ABSTRACT
Objective To analyze the advantages and surgical experience of laparoscopic anatomical surgery for adrenal tumors.Methods A total of 156 patients with benign or malignant adrenal tumors admitted to our hospital from April 2012 to September 2016 were enrolled and underwent laparoscopic anatomical surgery in the study.The curative effect and advantages of the operation were analyzed,and surgical experiences of laparoscopic anatomical surgery for adrenal tumors were summarized.Results Laparoscopic adrenalectomy was successfully completed in 155 of the 156(99.4％)patients and 1 patient with pheochromocytoma underwent open surgery due to pneumothorax caused by an accidental diaphragm injury.Postoperative pulmonary embolism occurred in 1 case and hematoma in right adrenal region in 6 cases,all of whom were completely relieved after intervention.Postoperative surgical specimen of adrenal glands in 54 patients were histopathologically examined,the results of which showed the negative boundaries in all patients.Patients were followed up for a mean of 11.6 months(range,4 to 26 months).All patients had a good recovery after surgery without recurrence of malignant tumor in local or trocar site.Conclusions As compared with open surgery,the transperitoneal laparoscopic adrenal surgery provides a larger operation area for good orientation and vision,and has such advantages as shorter hospital stay,fewer postoperative complications and better prognosis in patients with malignant adrenal tumors,which is worthy of clinical selection.
ABSTRACT
Objective To evaluate the efficacy and complications of flexible ureteroscopy for the treatment of upper urinary tract calculi in children.Methods The clinical data of upper urinary tract calculi in 20 children including 16 male and 4 female,treated by using flexible ureteroscopy,were collected from January 2014 to May 2015 in the First Affiliated Hospital of Zhengzhou University.The mean age was 6.4 years (ranging from 2.7-15.0 years old).Among them,6 cases had upper ureteral calculi and 14 cases had renal calculi.All the calculi was found unilaterally with on the left side in 12 cases and on the right side in 8 cases.Ipsilateral mild to moderate hydronephrosis were found in all of the cases.The mean stone size was 1.2 cm (ranging from 0.5-1.8 cm).All the cases were treated through retrograde flexible ureteroscopy holmium laser lithotripsy after the invalid conservative through conservative treatment.Double J tube was left routinely in the sick side 1 week before operation to expand the internal diameter of the ureter.A double J stent was left in place for 1 month after operation as a routine.Results The flexible ureteral access sheath failed to insert into the upper ureter in 2 cases because of the narrow ureter,then the flexible ureteroscopy was inserted into ureter through wire directly.The flexible ureteral access sheath was successfully inserted into the ureter for the others and flexible ureteroscopy were inserted through flexible sheath.The mean operative time was 38 min (ranging from 20-60 min).The patients were discharged from hospital after a mean of 4.5 days (ranging from 3-7 days).The rate of stone-free in one-stage was more than 90％.There were residual small stones in the lower calices of kidney in 2 cases.The perfusion liquid volume during the operation was 500 mL(ranging from 200-1 000 mL).There was no major perioperative complication,while transient macroscopic hematuria and fever were common complications after operation.The stone search was performed successfully in the whole 14 cases.NO residual stone could be found through ultrasound and kidney ureter bladder plain and Double-J stent was removed 1 month after operation.Conclusions Flexible ureteroscopy produces high stone-free rate and clinical safety for upper urinary calculi in children.However,the complications of flexible ureteroscopy lithotripsy cannot be ignored and sufficient preoperative preparation and careful perioperative safety control should be required.