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Objective To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic partial nephrectomy (RLPN) with individual operation plan in treatment of small renal cell carcinoma (RCC). Methods 98 patients with small RCC who was treated by RLPN from June 2012 to June 2016 were retrospectively analyzed. There were 57 males and 41 females with a mean age of 52 years old (ranging 28 ~ 75 years old). 52 cases were located on the right side while 46 cases were left. The mean tumor size was 3.1 cm in diameter (ranging 0.8 ~ 4.5 cm). 87 patients (A group) were underwent standard RLPN with clamping main renal artery. 7 patients (B group) with exophytic RCC were performed without clamping renal artery, but with separating main renal artery and prepared for possible clamping. 4 patients (C group) with endophytic RCC were performed with clamping renal artery under ultrosound monitoring. The feasibility and outcomes were evaluated by surgical and oncological outcomes. Results 84 cases among A group were underwent standard RLPN successfully, with 2 cases converted to open surgery and 1 case failed to excising tumor completely and converted to laparoscopic radical nephrectomy. The amount of bleeding during operation was 30 ~ 350 ml, average 93 ml, operation time was 70 ~ 245 min, average 127 min, warm ischemia time 20 ~ 42 min, average 26 min. 6 cases among B group were performed successfully without clamping renal artery with 1 case converted to clamp renal artery for 15 min during the operation because of obvious bleeding. The amount of bleeding was 160 ~ 380 ml, average 220 ml, operation time was 85 ~ 215 min, average143 min. 4 cases of C group were all performed successfully, The amount of bleeding was 35 ~ 250 ml, average 85 ml, operation time was 110 ~ 235 min, average 175 min, warm ischemia time 25 ~ 40 min, average 28 min. With a mean follow up of 28 months (ranging 18 ~ 42 months), there was only 1 case of A group occured local recurrence and lung metastases and accepted molecular targeted therapy with Sorafenib. Conclusion RLPN with individual operation plan in treatment of small RCC is safe and effective, the long-term effect of the procedure needs further investigation.
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Objective To investigate the expressions of E-cadherin (E-cad)in arterial chemoembolization interventional therapied bladder carcinoma.Methods The expressions of E-cad in bladder tumor tissues of30 non-muscle-invasive bladder carcinoma treated with preoperative interventional chemotherapy and 20 invasive bladder carcinoma treated with surgical were measured by streptavi-din-peroxidase immunohisto chemical method.The changes of E-cad expression in bladder carcinoma before and after interventional treatment were analyzed.Results The averaged normal expressions rate of E-cad in non-muscle-invasive and muscle invasive bladder carcinoma was 70.0% (21/30),25.0% (5/20)respectively.The averaged normal expressions rate of E-cad after interventional treatment was improved to 90% (27/30),the differences were statistically significant (P <0.05 ).Conclusion The expressions of E-cad in bladder carcinoma had significant relations with pathological grade and clinical stage.The abnormal expressions of E-cad in the mucosal surface, may be associated with inflammation.Interventional treatment can significantly improve the expressions of E-cad of tumor tissue and delay the progress of bladder cancer.
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Objective To investigate the influence of preoperative arterial chemoembolization on the expression of Survivin,and study the clinical significance in bladder cancer.Methods The tissue before and after chemoembolization of 50 patients with bladder cancer were selected,the Survivin expression was examined by immunohistochemical method.The Survivin expression was compared between before and after chemoembolization in bladder cancer tissue,and the relation of its expression to the pathological grade and clinical stage was evaluated clinically.Results The positive rate of Survivin expression before chemoembolization raised with the rising of the pathological grade and clinical stage,there was statistical difference (P ＜ 0.05).The positive rate of Survivin expression before and after chemoembolization was 72％ (36/50) and 22％ (11/50),there was statistical difference (P ＜0.01).The positive rate of Survivin expression in high grade pathological grade and T2-T4 clinical stage after chemoembolization was significantly lower than that before chemoembolization,there was statistical difference (P ＜0.01).The survival rate 3 years after chemoembolization in Survivin negative expression patients was higher than that in Survivin positive expression patients [94.87％(37/39) vs.7/11],but there was no statistical difference (P ＞ 0.05).The Survivin positive expression in recurrence patients was significantly higher than that in non-recurrence patients [5/8 vs.5.56％ (2/36)],there was statistical difference (P ＜ 0.01).Conclusions Preoperative arterial chemoembolization can reduce the expression of Survivin,adjust malignancy of bladder cancer,could downgrade and downstage the tumor,reduce recurrence rate.The expression of Survivin can serve as predictive factor for prognosis of bladder cancer.
