【摘要】：第一部分 國(guó)產(chǎn)與進(jìn)口等離子雙極電切環(huán)對(duì)犬前列腺組織病理學(xué)影響的對(duì)照研究目的：對(duì)比研究國(guó)產(chǎn)與進(jìn)口等離子雙極電切環(huán)對(duì)犬前列腺組織病理學(xué)影響。方法：18只成年雄性雜種犬隨機(jī)分為2組：進(jìn)口電切環(huán)組(9只)、國(guó)產(chǎn)電切環(huán)組(9只)。于術(shù)后0(術(shù)后立即)、1、6周分別取各組動(dòng)物處死,獲取前列腺標(biāo)本,光鏡下觀察前列腺組織病理學(xué)改變并測(cè)量創(chuàng)面凝固層厚度。結(jié)果：術(shù)后0、1周,進(jìn)口電切環(huán)組和國(guó)產(chǎn)電切環(huán)組前列腺組織創(chuàng)面的凝固層厚度分別為(235.45±25.37)μm、(110.87±20.23)μm和(238.12±32.47)μm、(112.64±18.76)μm,術(shù)后0、1周兩組相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后6周,進(jìn)口電切環(huán)組和國(guó)產(chǎn)電切環(huán)組前列腺組織創(chuàng)面凝固層完全脫落,創(chuàng)面均被覆再生的尿路上皮。術(shù)后0、1、6周,進(jìn)口電切環(huán)組和國(guó)產(chǎn)電切環(huán)組前列腺組織均有不同程度的炎癥反應(yīng),凝固層下部分腺腔擴(kuò)張,上皮破壞。結(jié)論：使用進(jìn)口電切環(huán)和國(guó)產(chǎn)電切環(huán)對(duì)犬前列腺組織創(chuàng)面的病理學(xué)影響基本相似。第二部分前列腺等離子雙極電切技術(shù)在治療大體積前列腺增生(80g)中的應(yīng)用研究目的：研究經(jīng)尿道前列腺等離子雙極電切術(shù)(PKRP)在前列腺增生患者(前列腺體積大于80g)中應(yīng)用和臨床效果及比較PKRP對(duì)不同前列腺體積患者治療效果。方法：回顧性分析2011年1月-2011年12月在我院泌尿外科經(jīng)PRKP治療后的前列腺增生患者(前列腺體積大于80g)的臨床資料,收集患者的基本信息,包括術(shù)前指標(biāo)(年齡、前列腺大小、Qmax、殘余尿量、IPSS、fPSA、fPSA血Hb、血Na+)和術(shù)后指標(biāo)(住院天數(shù)(h)、手術(shù)時(shí)間(min)、置管時(shí)間、有無再手術(shù)、有無輸血)同時(shí)按照前列腺體積將上述患者分為兩組：80-100g和100g以上。通過對(duì)上述兩組年齡、前列腺大小、Qmax、殘余尿量、IPSS、fPSA、fPSA、血Hb、血Na+、住院天數(shù)(h)、手術(shù)時(shí)間(min)、置管時(shí)間等結(jié)果進(jìn)行t檢驗(yàn)并統(tǒng)計(jì)分析,對(duì)在手術(shù)和輸血行卡方檢驗(yàn),P0.05兩組間差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果：納入經(jīng)PKRP術(shù)后患者40例,手術(shù)過程順利。40例PKRP術(shù)后病理報(bào)告均為良性前列腺增生。經(jīng)PKRP手術(shù)治療的患者年齡為(72.3±6.65)歲,術(shù)前前列腺大小為(101.05±18.78) g,Qmax(7.25±2.62) ml/s,殘余尿量(131.09± 139.63) ml, IPSS(19.97±7.12),Total PSA (13.11±12.31) ng/L, f/t PSA (0.226±0.082),術(shù)前Hb(129.65±11.58)g/L,術(shù)前血Na+(141.34±2.62) mmol/L,總手術(shù)時(shí)間(112±40.62)min,切除重量(60±17.02)g,住院時(shí)間(25.475±8.464)天,置管時(shí)間(166.05±91.09)h。術(shù)后1例因出血再手術(shù),6例術(shù)后需要輸血,無TUR綜合征的發(fā)生。不同大小的前列腺增生患者經(jīng)尿道前列腺等離子雙極電切術(shù)后顯示,80-100g前列腺組(n=23)和100g以上前列腺組(n=1 7)經(jīng)PKRP術(shù)后在切除重量(51.52±11.02g vs.71.47±17.21g)、住院天數(shù)(23.17±7.50d vs.28.59±8.91d)、再手術(shù)(0 vs.1)和輸血例數(shù)(0 vs.6)有顯著的統(tǒng)計(jì)學(xué)差異(P0.05)。35例患者完成電話隨訪,隨訪時(shí)間為術(shù)后5-17個(gè)月,IPSS評(píng)分為2.51±1.15,僅一例患者述勃起功能較術(shù)前稍差。出院后無患者需要再手術(shù)。無患者發(fā)生尿失禁,7例患者有逆行射精,有20例發(fā)生了泌尿系感染。結(jié)論：PKRP術(shù)治療前列腺體積大于80g的前列腺增生是安全有效的,通過將生理鹽水作為術(shù)中沖洗液,它明顯消除了TUR綜合征的發(fā)生危險(xiǎn),且對(duì)性功能無明顯影響。PKRP是治療大前列腺的一種有前景的形式。它應(yīng)在泌尿外科界內(nèi)更多的推廣和應(yīng)用。第三部分Bcl-2蛋白表達(dá)與中國(guó)人群前列腺癌風(fēng)險(xiǎn)相關(guān)性的Meta分析目的：采用：neta分析的方法系統(tǒng)評(píng)價(jià)Bcl-2蛋白表達(dá)與中國(guó)人群前列腺癌及其不同臨床病理特征的相關(guān)性。方法：計(jì)算機(jī)檢索PubMed、Embase、CBM、CNKI、VIP和WanFang Data數(shù)據(jù)庫,查找關(guān)于Bcl-2蛋白表達(dá)與中國(guó)人群前列腺癌及其不同臨床病理特征相關(guān)性的病例-對(duì)照研究,檢索時(shí)限均為從建庫至2016年3月。由2位評(píng)價(jià)者獨(dú)立進(jìn)行文獻(xiàn)篩選、資料提取和方法學(xué)質(zhì)量評(píng)價(jià),然后采用RevMan 5.3軟件進(jìn)行Meta分析。結(jié)果：最終納入24個(gè)病例-對(duì)照研究,其中前列腺癌患者1081例,正常前列腺對(duì)照178例。Meta分析結(jié)果顯示：前列腺癌患者Bcl-2蛋白的表達(dá)量高于前列腺增生患者[OR=3.27,95%CI(1.68,6.38),P=0.0005],且高于正常前列腺對(duì)照[OR=3.77,95%CI (1.81,7.88),P=0.0004],差異均有統(tǒng)計(jì)學(xué)意義;前列腺癌中低分化組Bcl-2蛋白的表達(dá)量高于高分組[OR=3.60,95%CI(2.51,5.16),P0.00001]、前列腺癌J-W-P分期C+D期組組Bcl-2蛋白的表達(dá)量高于A+B期組[OR=2.17,95%CI(1.23,3.84),P=0.008]、前列腺癌伴轉(zhuǎn)移組Bcl-2蛋白的表達(dá)量高于不伴轉(zhuǎn)移組[OR=4.02,95%CI(1.85,8.75), P=0.0005],差異均有統(tǒng)計(jì)學(xué)意義。