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The necessity of presetting ureteral stents before ureteroscopic lithotripsy: a Meta-analysis 输尿管镜碎石前预先放置输尿管支架的必要性:一项荟萃分析
Q4 Medicine Pub Date : 2020-01-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.01.011
Yi Zhang, Xiulan Wang, Ji Zhang
Objective To systematically evaluate the necessity of presetting double-J stent before flexible ureteroscope lithotripsy. Methods Computer retrieved clinical studies on the effect of preoperative presetting double-J-catheter on flexible ureteroscope lithotripsy in PubMed, Cochrane Library, Embase, Scopus, Wan fang, CNKI and VIP databases were reviewed. The retrieval time was from the database construction to November 2018. All of the possible combinations of the following terms were used for the search: flexible ureteroscopic, preoperative, double J stent, and calculus. Two researchers independently conducted literature screening, quality evaluation and data extraction, and completed Meta analysis by using statistical software RevMan5.3. Results Thirty-two case-control trials and 14 randomized controlled trials were screened, with a total of 17 480 patients, including 6 211 patients in the experimental group and 11 269 patients in the control group. The results of meta-analysis showed that the experimental group was superior to the control group in term of the overall postoperative stone clearance rate (OR=1.69, 95%CI 1.37-2.08, P<0.05). In terms of postoperative kidney stone removal rate, the experimental group was superior to the control group (OR=1.67, 95%CI 1.41-1.99, P<0.05). In terms of the removal rate of ureteral calculi after surgery, there was no significant difference between the two groups (OR=1.71, 95%CI 0.91-3.20, P=0.10). The success rate of flexible ureteroscope access sheath implantation was higher in the experimental group (OR=5.77, 95%CI 3.32-10.31, P<0.05). The rate of passive usage balloon dilation in the control group was higher(OR=0.23, 95%CI 0.15-0.35, P<0.05). For the incidence of intraoperative complications, the experimental group was lower (OR=0.56, 95%CI 0.38-0.84, P=0.004). For the incidence of postoperative complications, the experimental group was also lower(OR=0.64, 95%CI 0.45-0.90, P=0.01). The operation time of the control group was longer(MD=-4.95, 95%CI -8.90--1.01, P=0.01). Conclusions Presetting double-J-catheter can improve the stone removal rate after flexible ureteroscope lithotripsy for the treatment of kidney stone, improve the success rate of flexible ureteroscope access sheath implantation, reduce the utilization rate of ureteral balloon dilator, reduce the incidence of intraoperative and postoperative complications, and shorten the operation time. Key words: Urinary calculus; Flexible ureteroscopic; Double J stent; Meta-analysis
目的系统评价输尿管软镜碎石术前预置双j型支架的必要性。方法计算机检索PubMed、Cochrane Library、Embase、Scopus、万方、CNKI、VIP等数据库中术前预置双j型导尿管对输尿管软镜碎石效果的临床研究。检索时间为数据库建设至2018年11月。以下所有可能的组合被用于搜索:柔性输尿管镜、术前、双J型支架和结石。2名研究者独立进行文献筛选、质量评价和数据提取,使用统计软件RevMan5.3完成Meta分析。结果共筛选32项病例对照试验和14项随机对照试验,共纳入患者17 480例,其中实验组6 211例,对照组11 269例。meta分析结果显示,实验组术后结石整体清除率优于对照组(OR=1.69, 95%CI 1.37 ~ 2.08, P<0.05)。在术后肾结石摘除率方面,实验组优于对照组(OR=1.67, 95%CI 1.41 ~ 1.99, P<0.05)。在输尿管结石术后切除率方面,两组比较差异无统计学意义(OR=1.71, 95%CI 0.91-3.20, P=0.10)。实验组输尿管软镜输尿管鞘植入术成功率较高(OR=5.77, 95%CI 3.32 ~ 10.31, P<0.05)。对照组被动使用球囊扩张率较高(OR=0.23, 95%CI 0.15 ~ 0.35, P<0.05)。术中并发症发生率实验组较对照组低(OR=0.56, 95%CI 0.38 ~ 0.84, P=0.004)。对于术后并发症的发生率,实验组也较低(OR=0.64, 95%CI 0.45-0.90, P=0.01)。对照组手术时间较长(MD=-4.95, 95%CI -8.90—1.01,P=0.01)。结论预置双j型导尿管可提高输尿管软镜碎石治疗肾结石后的结石取出率,提高输尿管软镜通路鞘植入术成功率,降低输尿管球囊扩张器的使用率,减少术中术后并发症的发生,缩短手术时间。关键词:尿路结石;灵活ureteroscopic;双J型支架;荟萃分析
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引用次数: 1
The prognostic value of concomitant carcinoma in situ in patients with upper tract urinary carcinoma after radical nephroureterectomy: an systematic review and Meta-analysis 上尿路癌根治性肾输尿管切除术后并发原位癌的预后价值:一项系统回顾和meta分析
Q4 Medicine Pub Date : 2020-01-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2020.01.010
Lijin Zhang, Z. Zha, Hu Zhao, Jun Yuan, P. Guo, Yejun Feng
Objective The aim of this study was to evaluate the influence of concomitant carcinoma in situ (CCIS) on tumor survival for the upper tract urinary carcinoma (UTUC) through systematic review and meta-analysis. Methods In the light of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search of Web of Science, PubMed and EMBASE China National Knowledge Infrastructure (CNKI) and Wanfang database by key words "upper urinary tract urothelial carcinoma" "renal sputum cancer" "concomitant carcinoma in situ" , and "radical ureterectomy" were performed for all reports that included detailed results on the predictors of CCIS. The search deadline is June 2019, and the search terms are English and Chinese. Methodological