀胱內(nèi)血凝塊及膀胱結(jié)石等掩蓋?！〗Y(jié)論 超聲是診斷腺性膀胱炎常用方法，但存在一定的誤、漏診，改進(jìn)檢查方法，可減少其誤、漏診發(fā)生。【Abstract】 Objective To analyze the reasons of missed diagnosis and misdiagnosis of glandularis cystitis by ultrasonography. Methods The sonographic outcomes of 135 patients with glandular cystitis diagnosed by pathological examination from January 2006 to February 2010 were retrospectively analyzed. Results In 135 patients, misdiagnosis was in 26 with a rate of 19.3%, missed diagnosis was in 11 with a rate of 8.2%. The reasons of misdiagnosis included: the sonographic outcomes of mastoid and tuberculous conglomeration were similar to those of bladder tumour; the ultrasonographic professionals didn’t clearly observe each layer of the bladder wall, and didn’t pay enough attention to the disease history. The reasons of missed diagnosis included: the bladder was under-filled or unfilled, the size of the lesions were too small and were located at the anterior wall or the top, and the lesions were located at the posterior wall and neck of the bladder which were covered up by obvious prostate hyperplasia,and gores or stones of bladder so that the lesions could not be observed. Conclusion Ultrasonography is a usual method for diagnosing glandular cystitis,and we should ameliorate the examination to decrease the misdiagnosis and missed diagnosis.
【摘要】 目的 總結(jié)脊髓損傷所致神經(jīng)源性膀胱患者，在排尿方式改變后自我護(hù)理的方法與經(jīng)驗(yàn)。 方法 2008年7月-2010年1月，通過(guò)制定個(gè)體化健康宣教計(jì)劃、規(guī)律性飲水排尿方法、熟練的清潔間歇性導(dǎo)尿技術(shù)，指導(dǎo)和幫助患者掌握和進(jìn)行自我排尿管理?！〗Y(jié)果 21例患者采用清潔間歇性導(dǎo)尿術(shù)，無(wú)一例出現(xiàn)嚴(yán)重的泌尿系感染、泌尿系結(jié)石、膀胱憩室、輸尿管擴(kuò)張、腎積水等泌尿系統(tǒng)的其它并發(fā)癥?！〗Y(jié)論 掌握正確的清潔間歇性導(dǎo)尿術(shù)自我護(hù)理方法，對(duì)維持患者的膀胱、尿道的正常生理功能，預(yù)防泌尿系統(tǒng)其它并發(fā)癥，提高患者的生活質(zhì)量，延長(zhǎng)生命有重要意義。
摘要:目的:探討經(jīng)腹腔鏡行輸尿管膀胱再植手術(shù)的臨床療效。 方法:對(duì)3例先天性巨輸尿管疾病患者采用經(jīng)腹腔鏡行輸尿管下段整形膀胱移植術(shù)。結(jié)果:3例手術(shù)順利,均獲成功,術(shù)中出血量20～80 mL,術(shù)后吻合口或切口無(wú)漏尿,術(shù)后住院時(shí)間7～12 d。所有患者隨訪(fǎng)3～6個(gè)月,靜脈腎盂造影(IVU)或B超均提示造影劑通過(guò)良好,腎積水均得到明顯改善,輸尿管不擴(kuò)張,無(wú)輸尿管吻合口狹窄。結(jié)論:經(jīng)腹腔鏡輸尿管膀胱再植手術(shù)具有創(chuàng)傷小、出血少、術(shù)后恢復(fù)快、住院時(shí)間短等特點(diǎn),療效肯定,值得臨床推廣。Abstract: Objective: To evaluate the clinical efficacy of transperitoneal laparoscopic ureterovesical reimplantation. Methods: Three patients who were diagnosed with simple congenital ureter outlet stricture,underwent transperitoneal laparoscopic ureterovesical reimplantation. Results: All the operations were successful. The intraoperative blood loss was 2080 mL (mean 45 mL). And the postoperative hospitalization was 712 day.No complications were occurred during operation and the follow up period for 36 months in 3 cases. 〖WTHZ〗Conclusion〖WTBZ〗: Transperitoneal laparoscopic ureterovesical reimplantation has the advantages of minimal invasion,less blood loss and rapid postoperative rehabilitation,which is an effective and practical procedure.