結(jié)論：Bcl-2蛋白表達(dá)與中國(guó)人群前列腺癌及其臨床病理特征有顯著相關(guān)性。受納入研究樣本量和質(zhì)量限制,上述結(jié)論需進(jìn)一步開展大樣本、高質(zhì)量研究加以驗(yàn)證。第四部分E-cadherin表達(dá)與中國(guó)人群前列腺癌風(fēng)險(xiǎn)相關(guān)性的Meta分析目的：采用neta分析的方法系統(tǒng)評(píng)價(jià)E-cadherin表達(dá)與中國(guó)人群前列腺癌及其不同臨床病理特征的相關(guān)性。方法：計(jì)算機(jī)檢索PubMed、Embase、CBM、CNKI、VIP和WanFang Data數(shù)據(jù)庫,搜集關(guān)于E-cadherin表達(dá)與中國(guó)人群前列腺癌及其不同臨床病理特征相關(guān)性的臨床研究,檢索時(shí)限均為從建庫至2015年12月。由2位評(píng)價(jià)者按納入排除標(biāo)準(zhǔn)獨(dú)立進(jìn)行文獻(xiàn)篩選和資料提取,然后采用RevMan5.3軟件進(jìn)行Meta分析。結(jié)果：最終納入21個(gè)研究,其中前列腺癌組920例,前列腺增生組415例,正常前列腺組織組48例。Meta分析結(jié)果顯示,E-cadherin在前列腺癌組的表達(dá)顯著低于前列腺增生組[OR=0.07,95%CI(0.05,0.11),P0.01]和正常前列腺組織組[OR=0.04, 95%CI (0.01,0.18), P0.01],且E-cadherin在前列腺癌組織中的表達(dá)隨著前列腺癌病理分級(jí)和臨床分期的增加、伴淋巴結(jié)或骨轉(zhuǎn)移及血清PSA水平的增加而逐漸降低。結(jié)論：E-cadherin低表達(dá)與中國(guó)人群前列腺癌及其臨床病理特征有顯著相關(guān)性。受納入研究樣本量和質(zhì)量限制,該結(jié)論需進(jìn)一步高質(zhì)量開展研究加以驗(yàn)證。第五部分Survivin蛋白表達(dá)與中國(guó)人群前列腺癌風(fēng)險(xiǎn)相關(guān)性的Meta分析目的：采用Meta分析的方法評(píng)價(jià)Survivin蛋白表達(dá)與中國(guó)人群前列腺癌及其不同臨床病理特征的相關(guān)性。方法：計(jì)算機(jī)檢索PubMed、Embase、CBM、CNKI、VIP和WanFang Data數(shù)據(jù)庫,查找關(guān)于Survivin蛋白表達(dá)與中國(guó)人群前列腺癌及其不同臨床病理特征相關(guān)性的病例-對(duì)照研究,檢索時(shí)限均為從建庫至2015年11月。由2位作者按納入排除標(biāo)準(zhǔn)獨(dú)立進(jìn)行文獻(xiàn)篩選、資料提取和方法學(xué)質(zhì)量評(píng)價(jià),然后采用RevMan 5.3軟件進(jìn)行Meta分析。結(jié)果：最終納入32個(gè)病例-對(duì)照研究,其中前列腺癌組1613例,前列腺增生組708例,正常前列腺組織組93例。Meta分析結(jié)果顯示：Survivin蛋白在前列腺癌組與前列腺增生組[OR=32.95,95%CI(19.88,54.63),P0.01]、前列腺癌組與正常前列腺組織組[OR=75.78,95%CI(26.97,212.98),P0.01]的表達(dá)差異均有統(tǒng)計(jì)學(xué)意義；Survivin蛋白在前列腺癌中低分化組與高分組[OR=4.45,95%CI (3.13,6.32), P0.01],前列腺癌J-W-P分期C+D期組與A+B期組[OR=5.42,95%CI (2.91,10.10), P0.01],伴淋巴結(jié)轉(zhuǎn)移組與不伴淋巴結(jié)轉(zhuǎn)移組[OR=4.07,95%CI (2.91,10.10), P0.01]的表達(dá)差異均有統(tǒng)計(jì)學(xué)意義。結(jié)論：Survivin蛋白表達(dá)與中國(guó)人群前列腺癌及其臨床病理特征有顯著相關(guān)性。受納入研究樣本量和質(zhì)量限制,上述結(jié)論需進(jìn)一步開展研究加以驗(yàn)證。
[Abstract]:Part 1 a comparative study of the effects of domestic and imported plasma bipolar electrotangent rings on the histopathology of prostatic prostate in dogs. Objective: To compare the histopathological effects of domestic and imported plasma bipolar rings on the histopathology of the prostate in dogs. Methods: 18 adult male hybrid dogs were randomly divided into 2 groups: the imported electric cutting ring group (9), and the domestic electric cut ring group (9 0 after the operation (immediately after the operation), the animals were sacrificed at 1,6 weeks and the prostate specimens were obtained. The pathological changes of the prostate tissue were observed under the light microscope and the thickness of the solidified layer of the wound was measured. Results: the thickness of the coagulation layer of the prostate tissue in the imported electric cutting ring group and the domestic electric cutting ring group was (235.45 + 25.37) mu m respectively, (110.87 +). 20.23) mu m and (238.12 + 32.47) mu m, (112.64 + 18.76) mu m, there was no significant difference in the two groups after the operation (P0.05). 