quality evaluation was performed using the QUIPS tool, and statistical analysis of the relevant data was performed using Stata 12.0 and RevMan 5.3 software. Results Sixteen articles were included in this study and all published between 2012 and 2019. A total of 11 131 patients with UTUC, including 1 774 (15.9%) patients with CCIS. According to our final results, there was a significant correlation of CCIS with worse cancer-specific survival (CSS) (HR=1.10, 95%CI 1.05-1.16, P<0.001), recurrence-free survival (RFS) (HR=1.15, 95%CI 1.09-1.21, P<0.001) and overall survival (OS) (HR=1.10, 95%CI 1.03-1.17, P=0.003). Begg′s bias analysis showed no significant publication bias in CSS (P=0.822), RFS (P=0.348), and OS (P=0.452). Conclusions This study demonstrated that CCIS was associated with poor oncological outcome and could serve as a independent prognostic factor for patient with UTUC after radical nephroureterectomy. Key words: Urologic diseases; Upper tract urinary carcinoma; Radical nephroureterectomy; Concomitant carcinoma in situ; Prognosis; Meta-analysis
目的通过系统评价和荟萃分析,探讨合并原位癌(CCIS)对上尿路癌(UTUC)患者肿瘤生存的影响。方法根据PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis)指南,系统检索Web of Science、PubMed、EMBASE中国国家知识基础设施(CNKI)和万方数据库,检索关键词为“上尿路尿路上皮癌”、“肾口癌”、“合并原位癌”、“根治性输尿管切除术”的所有报道,并对CCIS的预测因素进行详细结果分析。搜索截止日期为2019年6月,搜索词为英文和中文。采用QUIPS工具进行方法学质量评价,使用Stata 12.0和RevMan 5.3软件对相关数据进行统计分析。结果本研究纳入16篇文章,均发表于2012 - 2019年。共11131例UTUC患者,其中CCIS患者1774例(15.9%)。根据我们的最终结果,CCIS与较差的癌症特异性生存(CSS) (HR=1.10, 95%CI 1.05-1.16, P<0.001)、无复发生存(RFS) (HR=1.15, 95%CI 1.09-1.21, P<0.001)和总生存(OS) (HR=1.10, 95%CI 1.03-1.17, P=0.003)有显著相关性。Begg偏倚分析显示,CSS (P=0.822)、RFS (P=0.348)和OS (P=0.452)均无显著发表偏倚。结论CCIS与不良的肿瘤预后相关,可作为根治性肾输尿管切除术后UTUC患者的独立预后因素。关键词:泌尿系统疾病;上尿路癌;激进nephroureterectomy;伴发原位癌;预后;荟萃分析
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引用次数: 0
Clinical analysis of female urethral diverticulum resection and reconstruction under Jacknife position Jacknife体位下女性尿道憩室切除重建的临床分析
Q4 Medicine Pub Date : 2019-12-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.009
Weidong Chen, J. Xing, Ya-Huei Zeng, Fei Liu, Yuxin Chen
Objective To explore the clinical efficacy of female urethral diverticulum resection and reconstruction under the folding position. Methods Retrospective analysis of 22 female patients with urethral diverticulum was performed from September 2010 to December 2018. There were 12 cases of simple diverticulum, 6 cases of horseshoe diverticulum, 4 cases of circumferential diverticulum, aged from 26 to 72 years, with an average of 46.2 years, whose BMI ranged from 24.2 to 34.8 kg/m2, with an average of 30.4 kg/m2. Eleven cases (50%) presented with dysuria, 10 cases (45.5%) with repeated urinary tract infections, 7 cases (31.2%) with difficulty of voiding, 10 cases (45.5%) with urethral secretion, 9 cases (40.1%) with difficulty of sexual intercourse, and 4 cases (18.2%) without symptoms. Unlike the traditional surgical procedure under the lithotomy position, the folding position was used to expose the vagina and separate the vaginal mucosa by longitudinal incision, and the diverticulum was completely removed to the neck. The peri-operative complications and efficacy were recorded. Results All 22 cases underwent successful procedures, and were followed up for 25.2 months on average (ranged 8 to 42 months). One of them suffered from weak stream 2 months after operation, with residual urine volume of 100ml by ultrasonography. Her symptoms improved after dilatation of the urethra. Two cases suffered from different degrees of lower urinary tract storage symptoms 1 month after the operation (1 case of mild dysuria and 1 case of urinary tract infection), who improved after oral administration of levofloxacin tablets for 3-5 days. All patients had no urethral diverticulum recurrence 3 months later by ultrasonography, half a year by cystoscopy, and every six months by ultrasonography. Conclusions Surgical treatment is still the best choice for patients with urethral diverticulum. The success rate of transvaginal urethral diverticulum reconstruction with a Jackknife position is high, postoperative recurrence rate is low, and postoperative complications are few. Key words: Diverticulum; Urethra; Female; Jacknife position; Surgery
目的探讨女性尿道憩室折叠位切除重建术的临床疗效。方法对2010年9月至2018年12月收治的22例女性尿道憩室患者进行回顾性分析。单纯性憩室12例,马蹄形憩室6例,环状憩室4例,年龄26~72岁,平均46.2岁,BMI 24.2~34.8kg/m2,平均30.4kg/m2。排尿困难11例(50%),反复尿路感染10例(45.5%),排尿困难7例(31.2%),尿道分泌物10例(4.55%),性交困难9例(40.1%),无症状4例(18.2%)。与传统的取石位下的手术不同,折叠位是通过纵向切口暴露阴道并分离阴道粘膜,并将憩室完全切除至颈部。记录围手术期并发症及疗效。结果22例患者均获得成功,平均随访25.2个月(8~42个月)。其中1例术后2个月出现弱流,超声检查残余尿量为100ml。尿道扩张后她的症状有所改善。2例患者术后1个月出现不同程度的下尿路积水症状(1例轻度排尿困难,1例尿路感染),口服左氧氟沙星片3~5天后症状好转。超声检查3个月后,膀胱镜检查半年后,超声检查每6个月一次,所有患者均无尿道憩室复发。结论手术治疗仍是治疗尿道憩室的最佳选择。Jackknife体位经阴道尿道憩室重建成功率高,术后复发率低,术后并发症少。关键词:憩室;尿道;女性;Jacknife位置;外科