目的 探討利用膀胱壓、胃內(nèi)壓來(lái)間接監(jiān)測(cè)腹內(nèi)壓的可行性，以便于腹腔間隔室綜合征（ACS）的診斷。方法對(duì)24例行腹腔鏡膽囊摘除術(shù)（LC）患者進(jìn)行前瞻性對(duì)照研究。在行LC時(shí)，在腹內(nèi)壓為10、 15、 20及25 mm Hg時(shí)同時(shí)測(cè)定膀胱壓和胃內(nèi)壓。結(jié)果腹內(nèi)壓與膀胱壓的回歸方程為Y=-10.193+1.228X，相關(guān)系數(shù)為0.941； 腹內(nèi)壓與胃內(nèi)壓的回歸方程為Y=-7.408+1.478X，相關(guān)系數(shù)為0.996。由此表明，腹內(nèi)壓與膀胱壓和胃內(nèi)壓呈顯著正相關(guān)。結(jié)論腹內(nèi)壓與胃內(nèi)壓和膀胱壓有很好的相關(guān)性，可以利用胃內(nèi)壓和膀胱壓來(lái)反映實(shí)際腹內(nèi)壓。
目的探討膀胱平滑肌細(xì)胞（bladder smooth muscle cells， BSMCs）條件培養(yǎng)液能否誘導(dǎo)臍帶MSCs（umbilical cord MSCs，UCMSCs）向平滑肌細(xì)胞（smooth muscle cells，SMCs）分化，為組織工程技術(shù)應(yīng)用于泌尿系統(tǒng)修復(fù)重建尋找可供選擇的種子細(xì)胞。 方法取足月新生兒臍帶和行膀胱全切術(shù)患者捐贈(zèng)的正常膀胱組織，分別分離培養(yǎng)UCMSCs和BSMCs。收集第1～5代BSMCs的培養(yǎng)液，與完全培養(yǎng)基以1∶1比例配制成BSMCs條件培養(yǎng)液。取第3代UCMSCs作為誘導(dǎo)細(xì)胞，使用BSMCs條件培養(yǎng)液培養(yǎng)為誘導(dǎo)組（A組），完全培養(yǎng)基培養(yǎng)為對(duì)照組（B組），倒置顯微鏡觀察兩組細(xì)胞形態(tài)變化；另設(shè)單純BSMCs為陽(yáng)性對(duì)照組（C組）。培養(yǎng)7、14 d，采用免疫熒光染色和Western blot檢測(cè)各組細(xì)胞中α-平滑肌肌動(dòng)蛋白（α-smooth muscle actin，α-SMA）、Calponin、平滑肌肌球蛋白重鏈（smooth muscle myosin heavy chain，SM-MHC）的表達(dá)情況。 結(jié)果誘導(dǎo)培養(yǎng)后，A組細(xì)胞逐漸變長(zhǎng)，由短棒狀、多個(gè)突起逐漸轉(zhuǎn)變?yōu)殚L(zhǎng)梭形，與BSMCs形狀相似；B組細(xì)胞形態(tài)未見(jiàn)明顯變化。免疫熒光染色示，C組BSMCs中α-SMA、Calponin和SM-MHC均呈陽(yáng)性表達(dá)。培養(yǎng)7 d，A、B組可見(jiàn)α-SMA呈陽(yáng)性表達(dá)；14 d時(shí)，A組α-SMA陽(yáng)性表達(dá)逐漸增多，B組無(wú)明顯變化。培養(yǎng)7 d，A組可見(jiàn)Calponin陽(yáng)性表達(dá)，14 d時(shí)陽(yáng)性表達(dá)明顯增多；B組各時(shí)間點(diǎn)均未見(jiàn)Calponin陽(yáng)性表達(dá)。各時(shí)間點(diǎn)A、B組均未見(jiàn)SM-MHC陽(yáng)性表達(dá)。Western blot檢測(cè)示各組細(xì)胞α-SMA、Calponin和SM-MHC蛋白表達(dá)情況與免疫熒光染色結(jié)果基本一致。 結(jié)論BSMCs條件培養(yǎng)液能誘導(dǎo)UCMSCs向SMCs分化，UCMSCs有望成為泌尿系統(tǒng)修復(fù)重建可供選擇的種子細(xì)胞之一。
目的綜述根治性膀胱切除術(shù)后常用的尿流改道方式。 方法廣泛查閱近年國(guó)內(nèi)外有關(guān)根治性膀胱切除術(shù)后尿流改道的文獻(xiàn)并進(jìn)行總結(jié)。 結(jié)果尿流改道術(shù)包括不可控性尿流改道皮膚造口術(shù)、可控性尿流改道皮膚造口術(shù)、原位新膀胱術(shù)，其中不可控性尿流改道造口術(shù)中的回腸流出道術(shù)是一種應(yīng)用廣泛、療效理想的術(shù)式。組織工程膀胱的一系列基礎(chǔ)研究顯示其具有廣闊臨床應(yīng)用前景。 結(jié)論腸管在較長(zhǎng)時(shí)間內(nèi)仍將是尿流改道及膀胱重建的主要材料；組織工程膀胱有望成為膀胱替代的理想材料，成為解決膀胱缺失的最終途徑。
目的綜述脫細(xì)胞基質(zhì)在組織工程氣管中的研究現(xiàn)狀、進(jìn)展及未來(lái)前景。 方法廣泛查閱脫細(xì)胞基質(zhì)在組織工程氣管研究中的相關(guān)文獻(xiàn)，對(duì)不同脫細(xì)胞基質(zhì)修復(fù)人和動(dòng)物氣管病損的研究現(xiàn)狀進(jìn)行綜合分析。 結(jié)果氣管組織工程應(yīng)用的脫細(xì)胞基質(zhì)包括空腸、膀胱、主動(dòng)脈和氣管。 結(jié)論脫細(xì)胞膀胱基質(zhì)及空腸基質(zhì)在修復(fù)氣管小范圍非環(huán)形病損中具有較好效果，脫細(xì)胞主動(dòng)脈基質(zhì)在長(zhǎng)段氣管病損中的應(yīng)用還需進(jìn)一步研究，脫細(xì)胞氣管基質(zhì)在長(zhǎng)段氣管病損中具有良好的應(yīng)用前景。