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ObjectiveTo investigate the serum prostate-specific antigen (tPSA),serum free PSA to total PSA ratio (f/tPSA),prostate volume (PV) and prostate-specific antigen density (PSAD) in early prostate cancer (PCa) diagnosis.MethodsRetrospective analysis was performed on serum PSA values and related test results from 252 cases of BPH patients and 49 patients with PCa.Prostate volume (PV) was measured by transrectal ultrasound (TRUS),and the f/tPSAand PSAD values were calculated.The differences of serum tPSA,f/tPSA,PV,and PSAD between BPH and PCa group were compared,the area under the ROC curve was used to evaluate these four indicators for its diagnostic sensitivity and diagnostic specificity.ResultsThe values of tPSA,PSAD in PCa group were significantly higher than BPH group ( P ＜0.05),while the values of f/tPSA,PV in PCa group were significantly lower than BPH group ( P ＜0.01orP ＜0.05).The ROC area showed that serum tPSA(0.8013),f/tPSA(0.7390),PV(0.5613) had lower diagnosis value than PSAD(0.9214) in early prostate cancer ( PSAD ＞ tPSA ＞ f/tPSA ＞ PV).When the upper limit of normal PSA was set to take 4ng/ml,the sensitivity was 91.49％,diagnostic specificity was 51.05％.When the f/tPSA threshold set to 0.16,the diagnostic sensitivity was 57.78％,diagnostic specificity was 78.72％.When PSAD threshold was set to 0.15,diagnostic sensitivity was 88.24％,diagnostic specificity was 81.52％.ConclusionsPSA,f/tPSA and PSAD are indicators for biopsy or followup in early diagnosis of prostate cancer.In particular,the diagnostic value of PSAD has higher sensitivity and specificity than PSA and f/tPSA in the diagnosis of prostate cancer.
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Objective To investigate the clinical and imaging features of von Hippel-Lindau disease to raise awareness of the disease. Methods The clinical and imaging data of a case of VHL patient were analyzed retrospectively and discussed with relative literature review. The patient was a 50-year-old man, who was admitted with the chief complaints of painless gross hematuria and blurred vision for 5 months. Imaging data and ophthalmoscopy examination showed bilateral multiple renal tumors, renal cysts, pancreatic cysts, hepatic cysts and retinal angioma in his right eye. He suffered a surgical operation for his cerebellar hemangioblastoma 12 years ago without family history. Results The patient underwent nephron- sparing surgery (NSS) in the left kidney. Five renal tumors were removed, and the largest tumor was 3.5 cm× 3.5 cm. Postoperative oral administration of Sorafenib agents was applied. Followed up for 4 months, the renal function was normal and the right kidney tumor reduced. Pathology confirmed the diagnosis of multiple renal clear cell carcinoma. Conclusions VHL disease is a familial autosomal dominant hereditary syndrome, with the performance of hemangioblastorna in central nervous system, visceral tumors and multiple visceral cysts. Comprehensive imaging examination plays a major role in both the diagnosis and the follow-up of VHL disease.
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Objective To investigate the relationship of urinary vascular endothelial growth factor (VEGF) and occurrence and invasiveness of bladder cancer. Method The expression of urinary VEGF in 48 patients with bladder cancer (bladder cancer group) and 45 normal cases (control group) were examined by ELISA immunohistochemical staining. Results VEGF levels in urine in bladder cancer group [(174.77±83.41) μg/L] were higher statistically than those in control group [(63.53 ±22.62) μg/L] (P < 0.01), and related to the staging and grading of tumors. VEGF levels were significant higher in invasive lesions [(223.00 ± 83.13) μg/L] than those in superficial ones [(130.40 ± 54.86) μg/L] (P < 0.01). VEGF levels of G3 [(259.23 ± 75.82) μg/L] were significant higher compared with G1 [(138.00± 85.60) μ g/L] and G2 [(146.22 ±47.53) μ g/L] (P < 0.01). Conclusion The concentration of urinary VEGF relates to the clinical staging and pathological grading, and it is a labeling index of the biological behavior of bladder cancer.