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引用次数: 0
Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children 超小型经皮肾穿刺取石术(SMP)治疗成人和儿童上尿路结石的疗效评价
Q4 Medicine Pub Date : 2019-12-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.011
A. Simayi, Talaiti Tayier, Lei Peng, Aihemaiti Aimaier, Zhang Xiaoan, Yalikun Alimu
Objective To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children(<14years). Methods From May 2015 to July 2018, 81 cases of children(53%) and 71(47%) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance. In the group of children, it’s including 53 male and 28 female with 85 channels in total, the patients age ranged from 10 months to 14 years, [mean (56.0±39.7) months], The stone size ranged from 0.8-3.5 cm, [mean (1.7±0.7)cm]. About stone distribution, 42 cases of pelvic stones, 25 cases of calyceal and pelvic stones, 5 cases of calyceal stones, 7 cases of upper uretaral stones, 1 case of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 86.4%(70/81), positive rate of urinary culture was 39.5%(32/81). In the group of adults, it’s including 43 male and 28 female, the patients aged from 18 to 81 years, [mean (44.1±15.4)years], The stone size ranged from 1.0-3.0 cm, [mean (1.7±0.6)cm]. About Stone distribution, 19 cases of pelvic stones, 13 cases of calyceal and pelvic stones, 7 cases of calyceal stones, 24 cases of upper uretaral stones, 3 cases of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). The patient was placed in the lithotomy position under general anesthesia. A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder. The patient was then turned prone. The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system. Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F). After the corresponding size of suction-evacuation sheath was placed, the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector. The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter. Stone free rate after surgery at 1day(SFR) and 1 month(1 month SFR), stone size, operative time(from starting fragmentation to the end of the surgery), hemoglobin drop and hematocrit drop in the first day after surgery, rate of surgecal complications, tubeless rate(totally tubless: no ureteric stent and nephrostomy tube; tubeless: no nephrostomy tube but ureteric stent), average length of hospital stay and urinary infection were recorded and compared. Results In children group, mean operative time was (27.7±13.0)min(range 5-60 min), SFR and SFR at 1 month were 96.3%(78/81)and 98.8%(80/81), mean hemoglobin drop was (8.0±9.1)g/L(range 0-41 g/L), mean hematocrit
目的比较全超声引导下超小型经皮肾取石术(SMP)治疗成人和儿童(<14岁)上尿路结石的安全性和有效性。方法自2015年5月至2018年7月,81例(53%)儿童和71例(47%)成人上尿路结石患者在全超声引导下接受SMP检查。儿童组男53例,女28例,共85个通道,年龄10个月~14岁[平均(56.0±39.7)个月],结石大小0.8~3.5cm[平均(1.7±0.7)cm],输尿管上段及肾盏结石1例,双肾盂及输尿管畸形1例。尿路感染率为86.4%(70/81),尿路培养阳性率为39.5%(32/81),其中男性43例,女性28例,年龄18~81岁,[平均(44.1±15.4)岁],结石大小1.0-3.0cm,[平均值(1.7±0.6)cm],肾盏结石7例,输尿管上段结石24例,输尿管上端及肾盏结石3例,双肾盂输尿管畸形1例。尿路感染率为87.3%(62/71),尿路培养阳性率为26.8%(19/71)。患者在全身麻醉下置于切开取石位。将5F输尿管导管逆行插入收集系统,并将导尿管放入膀胱。患者随后俯卧。在18G穿刺针的超声引导下对选定的杯状物进行穿刺,并将0.032英寸的导丝插入收集系统中。使用扩张器建立肾造瘘道(12F分一步进行,14F分两步进行)。放置相应尺寸的抽吸抽气鞘后,通过金属连接器的倾斜分支将鞘连接到样本采集瓶。将微型内窥镜插入鞘内观察收集系统,并使用YAG激光或气压弹道碎石机完成碎石。术后1天(SFR)和1个月(SFR 1个月)的结石清除率、结石大小、手术时间(从开始碎裂到手术结束)、术后第一天血红蛋白下降和红细胞压积下降、手术并发症发生率、无管率(完全无管:无输尿管支架和肾造瘘管;无管:没有肾造瘘导管但有输尿管支架),记录并比较平均住院时间和尿路感染情况。结果儿童组平均手术时间为(27.7±13.0)min(5~60min),1个月时SFR和SFR分别为96.3%(78/81)和98.8%(80/81),平均血红蛋白下降为(8.0±9.1)g/L(0~41g/L),平均红细胞压积下降为0.026±0.029(0~0.135),完全无管率为86.4%(71/81)。观察并发症9例,采用Calvien分级系统进行分类,Ⅰ级8例:术后发热4例,积血1例,肾周血肿,术后输尿管远端结石1例,肠功能延迟恢复1例,均为自发恢复,无特殊处理;Ⅲb级1例,术中发现大量腹水,经穿刺引流治愈。成人组平均手术时间为(31.2±15.3)分钟(范围7-80分钟),1个月时SFR和SFR分别为97.2%(69/71)和98.6%(70/71),平均血红蛋白下降为(11.9±8.7)g/L(范围0-32 g/L),平均红细胞压积下降为0.030±0.027(范围0-0.106),完全无管率为87.3%(62/71),平均住院时间为(2.4±1.1)天(范围1-8天),尿路感染率为87.3%(62/71,尿培养阳性率26.8%(19/71),并发症4例,Ⅰ级3例,2例出血,1例肠功能恢复迟缓,均为自发恢复,无特殊处理;Ⅲb级1例,术后输尿管远端结石1例,经输尿管镜碎石术治愈。结论超小型经皮肾镜取石术具有安全、有效、快速恢复的特点,可作为成人和儿童上尿路结石的首选治疗方法。关键词:肾造口术,经皮;超小型经皮肾取石术;上尿路结石;成人和儿童;无管
{"title":"Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children","authors":"A. Simayi, Talaiti Tayier, Lei Peng, Aihemaiti Aimaier, Zhang Xiaoan, Yalikun Alimu","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.12.