6 weeks after the operation, the coagulation layer of the wound surface of the prostate tissue in the imported electric cutting ring group and the domestic electrocut ring group was completely off, and the wound was covered with the regenerated urinary tract epithelium. After 0,1,6 weeks after the operation, the imported electric cutting ring group and the domestic electric cutting ring group were in the forefront. The adenoid tissues have different degrees of inflammation, the dilatation of the lumen and the destruction of the epithelium under the solidified layer. Conclusion: the pathological effects of the imported electrotangent ring and the domestic electrotangent ring on the wound of the prostate tissue are basically similar. The application of second parts of the prostatic plasma bipolar electrocutting technique in the treatment of large volume prostatic hyperplasia (80g) Objective: To study the application and clinical effect of transurethral prostatic plasma bipolar electrosurgical resection (PKRP) in patients with prostatic hyperplasia (prostate volume greater than 80g) and to compare the therapeutic effect of PKRP on patients with different prostate volumes. Methods: a retrospective analysis of the prostatic hyperplasia in the Department of Urology of our hospital in December January 2011 after the treatment of PRKP in the Department of urology. The basic information of the patients (prostate volume greater than 80g) was collected, including preoperative parameters (age, size of the prostate, Qmax, residual urine, IPSS, fPSA, fPSA blood Hb, blood Na+) and postoperative index (hospitalization days (H), operation time (min), catheterization time, reoperation, or blood transfusion) at the same time according to the volume of the prostate. Two groups: 80-100g and 100g. Through the above two groups of age, the size of the prostate, Qmax, residual urine, IPSS, fPSA, fPSA, blood Hb, blood Na+, the days of hospitalization (H), operation time (min), tube time and other results were carried out t test and statistical analysis, the difference between the two groups of the two groups was statistically significant. 40 patients were treated with PKRP, and the pathological report of.40 PKRP after operation was benign prostatic hyperplasia. The age of the patients treated with PKRP was (72.3 + 6.65) years old. The size of the prostate was (101.05 + 18.78) g, Qmax (7.25 + 2.62) ml/s, residual urine volume (131.09 + 139.63) ml, IPSS (19.97 + 7.12), Total PSA (13.11 + 12.31) ng/. L, f/t PSA (0.226 + 0.082), preoperative Hb (129.65 + 11.58) g/L, preoperative blood Na+ (141.34 + 2.62) mmol/L, total operation time (112 + 40.62) min, resection weight (60 + 17.02) g, hospitalization time (25.475 + 8.464) days, and catheterization time (166.05 + 91.09) H. after surgery for bleeding and reoperation. After transurethral resection of the prostate, the patients with adenosine hyperplasia showed that the 80-100g prostatic group (n=23) and the prostate group above 100g (n=1 7) were excised (51.52 + 11.02g vs.71.47 + 17.21g) after PKRP, and the number of hospitalized days (23.17 + 7.50d vs.28.59 +. 