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Objective To investigate the influence of preoperative arterial chemoembolization on expression of Ki-67,and clinical significance in bladder cancer. Methods Before and after chemoembolizafion of therapy,the expression of Ki-67 in 30 patients of bladder cancer tissue were examined by immunohistochemical staining.The rehtion of its expression to the pathological grade and clinical stage was evaluated clinically.Results Positive rate of Ki-67 expression in the bladder cancer tissue was 70.00% and 26.67% respectively.There was significant difference between the before and after therapy (P＜0.01). Follow-up for mean 24.6 months recurrence rate in 30 cases was 16.67%.The expression of Ki-67 correhted to the pathological grade, clinical stage and patient recurrence rates of bladder cancer.Conclusions Preoperative arterial chemeembelization can reduce the expression of Ki-67,adjust malignancy of bladder cancer,could downgrade and downstage the tumors,and cut down the postoperative metastasis,improve survival rate and reduce recurrence rate.Both of the Ki-67 labeling index are predictive factor for recurrence of superficial bladder cancer.
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Objective To investigate the effect of transcatheter bladder arterial chemoembolization on microvessel density(MVD)change in bladder cancer. Methods The MVD count of bladder cancer tissue of 30 patients before and after chemoembolization were examined by SP immunohistochemical staining.Cancer tissues were examined pathology after chemoembolization.All the cases were followed up for 12 to 36 months(mean 24.6 months),the 3 years survival rate was evaluated clinically. Results MVD counts were 69.8±3.4 and 56.4±3.3 before and after therapy respectively(P<0.05).Cancer tissues were severely damaged ultramicroscopically after interventional chemotherapy.The recurrent rate was 16.67%in 30 cases. Conclusions The chemoembolization could decrease MVD,improve survival rate and reduce the recurrence rate.
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Objective To study the influence of transeatheter bladder arterial chemoembolization on neovascularization and vascular endothelial growth factor (VEGF) expression in bladder cancer treatment. Methods Thirty bladder cancer patients (Tis =1, Ta =2, T1 =6, T2 =11, T3 =9, T4 = 1; G1 = 9, G2=13, G3 = 8) were treated with transcatheter arterial chemotherapy with Mitomycin (20 mg) or Hydroxycamptothecin (10 nag) adding cisplatin (60 rag) and embolization with gelatine sponge particle gelform 1 week before surgery. Before and after the chemoembolization, the expression of VEGF and microvessel density (MVD) count in cancer tissue were examined by SP immunohistochemical staining. Tumor samples after chemoembolization were taken and sent for pathological examination. The over all survival rates were recorded and analyzed as well. Results Before and after the chemoembolization, positive rates of VEGF expression in bladder cancer tissue were 73. 3% and 43.3%, respectively and MVD were 69.8±3.4 and 56. 4±3.3, respectively. There were significant differences between the parameters before and after the treatment (P<0.05). After the intervention, tumor diameter decreased from 2.2±0.9 cm to 1.6±0. 9 cm (P<0.05) and tumor tissues were in severe necrosis and degeneration. During the follow-up of 24. 6 months (ranging from 12 to 36 months),there were 5 recurrent cases (G1 T1 =1, G2 T1=1, G2T3=1, G3T3 = 1, G3 T4 =1, primary transitional cell carcinoma= 4, admixture carcinoma= 1). In the recurrent group, VEGF expression were positive in 5 cases (100% strong positive) and 4 cases (80%, 3 positive, 1 strong positive) (P>0. 05) before and after the chemoembolization. However, it had significant difference in strong positive expression (P<0.05); MVD were 87.4±3.0 and 72.4±4.1 (P<0.05) before and after the treatment. The MVD in no recurrent group was 53.2±3. 5 after chemoembolization, and it had statistical significance comparing with the recurrent group (P<0. 05). Conclusions The chemoembolization can decrease the expression of tumor VEGF and MVD. Thus, it can adjust bladder cancer malignancy, downgrade and downstage the tumors and decrease the risk of postoperative metastasis. For the long-term, this treatment will improve the survival rate and reduce recurrence rate.
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Objective To study the feasibility of retroperitoneal laparoscopic partial nephrectomy. Methods Retroperitoneal laparoscopic partial nephrectomy was performed in 2 cases of renal malignant tumor and 2 cases of renal hamartoma from August to November 2005.After a retroperitoneal working space was established under laparoscope,the diseased kidney was mobilized with a harmonic scalpel.The renal artery and veins and the ureter were exposed and dissected.Then a laparoscopic partial nephrectomy was conducted.During operation a cotton thread was passed around the renal artery to control the blood supply.ResultsAll the operations were successfully accomplished.No conversions to open surgery were required.The operation time was 1.5 h,1.5 h,2 h,and 3 h,respectively.The intraoperative blood loss was 50~180 ml.A renal pedicel blockage for 25 min was needed in 1 case and was not required in the remaining 3 cases. Conclusions Retroperitoneal laparoscopic partial nephrectomy is feasible.