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.12.011","url":null,"abstract":"Objective \u0000To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children(<14years). \u0000 \u0000 \u0000Methods \u0000From May 2015 to July 2018, 81 cases of children(53%) and 71(47%) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance. In the group of children, it’s including 53 male and 28 female with 85 channels in total, the patients age ranged from 10 months to 14 years, [mean (56.0±39.7) months], The stone size ranged from 0.8-3.5 cm, [mean (1.7±0.7)cm]. About stone distribution, 42 cases of pelvic stones, 25 cases of calyceal and pelvic stones, 5 cases of calyceal stones, 7 cases of upper uretaral stones, 1 case of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 86.4%(70/81), positive rate of urinary culture was 39.5%(32/81). In the group of adults, it’s including 43 male and 28 female, the patients aged from 18 to 81 years, [mean (44.1±15.4)years], The stone size ranged from 1.0-3.0 cm, [mean (1.7±0.6)cm]. About Stone distribution, 19 cases of pelvic stones, 13 cases of calyceal and pelvic stones, 7 cases of calyceal stones, 24 cases of upper uretaral stones, 3 cases of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). The patient was placed in the lithotomy position under general anesthesia. A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder. The patient was then turned prone. The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system. Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F). After the corresponding size of suction-evacuation sheath was placed, the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector. The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter. Stone free rate after surgery at 1day(SFR) and 1 month(1 month SFR), stone size, operative time(from starting fragmentation to the end of the surgery), hemoglobin drop and hematocrit drop in the first day after surgery, rate of surgecal complications, tubeless rate(totally tubless: no ureteric stent and nephrostomy tube; tubeless: no nephrostomy tube but ureteric stent), average length of hospital stay and urinary infection were recorded and compared. \u0000 \u0000 \u0000Results \u0000In children group, mean operative time was (27.7±13.0)min(range 5-60 min), SFR and SFR at 1 month were 96.3%(78/81)and 98.8%(80/81), mean hemoglobin drop was (8.0±9.1)g/L(range 0-41 g/L), mean hematocrit","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45019623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) for prostate cancer: initial experience 改良腹膜外腹腔镜VIP(Vattikuti研究所前列腺切除术)治疗前列腺癌症:初步经验
Q4 Medicine Pub Date : 2019-12-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.005
Cheng Sida, Hong-Yun Peng, Zhang Lei, Tang Qi, H. Han, Li Xuesong, Z. Liqun
Objective To investigate the operating key steps and the initial experience of IUPU (Institute of Urology, Peking University) modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) technique and the initial follow-up outcomes. Methods 46 patients of prostate cancer underwent the modified extraperitoneal laparoscopic VIP and were reviewed from November 2017 to September 2018. Patients aged 54 to 77 years, with mean age of 65.5 years old. Their preoperative PSA was 0.15 to 69.76 ng/ml with an average of 13.4 ng/ml. All patients were diagnosed by prostate biopsy and Gleason score was 6 to 10 with an average of 7.5. MRI was used to assess their clinical stage before operation. All the modified laparoscopic VIP were done through the extraperitoneal approach by a single surgeon and the follow-up by telephone for the PSA level and continence recovery (urine pad test). The major differences between modified laparoscopic VIP and the routine steps of radical prostatectomy are as follows: use of extraperitoneal approach and traditional laparoscopic operation; after the setup of the extraperitoneal cavity, the bladder neck is separated, isolated and cut down first; the management of DVC: Cut down the super-facial and deep layers of DVC just along the capsule of the prostate apex and it’s unnecessary to suture it. Perioperative data of these patients were collected retrospectively, including operation time, intraoperative blood loss, length of hospital stay, postoperative pathology, and continence outcome after surgery. Result All 46 patients underwent the IUPU modified extraperitoneal laparoscopic VIP successfully without converting to open surgery. The operation time was 69-143 min with an average of 95.7 min and the estimated blood loss was 20-200 ml with an average of 81.5 ml. It was 3-17 days for the average time to remove the retropubic drainage tube postoperatively, with an average of 4.3 days. The postoperative hospital stay was 3-17 days with an average of 5.3 days. The Foley catheter was removed 14 days postoperatively. Five patients suffered from urine leakage and were managed successfully with conservative treatment. For the postoperative pathological stage, 1 patient was pT2a, 12 patients were pT2c, 12 patients were pT3a and 21 patients were pT3b. The postoperative Gleason score was 6-9 with an average of 7.7. The postoperative follow-up time was 1-11 months with an average of 6.3 months. The PSA was 0.001-0.966 ng/ml with an average of 0.181 ng/ml 1 month postoperatively and the continence rate was 54%(25/46) and 89%(34/38) 1 month and 3 months after operation respectively. Conclusions The IUPU modified extraperitoneal laparoscopic VIP might be a safe and feasible for the radical prostatectomy. It’s simplified for the operative steps, unnecessary to isolate and suture DVC and doesn’t increase the blood loss. It’s almost left intact for the surrounding tissues of the prostate apex and satisfactory for the