8.91d), and the number of reoperations (0 vs.1) and the number of blood transfusion (0) had significant statistical differences. P0.05).35 patients were followed up by telephone. The follow-up time was 5-17 months after the operation, and the IPSS score was 2.51 + 1.15. Only one case had a slightly worse erectile function than before the operation. No patients needed reoperation after discharge. No patients had urinary incontinence, 7 patients had retrograde ejaculation and 20 cases of urinary tract infection. Conclusion: PKRP was used to treat the large volume of prostate. The prostatic hyperplasia at 80g is safe and effective. By using saline as an intraoperative irrigation fluid, it clearly eliminates the risk of TUR syndrome and has no obvious effect on sexual function..PKRP is a promising form for the treatment of the large prostate. It should be more popularized and applied in the Department of urology. The third part of the Bcl-2 protein expression should be expressed. Meta analysis of the risk of prostate cancer risk in Chinese people: use the NETA analysis method to systematically evaluate the correlation between Bcl-2 protein expression and the different clinicopathological features of prostate cancer in Chinese population. Methods: PubMed, Embase, CBM, CNKI, VIP and WanFang Data databases were retrieved by computer to search for the expression of Bcl-2 protein. A case-control study on the correlation between prostate cancer and its different clinicopathological features in Chinese people, the retrieval time was from the establishment of the library to March 2016. 2 evaluators were selected independently, the data extraction and the methodological quality evaluation, and then the RevMan 5.3 software for Meta analysis. Results: the final inclusion of 24 case control studies, Among the 1081 cases of prostate cancer and 178 cases of normal prostate control, the results of.Meta analysis showed that the expression of Bcl-2 protein in prostate cancer patients was higher than that of [OR=3.27,95%CI (1.68,6.38), P=0.0005], and [OR=3.77,95%CI (1.81,7.88) and P=0.0004], and the difference was statistically significant higher than that of normal prostate control; in prostate cancer, the prostate cancer was statistically significant. The expression of Bcl-2 protein in low differentiation group was higher than that of high group [OR=3.60,95%CI (2.51,5.16), P0.00001]. The expression of Bcl-2 protein in J-W-P stage group C+D group was higher than that of A+B stage group [OR=2.17,95%CI (1.23,3.84), P=0.008], and the expression of Bcl-2 protein in prostate cancer group was higher than that of non metastasis group. Conclusion: there is a significant correlation between the expression of Bcl-2 protein and the prostatic cancer and its clinicopathological features in Chinese population. The above conclusions need to be further developed and verified by high quality research. The fourth part of E-cadherin expression is related to the risk of prostate cancer in Chinese population. Meta analysis objective: to systematically evaluate the correlation between E-cadherin expression and the different clinicopathological features of prostate cancer in Chinese population by NETA analysis. Methods: the database of PubMed, Embase, CBM, CNKI, VIP and WanFang Data was retrieved by computer to collect the expression