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Objective:To explore the feasibility and safety of robot-assisted retrohepatic inferior vena cava(IVC) tumor thrombectomy for renal tumor patients with a single position.Methods:The clinical data of 6 renal tumor patients with retrohepatic IVC thrombus (5 males and 1 female, mean age of 58 years) who underwent robot-assisted retrohepatic IVC tumor thrombectomy with a single position in First Affiliated Hospital of Zhengzhou University from December 2015 to August 2020 were retrospectively reviewed. Four cases had the renal tumor on the right side and two on the left side. The mean tumor size was 9.6 cm(range 7-13 cm). There were 4 cases of Mayo level Ⅱ and 2 cases of level Ⅲ IVC thrombus with the mean IVC thrombus length of 6.5 cm(range 5-8cm). The "IVC-first, kidney-last" robotic technique was developed to minimize chances of IVC thrombus embolization for retrohepatic IVC thrombus, and a "artery-first, vein-second" robotic operative strategy were developed to minimize chances of intraoperative hemorrhage. The whole procedure (the suprahepatic infradiaphramatic IVC, first porta hepatis and left renal vein control, caval exclusion, tumor thrombectomy, IVC repair, radical nephrectomy) was performed exclusively robotically with a single position.Results:All 6 robotic procedures were successful, without open conversion or mortality. The mean operative time was 210 min(130-320 min), estimated blood loss was 800 ml(300-2 100 ml) and three patients (5%) received intraoperative blood transfusion. The mean time of occlusion of IVC was 21 min (15-43min). Incomplete blocking occurred in two cases(one IVC, one first porta hepatis), and tumor thrombectomy were completed with intraoperative loss. IVC invasion was confirmed intraoperatively in one patient and we staple-transected the IVC without reconstruction. Six patients were all transferred to the intensive care unit for median of 2.1 days (1-4 days) after surgery. The mean time of postoperative drainage was 5 days (4-9 days). Renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients, and all recovered after medical therapy. Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma and 1 case of renal sarcoma, and the 5 cases received targeted therapy. With a median follow-up of 27 months (3-54 months), 3 patients were alive, 1 alive with tumor recurrence, and 2 died of cancer.Conclusions:Robot-assisted laparoscopic retrohepatic IVC thrombectomy with a single position have the advantage of simple procedure, shorter operative time, less trauma and quicker recovery, and it is a feasible and effective method for renal tumor patients with retrohepatic IVC thrombus.
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Objective:To analyze the correlation between preoperative parametres and positive surgical margin after robot-assisted laparoscopic radical prostatectomy.Method:From October 2014 to January 2019, the clinical data of 310 patients who underwent robot-assisted laparoscopic radical prostatectomy(RARP) by single surgeon were collected retrospectively. The median age, PSA, f/t PSA and PSAD was 68(62-72)years, 26(13-63) ng/ ml, 0.12 (0.07-0.18) and 0.36(0.20-0.75) ng/ml 2, respectively. There were 115 cases with clinical T 1, 100 with clinical T 2, 41 with clinical T 3, and 15 with clinical T 4. Based on the MRI or ultrasound examination, the median value for the transverse diameter, anteroposterior diameter, vertical diameter, and volume of the prostate is 44(35-50)mm, 45(40-51)mm, 41(36-50)mm, and 76(54-118)ml, respectively. In this study, 84(27%)cases were diagnosed pathologically by transurethral resection of the prostate, and 226(73%)cases by prostate biopsy. The biopsy technique was transrectal ultrasound-guided systematic 12-point biopsy, and additional 1-5 needles were performed in regions with abnormal ultrasound echoes. The median for total number of puncture needles, number and percentages of positive needles were 12(12-13), 9(4-12)and 85%(35%-100%), respectively. Of all the patients, there were 61 cases with Gleason score≤6, 95 with Gleason score=7 and 84 with Gleason score≥8. There were 237(76%)patients undergoing neoadjuvant endocrine therapy. The patients were divided into the negative surgical margin group and positive surgical margin group. The correlation between positive surgical margin and general clinical data, PSA derivates, prostate size (transversal diameter, anteroposterior diameter, vertical diameter, and prostate volume), percentage of positive biopsy cores, Gleason score, method of pathological diagnosis, and endocrine therapy were analyzed. Results:Of all the 310 enrolled patients, the overall positive surgical margin rate was 34.2%(106/310). Univariate analysis showed that tPSA(41.3 ng/ml vs.24.8ng/ml, P=0.029), f/tPSA(0.14 vs.0.10, P=0.004), transversal diameter of prostate(46 mm vs.38mm, P=0.049), percentage of positive biopsy cores(100% vs.58%, P=0.001), and biopsy Gleason score(Gleason score≤6, =7 and ≥8: 14, 31 and 32 cases vs. 47, 64 and 42 cases, P<0.05)exhibited significant correlation with postoperative positive surgical margin. Multivariate analysis showed that transversal diameter of prostate( P=0.026) and percentage of positive biopsy cores( P=0.048) were independent risk factors for positive surgical margin. Conclusions:Transversal diameter of prostate and percentage of positive biopsy cores were independent risk factors, which help to predict the occurrence of postoperative positive surgical margin.
