Application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score / 中华外科杂志

<p><b>OBJECTIVE</b>To study the application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score.</p><p><b>METHODS</b>From April 2005 to June 2011, 79 cases (48 males and 31 females) of intermediate risk PADUA score (range from 8 to 9 score) renal cell carcinoma were retrospectively analyzed. Mean age was (54 ± 9) years, mean tumor size was (2.8 ± 0.8) cm in diameter, with 37 cases on the left side and 42 cases on the right side. Tumor located anteriorly in 35 cases, and 44 cases were located posteriorly. Preoperative imaging examinations showed tumor invasion of the collecting system was dislocated or infiltrated by tumor invasion were in 13 cases, renal sinus were involved in 5 cases, tumor located near the renal hilum were in 10 cases. All of the 79 patients received retroperitoneal laparoscopic partial nephrectomy.</p><p><b>RESULTS</b>The 79 cases were operated successfully without conversion to open surgery, no severe perioperative complications. The mean operation time was (105 ± 24) minutes, and the median of operation time was 115 minutes (range from 80 - 180 minutes), and mean warm ischemia time (WIT) was (20 ± 5) minutes, and mean blood loss was (24 ± 8) ml; mean postoperative hospital stay was (5.2 ± 1.5) days. Postoperative urinary leakage in 3 cases, symptoms disappeared one week after indwelling catheterization and ureteral catheter. Serum creatinine transient increased in 7 cases after surgery, and fell to normal range within 6 weeks. In a mean follow up for (34 ± 12) months (range from 10 to 84 months), estimated glomerular filtration rate (eGFR) 6 months after operation was no statistical significance compared with preoperation in 77 cases, another 2 patients' eGFR decreased by 30% and 35%. Postoperative renal function remained in CKD3 period and CKD2 period were in 2 cases respectively, none of these cases were treated with hemodialysis, and the remaining patients with normal renal function after surgery, no tumor recurrence and metastasis during follow-up in all cases.</p><p><b>CONCLUSIONS</b>Treatment of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score is safe and effective, but its long-term effects still need to study with large samples compare and long-term follow-up.</p>

Evaluating the oncologic outcomes in 152 patients undergoing extraperitoneal laparoscopic radical prostatectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although many midterm oncologic data have been reported for extraperitoneal laparoscopic radical prostatectomy (ELRP) in western countries, few oncologic data of the extraperitoneal procedure was published in China. The aim of the study was to evaluate the oncologic outcomes of patients treated with ELRP in China.</p><p><b>METHODS</b>From January 2005 to March 2010, a total of 152 consecutive patients diagnosed with clinically localized prostate cancer were included in this study and treated with ELRP. The patients were staged according to the TNM (tumor, nodes, metastases) system. Median and mean postoperative follow-up were 28.1 months and 27.0 months, respectively. The patients were retrospectively analyzed for progression-free survival.</p><p><b>RESULTS</b>One hundred and twelve cases (73.7%) were postoperatively diagnosed as pT2 in, and 40 cases (26.3%) as pT3. Positive lymph nodes were shown in 5 patients (3.3%). Gleason score was < 7 in 49 men (32.2%), 7 in 69 men (45.4%), and > 7 in 34 men (22.4%). Positive surgical margins (PSM) were observed in 15 patients (9.9%), which included 32.0% of all pT3a cases and 46.7% of all pT3b cases, respectively. The overall prostate-specific antigen recurrence-free survival rate was 86% in all patients. The recurrence-free survival rates were 91.8% and 62.2% in pT2N0 patients and pT3N0 patients, respectively. Preoperative prostate-specific antigen, surgical margins, tumor stage, and lymph nodal status were identified as independent predictors of biochemical recurrence-free survival using multivariate Cox proportional hazard model.</p><p><b>CONCLUSIONS</b>ELRP is a precise, safe and effective procedure at this particular Chinese institution. The prognostic power of prostate-specific antigen relapse after ELRP is not identical to that described previously with transperitoneal or open retropubic approaches.</p>

Adrenocorticotropic hormone-producing pheochromocytoma: a case report and review of the literature / 中华医学杂志(英文版)

Ectopic Cushing’s syndrome caused by pheochromocytoma is rare. We reported a 15-year-old female patient who was admitted to hospital with typical Cushing’s syndrome. She had not started menstruation. Her plasma adrenocorticotropic hormone (ACTH) and 24-hour urinary free cortisol levels were extremely high. Gonadal and progestational hormone levels were also abnormal. Abdominal computed tomography scans and enhanced scans revealed multiple irregular tumors in the right adrenal. Pelvic echogram showed an infantile uterus, while the ovaries were at an immature stage of development. Retroperitoneal laparoscopic right adrenalectomy was performed without intraoperative complications. Histology and immunohistochemistry of the tumor were consistent with pheochromocytoma. Retroperitoneal laparoscopic adrenalectomy is a safe procedure with satisfactory outcomes and allows for rapid recovery.

Prevention and treatment of urethrovesical anastomotic leakage following laparoscopic radical prostatectomy / 第二军医大学学报

Objective To search for method for treatment and prevention of urethrovesical anastomotic leakage (PUAL) follownng laparoscopic radical prostatectomy (LRP). Methods Eight (5. 3%) of the 151 laparoscopic radical prostatectomies performed between Jan. 2006 and Jan. 2011 developed PUAL. Running urethrovesical anastomosis was used for 58 patients and traditional suture was used in 93 during LRP. The mean age of the 8 patients was 66 years (ranging 53 to 78 years), the mean preoperative total prostate specific antigen(T-PSA) was 34. 3 ng/ml (ranging 1. 1 to 165. 0 ng/ml). The preoperative Gleason sum was 7 in 2 patients. The mean preoperative Gleason score was 7 (ranging 5 to 9). Pathological stage was T1c nn 5, T2a in 2, and T2c in 1 patient. The mean operation time was 202 min (ranging 60 to 360 min). Several treatments were used, including prolonged retropubic drainage, bladder catheter traction, drain position adjustment, reduction of fluid intake, delayed bladder catheter removal and enhancing nutrition for patients. Patients underwent reoperation using a laparoscopic approach after failure of the initial management. Results PUAL was not observed in LRP cases with running laparoscopic suture technique, which was significantly better than cases with traditional suture method (0 vs 8. 6% [8/93], P<0. 05). Six patients were cured by conservative treatments, 2 patients required reintervention via a laparoscopic approach. The catheters of all patients were removed after a mean of 33 d (ranging 21-43 d). Urethral stricture was not found during a 39-month follow-up(ranging 22to 60 months). Concision Urethrovesical anastomotic leakage can be effectively avoided by running urethrovesical anastomosis; conservative treatment and laparoscopic repair are effective managements to treat PUAL.