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This paper analyzed the problems existing in China’s basic medical and health services from the perspective of fairness and efficiency, and the main restricting factors of balanced developmen. The main factors were: the far-reaching influence of "dual economic structure" between urban and rural areas, the government’s low-efficiency intervention in the allocation of health resources, the efficiency of hierarchical diagnosis and treatment system has not been fully released, the level of basic medical security needs to be improved, and the reform of the management and operation mechanism of medical institutions is lagging. It is proposed to adhere to the value concept of appropriate balance between fairness and efficiency, give full play to the functions of the government and the market, and take concrete measures to improve the financing mode, optimize the allocation of resources and improve the service system.
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Objective To summarize the clinical experie nce in the diagnosis and treatment of cystolithiasis complicated by squamous cel l carcinoma (SCC) of the bladder. Methods Retrospective analysis was performed in 28 patients (19 men and 9 women) with cystolithiasis c omplicated by SCC of the bladder.Their age ranged from 26 to 68 years with a mea n of 33 years.The disease course of cystolithiasis ranged from 2 to 18 years wit h a mean of 4.5 years. Among the 24 cases who underwent urine cytology,atypical cells were found in 19 cases.KUB showed solitary stone of the bladder in 5 case and multiple stones in 23.Space-occupying lesions were noted in 11 cases on IVU ,in 17 cases on B-ultrasonography and CT scan.Cystoscopy was performed in 28 ca ses, and tumors were found in 21 cases.The size of the tumors ranged from 1.2 cm ?1.5 cm to 2.2 cm?5.0 cm. Partial cystectomy was performed in 21 cases, includ ing ureterocysto-transplantation in 6 cases.Radical cystectomy was performed in 7 cases. Results Pathology revealed SCC of the bladder in all 28 cases,including G_1 in 11 cases,G_2 in 12 cases,G_3 in 5 cases;T_1 in 11 cases,T_2 in 12 cases,T_3 in 5 cases. Twenty-two patients were followe d up for 1 to 8 years with a mean of 3 years. The 1- and 5-year survival rates were 63.6% (14/22) and 16.7% (3/18),respectively. Conclusions Cystolithiasis is the main cause of SCC of the bladder. Early diagnosis a nd surgical treatment is very important for such patients.
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9.81 kPa (TypeⅠ);12 cases,ALPP 6.38-9.81 kPa (TypeⅡ);22 cases,ALPP