ABSTRACT
Objective:To explore the application value of radical prostatectomy(RP) combined with extented pelvic lymph node dissection(ePLND) in patients with clinically localized prostate adenocarcinoma.Methods:We searched the PubMed, Embase, Cochrane Library databases, the China Knowledge Network(CNKI) database, Wanfang database, Chinese Biomedical Literature Database by computer.The following MeSH terms and their combinations were searched in English and Chinese, respectively: prostate neoplasms, prostate neoplasm, prostatic neoplasm, prostate cancer, prostate cancers, cancer of the prostate, prostatic cancer, prostatic cancers, cancer of prostate, lymph node excisions, lymphadenectomy; lymphadenectomies, lymph node dissections, radical prostatectomy, extent, extented, standard, standardized, limit, limited; prostate cancer, radical prostatectomy, lymph node dissections.The search was set for all case-control studies on the comparison in patients with clinically localized prostate cancer beteeen RP with ePLND with standard (sPLND) or limited PLND(lPLND). Two authors independently screened the literature, extracted relevant literature data, and evaluated the quality of the literature.The software Revman 5.3 and Stata 12.0 were used to perform meta-analysis in this study. The software R 3.6.0 was used to combine the total survival curves. The limited template was included in the sPLND for comparison.Results:Fourteen studies with a total of 12, 148 patients were included.Compared with sPLND, ePLND significantly improved lymph node yield(LNY)( WMD=9.72, 95% CI 6.81-12.63, P<0.05) and the detection of more lymph node positivity of metastasis(LN+ )( RR=2.89, 95% CI 2.16-3.86, P<0.00001). ePLND increased the complication rate, but the differences were not statistically significant( RR=1.39, 95% CI 0.95-2.05, P=0.09). The ePLND group had significantly lower biochemical recurrence(BCR)( RR=0.69, 95% CI 0.52-0.91, P=0.01) and higher biochemical-free survival( HR=0.59, 95% CI 0.56-0.63, P<0.05). Meanwhile, according to the overall survival, the two groups of curves became more and more distant over time( HR=0.59, 95% CI 0.56-0.63, P<0.05). Conlucsions:Compared with sPLND, RP combined with ePLDN could be more effective than standard PLND in patients with clinically localized prostate cancer and provides a better prognosis.
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Objective To summarize the operative experience and to study the value and efficacy of retroperitoneal laparoseopie adrenaleetomy.Methods Clinical data of 66 cases undergoing retroperitoneal laparoscopic adrenalectomy in Yijishan Hospital were retrospectively reviewed.There were 22 cases with adrenal adenoms located at left side and 44 cases at fight side.Tumor diameter was from 1.2 to 6.4 cm,with 3.3 cm as the average.There were 36 cases of nonfunctional adrenal adenoma,13 cases of primary hyperaldosteronism,10 cases of adrenal pheochromocytoma,6 cases of adrenal myelolipoma,and 1 case of adrenal cyst.Results 4 cases were converted to open surgery while the other 62 cases were completed successfully.The operation duration was from 35 to 190 min,with 90 min as the average.Intraoperative blood loss was from 20 to 800 ml,with 70 ml as the average.5 cases received blood transfusion because of massive hemorrhage.All cases were followed up for 3to 36 months.None of them had long-term complications or recurrence.Conclusion Retroperitoneal laparoscopic adrenalectomy has advantages of safety,less trauma,short hospitalization time,and quick recovery,making it the flint choice for patients with benign adrenal neoplasms.
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Objective To evaluate the clinical efficacy of pneumatic lithotripsy under ureteroscope in the treatment of ureteral calculi. Methods A total of 110 cases of ureteral calculi were treated by using 8/9.8 F Wolf rigid ureteroscope and JUN-AIR pneumatic lithotripter. Results Successful lithotripsy under ureteroscope was achieved on one session in 105 cases, with a success rate of 955% (105/110). Calculi were entirely extracted within 1~6 weeks. Conversions to open surgery were required in 2 cases because of failed ureteroscope insertion. Upper ureteral stones moved into the kidney in 3 cases, 2 of which underwent the ESWL and 1 of which received medical treatment. Postoperatively, 5 cases were complicated with urinary infection with mild hematuria lasting for 1~3 days. Conclusions Pneumatic lithotripsy under ureteroscope is an effective method for treating mid-lower ureteral calculi, with advantages of high efficiency, safety, minimal invasion, less complications and simplicity of performance.
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Objective To investigate the efficacy and safety of percutaneous nephrolithotomy (PCNL) combined with pneumatic lithotripsy for renal stones. Methods Clinical data of 95 cases of renal stones that were treated by PCNL from February 2007 to September 2008 were retrospectively analyzed. The operations were done by using ultrasonography and pneumatic lithotripter system (EMS Ⅲ). If the stones were easy to shatter,we used ultrasonic lithotripter,otherwise,pneumatic lithotripter or both of them were employed. Results The procedures were completed successfully in all of the 95 cases with the operation time ranged from 45-170 min (mean,85 min). No severe complications including pleural trauma and severe bleeding occurred during the operations. After the operation,9 patients had fever and 11 cases showed severe hemorrhage (9 of them were cured by conservative therapy and the other 2 recovered after nephrectomy). In the 95 patients,17 cases had residual stones,6 of them received a second operation. Conclusion PCNL combined with pneumatic lithotripsy is an effective and minimally invasive method for the treatment of renal stone.
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Objective: To evaluate the efficacy and safety of Naftopidil on patients with female urethral syndrome (FUS). Methods: Self-controlled clinical trial was performed in patients with FUS. Thirty-eight patients were treated with naftopidil tablet 25mg/po/qn for 4 weeks after one-week washout period. The effects were evaluated mainly by female urethral syndrome score (FUSS) and quality of life (QOL). Results: FUSS began to decrease after 2 (week's) administration and decreased significantly after 4 weeks' treatment. It had statistically significant difference of FUSS and QOL after treatment compared with control (P