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Objective To evaluate the relationship of prostate specific antigen(PSA)related variables and MRI+MRS examination with the results of prostate biopsy.Methods A total of 1227 patients aged(66.1± 7.7) years (range,55-90 years) undergoing prostate biopsy in our hospital from May 2014 to September 2018 were retrospectively analyzed.Two hundred forty-two patients with serum prostate-specific antigen (PSA)in "the grey zone (total PSA =4-10 μg/L)",and having indications for prostate biopsy were selected.According to the results of transrectal ultrasound-guided prostatic biopsy,patients were divided into the prostate cancer group and the benign prostate hyperplasia group.The levels of total PSA (tPSA),free PSA/tPSA ratios (f/t PSA),prostate specific antigen density(PSAD),(f/t) PSA/PSAD,prostate volume (PV) and other relevant data,as well as MRI+MRS test findings were statistically analyzed.Results The positive cancer rate of prostate biopsy was 26.0％ (63/242)in patients with total PSA in "the grey zone",including 56 cases of adenocarcinoma,3 cases of mucinous adenocarcinoma,and 4 cases of stromal sarcoma.Negative prostate biopsy results were found in 179 cases.Two hundred sixteen patients underwent MRI+MRS test before prostate biopsy,among which 81 were positive and 135 were negative.There were significant differences in PSAD,(f/t) PSA/PSAD,PV and MRI + MRS test findings (P =0.001,0.002,0.045 and 0.001)and there was no significant difference in tPSA and free/total PSA ratios(P＞0.05)between the prostate cancer group and the benign prostate hyperplasia group.Conclusions The positive cancer rate of prostate biopsy in patients with total PSA in the gray zone is 26.0％.The PSAD,(f/t)PSA/PSAD,prostate volume and MRI+ MRS examination are very useful for whether or not to perform the prostate biopsy,which can be used to guide the prostate biopsy in patients with total PSA in the "gray zone".
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Objective To investigate the effects of levels of serum C-reactive protein (CRP), B-natriuretic peptide (BNP) and cholinesterase (ChE) on prognosis of elderly patients with pulmonary infection.Methods Sixty cases aged ≥ 65 years old with lung infection admitted to Departments of Infectious Diseases and Respiration of Hebei Provincial People's Hospital from March 2012 to March 2014 were enrolled. According to the diagnostic criteria of pulmonary infection and the severity score (PSI) of pneumonia, the patients were classified into three groups with different grades of infectious severity (PSI Ⅰ-Ⅲ, PSI Ⅳ, PSI Ⅴ groups), 20 cases in each group; in the same period, 20 elderly healthy people having accepted the physical examination in this hospital were designed as the healthy control group. Furthermore, according to the difference in prognosis, the patients were divided into a survival group (52 cases) and a death group (8 cases). The PSI scores, the levels of white blood cell count (WBC), D-Dimer, CRP, BNP and ChE, mortalities, times of stay in hospital were compared between the PSI Ⅰ-Ⅲ, PSI Ⅳ, PSI Ⅴ groups and the healthy control group as well as between the survival and death groups.Results The periods of stay in hospital of patients with PSI Ⅳ and Ⅴ were much longer than that patients with PSI Ⅰ-Ⅲ (days: 14.7±2.1, 18.3±2.6 vs. 9.2±1.7, both P 0.05). Compared with the survival group, the PSI score, the levels of WBC, D-dimer, CRP and BNP after treatment in death group were markedly higher [PSI score: 141.5±23.3 vs. 97.6±18.2; WBC (×109/L): 15.9±1.9 vs. 12.1±1.8; D-Dimer (μg/L): 1 373.9±179.4 vs. 627.4±69.6; CRP (mg/L): 69.8±9.8 vs. 42.6±7.3; BNP (ng/L): 2 745.6±374.9 vs. 1 022.2±171.3; allP < 0.05], the level of ChE was significantly lower (U/L: 2 569±309 vs. 5 692±777,P < 0.05).Conclusion The serum levels of CRP, BNP and ChE in aged patients with pulmonary infection are helpful to the early diagnosis of disease severity, so as they have guiding significance in predicting prognosis.