目的探讨IUPU(北京大学泌尿外科研究所)改良腹膜外腹腔镜VIP(瓦蒂库蒂研究所前列腺切除术)技术的操作要点、初步经验及初步随访结果。方法2017年11月至2018年9月,对46例癌症前列腺癌患者进行改良腹膜外腹腔镜VIP检查。患者年龄54~77岁,平均年龄65.5岁。术前PSA为0.15~69.76 ng/ml,平均13.4 ng/ml。所有患者均经前列腺活检诊断,Gleason评分为6至10分,平均7.5分。术前应用MRI评估其临床分期。所有改良腹腔镜VIP均由一名外科医生通过腹膜外入路进行,并通过电话随访PSA水平和失禁恢复(尿垫试验)。改良腹腔镜VIP与常规根治性前列腺切除术的主要区别在于:腹膜外入路与传统腹腔镜手术;腹膜外腔建立后,首先对膀胱颈进行分离、隔离和切割;DVC的处理:沿着前列腺尖包膜切开DVC的表层和深层,无需缝合。回顾性收集这些患者的围手术期数据,包括手术时间、术中失血量、住院时间、术后病理和术后失禁结果。结果46例患者均顺利完成了IUPU改良腹膜外腹腔镜VIP手术,未转为开放手术。手术时间为69-143min,平均95.7min,估计失血量为20-200ml,平均81.5ml。术后取出耻骨后引流管的平均时间为3-17天,平均4.3天。术后住院3~17天,平均5.3天。术后14天取出Foley导管。5名患者出现尿漏,并通过保守治疗成功治疗。对于术后病理分期,1例患者为pT2a,12例患者为p T2c,12例为pT3a,21例为p T3b。术后Gleason评分为6-9分,平均7.7分。术后随访时间1~11个月,平均6.3个月。PSA为0.001-0.966 ng/ml,术后1个月平均为0.181 ng/ml,1个月和3个月的控尿率分别为54%(25/46)和89%(34/38)。结论IUPU改良腹膜外腹腔镜VIP术是一种安全可行的前列腺根治术。它简化了手术步骤,不需要隔离和缝合DVC,也不会增加失血。前列腺尖周围组织几乎完好无损,对早期尿失禁也很满意。肿瘤学结果需要进一步随访。关键词:前列腺肿瘤;根治性前列腺切除术;腹腔镜;瓦蒂库蒂研究所前列腺切除术;尿失禁
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引用次数: 0
The anatomical structure of fused renal pyramid and its imaging findings in ultrasound and computed tomography 融合肾锥体的解剖结构及其在超声和计算机断层扫描中的影像学表现
Q4 Medicine Pub Date : 2019-12-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.004
Xian Yuqi, Cheng Fan, Rao Ting, Lin Fangyou, Wei-min Yu, R. Yuan, Ning Jinzhuo, Yang Yuanting, Song Wanwan
Objective To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney, and discuss its appearances by CT and ultrasonic examinations. Methods From June 2018 to September 2018, 108 cadaveric kidneys were proceeded for regional anatomy. The distribution and anatomical manifestations of FRP was recorded. The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP. From October 2018 to January 2019, ultrasound imaging data of 112 patients with 224 kidneys were collected, including 60 males and 52 females, age (39.0±15.1), ranging from 16 to 73 years old. The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected, including 48 males and 41 females. Age (45.4±13.6), ranging from 23 to 69 years old. The imaging findings of FRP in ultrasound and enhanced CT was summarized. Results In cadaver kidneys, the proportion of FRP in upper and lower calyces was 68.6% (74/108) and 64.8% (70/108), respectively, higher than that in middle calyces 34.3% (37/108). In the middle group, the incidence of mild fusion was 39.0% (16/41) and severe fusion was 48.8% (20/41). The incidence of fusion of two renal pyramidal structures was 90.2% (37/41). HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear, and the protection of connective tissue was lacking. In Ultrasound, the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode. In ultrasound, the incidence of FRP was 18.8% (42/224). In enhanced CT, the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase. In enhanced CT, the incidence of FRP 27.5%(49/178). Conclusions The FRP is a common structure in human kidney. The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries. Ultrasound and enhanced CT have recognition ability for FRP. Key words: Kidney diseases; Fused renal pyramid; Anatomical structure; Percutaneous nephrolithotomy; Ultrasound; Computed tomography
目的分析尸体肾脏融合肾锥(FRP)的解剖结构和分布,探讨其CT和超声表现。方法从2018年6月至2018年9月,对108具尸体肾脏进行区域解剖。记录FRP的分布和解剖表现。肾锥体切片,HE染色,观察纤维增强塑料内的血管分布。从2018年10月到2019年1月,收集了112名患者的超声成像数据,共224个肾脏,其中男性60人,女性52人,年龄(39.0±15.1),年龄从16岁到73岁不等。收集了89例患者和178例肾CT增强患者的肾脏影像学数据,其中男性48例,女性41例。年龄(45.4±13.6),23~69岁。总结了FRP在超声和增强CT中的影像学表现。结果在尸体肾脏中,上肾盏和下肾盏FRP的比例分别为68.6%(74/108)和64.8%(70/108),高于中肾盏的34.3%(37/108)。在中间组中,轻度融合的发生率为39.0%(16/41),重度融合的发病率为48.8%(20/41)。两个肾锥体结构融合的发生率为90.2%(37/41)。HE染色显示FRP内动脉与周围肾锥体的边界不清楚,缺乏结缔组织的保护。在超声中,FRP表现为一个巨大的梯形低回声区,在多普勒模式下有红色和蓝色信号。在超声检查中,FRP的发生率为18.8%(42/224)。在增强CT中,FRP表现为皮质期大面积低密度区增强的索状高密度阴影。在增强CT中,FRP的发生率为27.5%(49/178)。结论FRP是人类肾脏中常见的结构。动脉位于FRP内,缺乏足够的结缔组织保护,这与正常动脉不同。超声和增强CT对FRP具有识别能力。关键词:肾脏疾病;融合肾锥体;解剖结构;经皮肾取石术;超声;计算机断层扫描