of prostate cancer and its different clinical diseases in Chinese population. The clinical study of the correlation of physical characteristics was from the establishment of the library to December 2015. The 2 evaluators were selected and extracted independently according to the exclusion criteria. Then the Meta analysis was carried out by RevMan5.3 software. Results: the results were included in 21 studies, including 920 cases of prostate cancer, 415 cases of prostatic hyperplasia and normal prostate. The results of.Meta analysis in 48 cases of tissue group showed that the expression of E-cadherin in prostate cancer group was significantly lower than that of [OR=0.07,95%CI (0.05,0.11), P0.01] and normal prostate tissue [OR=0.04, 95%CI (0.01,0.18), P0.01], and the expression of E-cadherin in prostate cancer tissue was increased with the pathological grading and clinical stage of prostate cancer. Conclusion: there is a significant correlation between the low expression of E-cadherin and the clinicopathological characteristics of prostate cancer in Chinese population and its clinicopathological features. The conclusion needs further high quality research to be verified. The fifth part of the expression of Survivin protein and the expression of Survivin protein in the Chinese population Meta analysis of the risk related prostate cancer risk in Chinese people: Meta analysis was used to evaluate the correlation between the expression of Survivin protein and the different clinicopathological features of prostate cancer in Chinese population. Methods: the database of PubMed, Embase, CBM, CNKI, VIP and WanFang Data was retrieved by computer to search for the expression of Survivin protein and China A case control study of the correlation between prostate cancer and its different clinicopathological features was studied. The retrieval time was from the establishment of the library to November 2015. 2 authors were screened independently by the inclusion criteria, the data extraction and the quality evaluation were evaluated, and the RevMan 5.3 software was used for the Meta analysis. The results were included in the final 32 cases. In the control study, 1613 cases of prostate cancer, 708 cases of prostatic hyperplasia and 93 cases of normal prostate tissue group.Meta analysis showed that the expression of Survivin protein in prostate cancer group and prostatic hyperplasia group [OR=32.95,95%CI (19.88,54.63), P0.01], prostate cancer group and normal prostatic gland group [OR=75.78,95%CI (26.97212.98), P0.01] expression. The differences were statistically significant, Survivin protein in the low differentiation group and the high group [OR=4.45,95%CI (3.13,6.32), P0.01], J-W-P stage C+D group and A+B stage [OR=5.42,95%CI (2.91,10.10), P0.01], lymph node metastasis group and no lymph node metastasis group [OR=4.07,95%CI (2.91,10.10), differences in expression. Conclusion: there is a significant correlation between the expression of Survivin protein and the prostatic cancer and its clinicopathological features in Chinese population.
【學(xué)位授予單位】：武漢大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R699.8

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