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Objeetive To discuss risk factors for postoperative complications after Mini-percutaneous nephrolithotomy (mPNL) using modified Clavien classification of surgical complications.Methods From September 1999 to December 2010,4533 patients having complications after mPNL were analyzed with five related clinical factors using the modified Clavien classification of surgical complications in the Second Affiliated Hospital of Kunming Medical University.Results Among 88 cases having complications (1.94％),69 had hemorrhage (0.24％),5 had colon injury (0.11％),3 had septic shock (0.06％),5 had liquid absorption syndrome (0.11％),6 had pleural effusion (0.13％).According to the modified Clavien classification,11 cases were clustered into Class Ⅰ (0.24％),71 cases into Class Ⅱ (1.56％),6 cases into Class Ⅲa (0.13％) and no cases was classified in Class Ⅲ b,Ⅳ a,Ⅳ b and Ⅴ.For patients having complications of Class Ⅱ and Ⅲ,the average hospital stay was significantly longer than those having either Class Ⅰ or no complications.Multiple logistic regression analysis showed that five factors were associated with postoperative complications,including operation time (OR=1.46),ASA score (0 =2.49),having cardiovascular disease or diabetes at the same time (0R=1.67),stone load (0R=1.34) and positive urine culture (0R=0.97).Conclusion Using modified Clavien classification of surgical complications in the analysis of mPNL was standard,objective,applicable and recommended.
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Objective To discuss the long term clinical effect of ileal orthotropic neobladder.Methods From 1991 to 1998,79 patients,mean age 55(41～75)years,male 74,female 6,were followed up.The serum creatinine and urea,electrolytes,blood routine,B ultrasonic scan of the neobladder residual urine and IVU or MRU of the patients were followed up.The max transverse diameter of renal pelvis and the max verticaI/level diameter of neobladder were measured in 5,10 to 14,15 years of postoperative when IVU or MRU.All results of different time were compared by the multiple comparisons.The local or distant cancer recurrence and the complications of the operation Were evaluated. Results Sixty-four cases,58 male,6 famle,were long term followed up:mean time was 167 (range,121～216)months.Seven cases died of other diseases.Seven cases had pelvic recarrence.Two cases had urethral recurrence.Three cases died of tumor metastasis.One case had ureter recurrence.Forty-eight patients were alive more than 10 years.The value of the serum creatinine,urea,electrolytes and bloods routine of the patients were normal after 5,10 to 14 and 15 vears postoperative (P＞0.05).The max transverse diameter of the renal pelvis in 5,10 to 14 and 15 years Dostoperative were 14.0 mm,14.1 mm and 13.7 mm,respectively,P＞0.05.The max vertical/level diameter of the neobladder in 5,10 to 14,15 years of postoperative were 110.4 mm/90.4 mm,111.5 mm/95.3mm and 127.0 mm/97.0 mm,respectively,P＞0.05.The residual urine of 5 cases was more than 50 ml and had not increased during follow up.Eight cases with neobladder stone were cured by the intracavitary lithothrypsis.Two cases with uretheral stricture were cured by the intracavitary therapy.Twelve cases of 14 cases with inguinal hernia were cured by reoperation,2 cases accepted conservative treatment.Only 17 cases had no complication involve of the cancer and the operation. Conclusion The upper urinary tract and neobladder of the ileal orthotopic neobladder could be stable for long time,the cure rate of tumor is satisfactory and the lifetime follow up is necessary.
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Objective To summarise the methods for a long segmental avulsed inj ury of ureter.Methods Ureteroscopies were performed on three male patients with upper ureteral calculi and one female patient with haematuria from upper urinary tract.Ureteral calculi caused small and middle hy-dronephrosis,obstruction wasn't seen on the upper urinary tract with haematuria.The kidney on the affected side showed normal founction on IVP.Four patients were suffered from a long segmental avulsed inj uries of full-thickness of ureter from ureteroscopy in a continuous epidural anesthesia.The injuries took place in UPJ and upper ureter.The length of avutsed ureters is 20-25 cm,mean length is 24 cm. Results The ureteroscopies were altered to open operations which were ileal ureteral substi-tutions on two patients,being anastomosed the avulsed ureter wrapped by caul on one patient and nc-phrectomy on one patient under general anesthesia in an emergercy.Two ileal ureteral substitutions had reached satisfied results that were no damaged renal functions,no metabolic acidosis,no repeatly U-rinary tract infections and no complains about micturition.One patient has maintained normal renal morphology and function after thirteen years followup,the other formed stricture in the anastomosis of the proximal piece of-ileum to the renal pelvis tWO years after operation,and then improved after ante-grade dilation.The patient with being replaced back and anastomosed the avulsed ureter had compli-cated with a renal atrophy on the affected side three months after the double-J was extracted.The kid-ney showed no function on isotop nephrogram and then was ablated.The last one with nephrectomy and the one before were followed up regularly,the renal functions and blood pressures remain normal.Conclusion Ileal ureteral substitution would be a good choice and has a stable curative effect and provide a good prognosis for treating long segmental avulsed injury of ureter suffered from ureterosco PY when no available urinary tract was utilized for reconstruction.
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Objective To investigate the clinical effects of retroperitoneal laparoscopic surgery in the management of diseases of adrenal glands, kidneys and ureters. Methods By using a closed puncture into retroperitoneal space to establish a surgical access ,87 patients with diseases of adrenal glands, renal cysts, ureteral calculi and ureteral deformities were operated on by means of retroperitoneal laparoscopic surgery. Results The surgery was successfully accomplished in 83 patients with an excellent therapeutic effect, whereas a conversion to open surgery was required in 4 patients. There were no blood transfusions or serious complications in the study. Conclusions Retroperitoneal laparoscopic operations of adrenalectomy, cyst unroofing, ureterolithotomy, ureterolysis and ureteroplasty has the advantages of minimal invasion, less blood loss and fewer complications, being an effective and practical procedure .