{"title":"The anatomical structure of fused renal pyramid and its imaging findings in ultrasound and computed tomography","authors":"Xian Yuqi, Cheng Fan, Rao Ting, Lin Fangyou, Wei-min Yu, R. Yuan, Ning Jinzhuo, Yang Yuanting, Song Wanwan","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.12.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.12.004","url":null,"abstract":"Objective \u0000To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney, and discuss its appearances by CT and ultrasonic examinations. \u0000 \u0000 \u0000Methods \u0000From June 2018 to September 2018, 108 cadaveric kidneys were proceeded for regional anatomy. The distribution and anatomical manifestations of FRP was recorded. The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP. From October 2018 to January 2019, ultrasound imaging data of 112 patients with 224 kidneys were collected, including 60 males and 52 females, age (39.0±15.1), ranging from 16 to 73 years old. The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected, including 48 males and 41 females. Age (45.4±13.6), ranging from 23 to 69 years old. The imaging findings of FRP in ultrasound and enhanced CT was summarized. \u0000 \u0000 \u0000Results \u0000In cadaver kidneys, the proportion of FRP in upper and lower calyces was 68.6% (74/108) and 64.8% (70/108), respectively, higher than that in middle calyces 34.3% (37/108). In the middle group, the incidence of mild fusion was 39.0% (16/41) and severe fusion was 48.8% (20/41). The incidence of fusion of two renal pyramidal structures was 90.2% (37/41). HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear, and the protection of connective tissue was lacking. In Ultrasound, the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode. In ultrasound, the incidence of FRP was 18.8% (42/224). In enhanced CT, the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase. In enhanced CT, the incidence of FRP 27.5%(49/178). \u0000 \u0000 \u0000Conclusions \u0000The FRP is a common structure in human kidney. The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries. Ultrasound and enhanced CT have recognition ability for FRP. \u0000 \u0000 \u0000Key words: \u0000Kidney diseases; Fused renal pyramid; Anatomical structure; Percutaneous nephrolithotomy; Ultrasound; Computed tomography","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48314025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP 阴茎游离皮瓣背侧马赛克手术治疗TURP术后前尿道狭窄的临床疗效
Q4 Medicine Pub Date : 2019-12-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.008
Xiaofang Bi, Ping Qinrong, Wang Chunhui, Yang Yang, Libing Hu, Yiming Zhong, Jian Li, Ying Zheng
Objective To investigate the clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP. Methods We analyzed the clinical data of the patients with anterior urethral stricture after TURP from January 2010 to December 2017 in Yan′an hospital affiliated to Kunming medical university retrospectively. The patients' age ranged from 58 to 75 years, with an average of 64.3 years. The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month, with an average of 3.5 months. 5 cases were urethral stricture at penis segment, 11 cases were urethral stricture at the junction of penis and scrotum, and the length of the narrow urethra was 2-5 cm, with an average of 3.4cm. The average maximum uroflowmetry in preoperative was (5.3±2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months, 5 cases were treated with intraurethral incision combined with urethral dilatation(1 or 2 times). 16 cases were not effective after receiving the above treatment, so that all cases were treated with dorsal mosaic surgery with penis free flap. Subarachnoid anesthesia combined with epidural anesthesia, the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator. Incision from the ventral side of the urethra. The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body. The length of the incision was extended 0.5 cm to the normal urethral mucosa. The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea, and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse, the full thickness of the penis flap was taken, and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra), the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side, Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra, the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine, and the fascia and skin were sutured layer by layer. The 5-0 absorbable thread sutures the wound after the foreskin was taken. Results The operations were successfully completed. The operation time was 90-120 min, with an average of 102.3 min. The intraoperative blood loss was 10-30 ml.
目的探讨阴茎游离皮瓣背侧马赛克手术治疗TURP术后前尿道狭窄的临床疗效。方法回顾性分析2010年1月至2017年12月昆明医科大学附属延安医院经尿道手术后前尿道狭窄患者的临床资料。患者年龄58 ~ 75岁,平均64.3岁。从TURP到诊断前尿道狭窄的时间为1-12个月,平均3.5个月。阴茎节段尿道狭窄5例,阴茎与阴囊交界处尿道狭窄11例,狭窄尿道长度为2 ~ 5 cm,平均3.4cm。术前平均最大尿流量为(5.3±2.7)ml/s。常规尿道扩张治疗11例,治疗持续时间均在6个月以上,经尿道切开联合尿道扩张治疗5例(1 ~ 2次)。16例经以上治疗无效,均行阴茎游离皮瓣背侧马赛克手术治疗。蛛网膜下腔联合硬膜外麻醉,患者取仰卧位。尿道扩张器确定尿道狭窄远端。从尿道腹侧切开。根据尿道血管造影显示的尿道狭窄长度,将切口长度延长0.5 cm。解剖尿道左右两侧狭窄,纵向切开尿道海绵体腹侧。切口长度延长0.5 cm至正常尿道粘膜。牵引线沿两侧牵拉尿道腹侧缘。将尿道背侧相应内侧线切入白膜,将尿道背侧边缘与白膜分离,在白膜上形成椭圆形区域。根据椭圆区大小取阴茎皮瓣全厚,皮瓣大小超出椭圆区边缘约0.3 cm。游离皮瓣在椭圆区(皮肤表面在尿道内侧)用6-0可吸收缝线覆盖,游离皮瓣边缘与尿道背侧边缘间歇缝合,多针间断缝合皮瓣表面于海绵体床上。使用硅胶导管作为新尿道的支架管,6-0可吸收缝线闭合切口尿道海绵的腹侧。缝合多层肉膜以防止尿漏,并逐层缝合筋膜与皮肤。取包皮后用5-0可吸收线缝合伤口。结果手术顺利完成。手术时间90 ~ 120 min,平均102.3 min。术中出血量10 ~ 30 ml。术后3周拔除导管后,所有患者排尿困难症状均得到缓解。术后4周,尿道造影未见尿道狭窄征象。13例最大流速为bb0 ~ 15ml /s, 3例为10 ~ 15ml /s。术后平均最大血流速率为[(20.4±7.3)ml/s],显著高于术前(t=7.7602, P<0.05)。b超示无残尿13例,残尿量<30 ml 3例,均无尿瘘、尿道憩室、尿外渗等严重并发症。随访1年,1例患者失访,其余15例患者均未发生尿道再狭窄梗阻。结论阴茎游离皮瓣背侧马赛克手术是治疗TURP术后前尿道狭窄的有效方法,无明显并发症。关键词:尿道狭窄;自由皮瓣;背马赛克;经尿道前列腺切除术
