ABSTRACT
Objective To investigate the therapeutic effect of modified transperitoneal laparoscopic dismembered pyeloplasty in children with with ureteropelvic junction obstruction (UPJO).Methods The clinical data of 27 children with UPJO treated with transperitoneal laparoscopic dismembered pyeloplasty were analyzed retrospectively.The age ranged from 5 to 104 months (mean,37 months).All cases were diagnosed by ultrasonography,IVU,CT and/or renal radionuclide scanning.The antero-posterior pelvic diameter was more than 3 cm by ultrasound in all cases.Indications of surgery were as followings:symptoms of upper abdominal pain or low back pain and/or split renal function ＜40％ and/or progressive dilatation.Modified transperitoneal laparoscopic dismembered pyeloplasty was performed.Double hitch stitches were transfixed at the top of pelvis and ureter to be anastomosed,and a 6 F urethral catheter was inserted as a ureteral stent percutaneously through the puncture hole and was removed 7-9 days postoperatively without double-J stent.Results All operations were completed laparoscopically without conversion to open surgery.The mean operative time was 118 min (range,85 to 176),the mean blood loss was 16 ml (range,10 to 30) and the mean postoperative hospital stay was 10.5 days (range 9 to 13).The perinephric urine drainage occurred in 2 patients with about 200 ml/d,and reduced to 6 ml/d and 4 ml/d 5 to 6 days after operation.During the follow-up period for 12 to 36 months(mean,22 months) in 27 cases,there was no stricture at UPJ and the hydronephrosis reduced significantly or disappeared.Conclusion Laparoscopic dismembered pyeloplasty with double hitch stitches and an ordinary urethral catheter as an ureteral stent is an easy method with high successful rate and less operative time,which avoids reoperation to remove the double-J stent and is worthy of clinical popularization.
ABSTRACT
Objective To assess the feasibility and efficacy of renal pelvis drainage and ureteral stent of laparoscopic pyeloplasty in treatment of ureteropelvic junction obstruction.Methods Eighteen patients(14 boys and 4girls) with ureteropelvic junction obstruction,the average patient age was 66 months (range 3-182 months),who underwent transabdominal laparoscopic Anderson-Hynes pyeloplasty in Capital Institute of Pediatrics from Aug.2011 to Oct.2012 were selected.The ureteral stent and renal pelvis drainage were installed during the performance of surgery.They were removed in 7 days and 9 days after operation respectively.Results Eighteen cases successfully underwent laparoscopic pyeloplasty,without conversion to open surgery.The mean operating time was 102.8 minutes (ranging between 90 and 150 minutes).Two cases had complications on postoperative day 3,one patients ureteral stent was inadver-tentely pulled out,another was removed because of blood clots.No patient had postoperative urinary leakage or anastomotic stenosis.Postoperative follow-up time was 6 months.The hydronephrosis vanished in 13 patients,reduced obvious ly in 5 patients as revealed by ultrasound examination.Conclusions Intraoperatively,renal pelvis drainage and ureteral stent for postoperative drainage is effective,and it is worthy of application in a large scale.Patients can avoid further anesthesia for removing stents and the complications of long-term indwelling stent tubes,and have an improved quality of life.
ABSTRACT
Objective To assess apoptosis mediated by the cell death receptor Fas in peripheral T lymphocytes of patients with abdominal aortic aneurysm. Methods The apoptotic pathway was triggered by anti-Fas monoclonal antibody in cultured and activated peripheral T-cells from 20 AAA patients. Control groups consisted of 15 patients with aortic atherosclerotic occlusive disease(AOD)and 25 healthy individuals. Cell survival and death rate were assessed. Results Cross-linkage of Fas receptor exerted a strong apoptotic response on T cells from AOD patients and healthy controls, while the effect on T cells was very limited from that of AAA patients. The evaluation of cell Survival rate showed a significantly higher percentage in AAA group(98.9%±10.3%)than in the AOD subjects(58.9%±15.2%)or the healthy group(59.4%±12.9%;P＜0.001＝.Apoptosis assessment by annexin V and propidium iodide staining and flow cytometry showed similar results. The defect in AAA group was not due to decreased fas expressed at normal levels. Moreover,it specifically involved the Fas system because cell death was induced in the normal way by methylprednisolone. Conclusions Fas-induced apoptosis in activated T cell from AAA patients is impaired. This may disturb the normal down-regulation of the immune response and thus provide a new insight into possible mechanisms and routes in the pathogenesis of AAA.