{"title":"Clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP","authors":"Xiaofang Bi, Ping Qinrong, Wang Chunhui, Yang Yang, Libing Hu, Yiming Zhong, Jian Li, Ying Zheng","doi":"10.3760/CMA.J.ISSN.1000-6702.2019.12.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1000-6702.2019.12.008","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of dorsal mosaic surgery with penis free flap for the treatment of anterior urethral stricture after TURP. \u0000 \u0000 \u0000Methods \u0000We analyzed the clinical data of the patients with anterior urethral stricture after TURP from January 2010 to December 2017 in Yan′an hospital affiliated to Kunming medical university retrospectively. The patients' age ranged from 58 to 75 years, with an average of 64.3 years. The time from TURP to the diagnosis of anterior urethral stricture was 1-12 month, with an average of 3.5 months. 5 cases were urethral stricture at penis segment, 11 cases were urethral stricture at the junction of penis and scrotum, and the length of the narrow urethra was 2-5 cm, with an average of 3.4cm. The average maximum uroflowmetry in preoperative was (5.3±2.7) ml/s.11 cases were treated with regular urethral dilatation and the treatment durable time was more than 6 months, 5 cases were treated with intraurethral incision combined with urethral dilatation(1 or 2 times). 16 cases were not effective after receiving the above treatment, so that all cases were treated with dorsal mosaic surgery with penis free flap. Subarachnoid anesthesia combined with epidural anesthesia, the patient took the supine position.The distal end of urethral stricture was defined by urethral dilator. Incision from the ventral side of the urethra. The length of the incision was extended 0.5 cm based on the length of urethral stricture in urethral angiography.Anatomize the left and right sides of the urethral stricture and longitudinally incision the ventral side of the urethral cavernous body. The length of the incision was extended 0.5 cm to the normal urethral mucosa. The traction line retracts the ventral urethral edge along both sides.The corresponding medial line of the dorsal urethra was incised to the tunica albuginea, and the urethral edge of the dorsal side was separated from the tunica albuginea to form an elliptical region on the tunica albuginea.According to the size of the ellipse, the full thickness of the penis flap was taken, and the size of the flap was beyond the edge of the elliptical area about 0.3 cm.The free flap was covered with the 6-0 absorbable suture on the elliptical area (the skin surface was on the inner side of the urethra), the edge of the free flap was intermittently sutured with the urethral edge of the dorsal side, Multi-needle intermittent sutured flap surface on the corpus cavernosum bed.Using a silicone catheter as the stent tube of the new urethra, the 6-0 absorbable suture closes the ventral side of the incisional urethral sponge.The multi-layered meat film was sutured to prevent leakage of urine, and the fascia and skin were sutured layer by layer. The 5-0 absorbable thread sutures the wound after the foreskin was taken. \u0000 \u0000 \u0000Results \u0000The operations were successfully completed. The operation time was 90-120 min, with an average of 102.3 min. The intraoperative blood loss was 10-30 ml.","PeriodicalId":10343,"journal":{"name":"Chinese Journal of Urology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45758736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The mechanism of Annexin A1 regulating the proliferation, apoptosis and migration of bladder cancer cells 膜联蛋白A1调节膀胱癌症细胞增殖、凋亡和迁移的机制
Q4 Medicine Pub Date : 2019-12-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.012
Tao Wang, Peide Bai, Shunqiang Xie, Anran Sun, J. Xing
Objective Explore the function and regulatory mechanism of Annexin A1 (ANXA1) in bladder cancer cell proliferation, apoptosis and migration. Methods From February 2018 to June 2019, we use T24 cells as the model and divide it into over-expression control group (ctrl), ANXA1 over-expression group (ANXA1), knockdown control group (shctrl), ANXA1 knockdown group 1 (shANXA1-1), ANXA1 knockdown group 2 (shANXA1-2) and ANXA1 knockdown group 3 (shANXA1-3). 24 hours after the culture, the cells were collected and the mRNA expression level of ANXA1 was detected by Real-Time quantitative PCR. The cell activity was detected by CCK-8; the cell apoptosis and cycle were detected by flow cytometry. The cell migration was detected by Transwell assay. Results The Real-Time quantitative PCR showed that the expression of ANXA1 in the over expression group was significantly higher than that in the over expression control group (15 369.00±874.20 and 1.00±0.07, P 0.05), while the number of apoptosis in the knockdown group 2 and 3 were significantly higher than that in the knockdown control group (13.04%, 14.58% and 7.76%, P<0.001). Cell function analysis showed that the number of cells passing through the membrane of the over expression group was significantly higher than that of the over expression group (525.00±9.30 and 385.70±13.40, P<0.01), while that of the knockdown group 2 and 3 were significantly lower than that of the knockdown control group (214.70±6.40, 226.00±5.30 and 398.70±10.00, P<0.001). Conclusions Over-expression of ANXA1 significantly promoted the proliferation, cycle and migration of T24 cells and inhibited apoptosis. On the contrary, ANXA1 knockdown inhibited the proliferation, cycle and migration of T24 cells and promoted apoptosis. Key words: Urinary bladder neoplasms; Annexin A1; Cell proliferation; Cell apoptosis; Tumor invasion and metastasis
目的探讨膜联蛋白A1 (Annexin A1, ANXA1)在膀胱癌细胞增殖、凋亡和迁移中的作用及调控机制。方法2018年2月~ 2019年6月,以T24细胞为模型,将其分为过表达对照组(ctrl)、过表达组(ANXA1)、敲低对照组(shctrl)、敲低组1 (shANXA1-1)、敲低组2 (shANXA1-1)和敲低组3 (shANXA1-3)。培养24 h后收集细胞,采用Real-Time定量PCR检测ANXA1 mRNA表达水平。CCK-8检测细胞活性;流式细胞术检测细胞凋亡及周期。Transwell法检测细胞迁移。结果Real-Time定量PCR结果显示,过表达组的ANXA1表达量显著高于过表达对照组(15 369.00±874.20和1.00±0.07,P< 0.05),而敲低组2和3的细胞凋亡数量显著高于敲低对照组(13.04%,14.58%和7.76%,P<0.001)。细胞功能分析显示,过表达组细胞膜穿过细胞数显著高于过表达组(525.00±9.30和385.70±13.40,P<0.01),而敲除组2和3的细胞膜穿过细胞数显著低于敲除对照组(214.70±6.40,226.00±5.30和398.70±10.00,P<0.001)。结论过表达ANXA1可显著促进T24细胞的增殖、周期和迁移,抑制细胞凋亡。反之,ANXA1敲低抑制T24细胞的增殖、周期和迁移,促进细胞凋亡。关键词:膀胱肿瘤;膜联蛋白A1;细胞增殖;细胞凋亡;肿瘤的侵袭和转移
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引用次数: 0
Factors influencing unplanned re-operation of prostatic cancer and its countermeasures 影响癌症非计划再手术的因素及对策
Q4 Medicine Pub Date : 2019-12-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.006
Q. Wo, X. Qi, Feng Liu, Qi Zhang, Zujie Mao
Objective To analyze the main causes for unplanned re-operation of prostatic cancer. Methods The clinical data of 4 patients with prostatic cancer who underwent an unplanned re-operation were analyzed retrospectively between September 2014 and July 2019 in our hospital.Preoperative data of patients was collected as follows: mean age of 65 years, ranged from 56 to 71 years.tPSA ranged from 5.17-13.20 ng/ml.Gleason score of 3+ 3 in 1 case, 3+ 4 in 2 cases, 4+ 4 in 1 case. pTNM pT2a in 2 Cases, pT2b in 2 cases. LRP(extraperitoneal approach) in 1 case, RARP(transperitoneal approach) in 3 cases. Results The main causes for unplanned re-operation were as follows: perioperative hemodynamic instability(75%, 3/4), post-operative fever(25%, 1/4). All 4 re-operations were performed by urologists using Laparoscopic exploration of abdomen. Conclusions Inadequate and inappropriate surgical hemostasis are the key to lead a second-look surgery of prostatic cancer.A complete hemostasis could help to lower the re-operation rate.Laparoscopic exploration of abdomen could be one of the choices to deal with re-operation after minimally invasive radical prostatectomy. Key words: Prostatic neoplasms; Prostatectomy; Minimally invasive; Unplanned re-operation; Complications
目的分析前列腺癌非计划再手术的主要原因。方法回顾性分析我院2014年9月至2019年7月4例非计划再手术前列腺癌患者的临床资料。患者术前资料收集如下:平均年龄65岁,56 ~ 71岁。tPSA范围为5.17 ~ 13.20 ng/ml。Gleason评分3+ 3 1例,3+ 4 2例,4+ 4 1例。pTNM pT2a 2例,pT2b 2例。LRP(腹腔外入路)1例,RARP(腹腔经入路)3例。结果非计划再手术的主要原因是围手术期血流动力学不稳定(75%,3/4),术后发热(25%,1/4)。所有4例再次手术均由泌尿科医师采用腹腔镜腹部探查。结论手术止血不充分和不当是导致前列腺癌二次手术的关键。彻底止血有助于降低再手术率。腹腔镜下腹部探查是处理微创前列腺根治术后再手术的选择之一。关键词:前列腺肿瘤;前列腺切除术;微创;再次手术;尚可计划外并发症
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引用次数: 0
Monitoring, evaluation and management in children with prenatal hydronephrosis 产前肾积水患儿的监测、评估和处理
Q4 Medicine Pub Date : 2019-12-15 DOI: 10.3760/CMA.J.ISSN.1000-6702.2019.12.001
Huixia Zhou
肾积水是小儿泌尿系常见的先天性畸形,是导致慢性肾病和肾衰竭的主要原因。近年来随着产前检查的普及,其发病率呈逐年上升趋势。目前有关产前检出肾积水的诊治仍存在很多争议,本文通过对最近发表的相关文献进行回顾并结合国内临床实际,针对产前检出肾积水患儿的评估与诊治策略等进行系统阐述。
Hydronephrosis is a common congenital malformation of the urinary system in children, and is the main cause of chronic kidney disease and renal failure. In recent years, with the popularization of prenatal examination, its incidence rate is increasing year by year. At present, there are still many controversies regarding the diagnosis and treatment of prenatal detection of hydronephrosis. This article reviews recent relevant literature and combines it with clinical practice in China to systematically elaborate on the evaluation and diagnosis and treatment strategies for children with prenatal detection of hydronephrosis.
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引用次数: 0
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