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Seven cases of renal tumor treated at our hospital from May 2009 to November 2011 were assigned to undergo laparoscopic ultrasonography assisted laparoscopic partial nephreetomy.The mean operative duration was 109 minutes (range:102-121).And the mean volume of blood loss was 82 ml (range:60-120).All patients had confirmed negative margins.Renal clear cell carcinoma was definitely diagnosed in all cases.Laparoscopic ultrasonography could provide more precise information of renal tumor within renal capsule.Thus it may be used to guide the operation so that tumors are excised more completely,residual tumor tissues avoided and normal renal tissues protected.
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Objective To study the growth suppressive effect of demethylation drug 5-aza-2'-deoxycytidine on bladder tumor cells. Methods The growth suppressive effect of DAC on 4 transitional cell carcinoma (TCC) cell lines was measured using the Cell Proliferation Reagent WST-1 assay.The effects of DAC on apoptosis induction and cell cycle arrest were analyzed by flow cytometric analysis. Caspase 3, 9 activities were analyzed by APOPCYTO Caspase Colorimetric Assay Kit and PCNA expression was also investigated by Western blot to clarify the mechanism of DAC against TCC. Results DAC inhibited the growth of all TCC cell lines tested in a dose-dependant manner, however,growth suppressive effect of DAC was independent of p53 status in TCC. DAC inhibited proliferation via inducing G2/M cell cycle arrest but not via inducing apoptosis. After treated with 0, 1 and 8 μmol/L DAC, cells of RTl 12 in G2/M phase was (36.3 ± 3.4) %, (46.2 ± 4.6) % and (56.5 ±6.2) %, TCCsup was (37.5 ± 3.8) %, (48.4 ±4.9) % and (60.1 ± 6.7) %, respectively. The expression of PCNA was decreased by DAC, but caspase3, 9 activities were not activated. Conclusion DAC could suppress the growth of TCC cells and might be a new strategy to treat bladder malignancy in the future.
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Objective To discuss the laparoscopic retroperitoneal dismembered pyeloplasty in the treatment of ureteropelvic junction (UPJ) obstruction. Methods From 2004 to 2007, a total of 41 consecutive patients (20 men and 21 women) with a mean age 30 years (range 12-45 years) un-derwent laparoscopic retroperitoneal dismembered pyeloplasty for UPJ obstruction. One patient had a congenital solitary kidney, 3 patients had renal calculi and 3 patients had horseshoe kidneys. Diuresis renogram and intravenous urography were performed at 3 and 6 months postoperatively, and annually thereafter. Success was defined by the absence of symptoms and improvement of intravenous urogra-phy and the diuretic renogram. Results The mean operative time was 160 min (range 95 to 300 min) with the average estimated blood loss was 35 ml (range 20 to 80 ml). There was no conversion to open surgery. Crossing vessels were found in 10 patients. Among these cases, the ureter was trans-posed anteriorly. Three patients with coexisting renal calculi were successfully had the stones re-moved. The mean hospital stay was 7.5 d (range 5 to 14 d). There were no intra-operative complica-tions. Postoperative complication was recorded in 1 patient with urine leakage. One patient developed an anastomotic stricture who took open surgery afterwards. The success rate was 97.6 % (40/41) at a mean follow-up of 28 months (range 13 to 52 months). Conclusion Laparoscopic retroperitoneal dismemebered pyeloplasty is effective and feasible.
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Objective To evaluate the feasibility of using pure laparoscopic radical nephrectomy and thrombectomy to treat renal tumor with renal vein and vena caval thrombus. Methods Two ca-ses o{ right renal tumor with renal vein and vena caval thrombus were reported. Contrast-enchanced CT showed renal tumor extended into renal vein and vena cava in 1 case, and filling defect was found in right renal vein and extended to vena cava in the other. Both patients received pure laparoscopic ra-dical nephrectomy and thrombectomy through retroperitoneal approach. Four trocars were placed du-ring the operation, and the renal artery was dissected before the vena cava was mobilized circumferen-tially above and below the renal vein, a faparoscopic vessel blockage clamp was used to partly occlude the vena cava containing the thrombus. The vena cava was repaired after the intact tumor thrombus was extracted. Results The tumor thrombus extended 0.3 cm and 1.0 cm above the renal vein, re-spectively. Both patients were discharged 5 d after operation. Pathological examinations showed that tumors were epithelioid renal angiomyolipoma and grade Ⅰ-Ⅱ clear cell carcinoma separately. Both patients were free of local recurrence and metastasis 5 months after operation. Conclusion Pure la- paroscopic radical nephrectomy and thrombectomy for renal tumor with vena caval and renal vein thrombus is feasible in carefully selected patients.
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Objective To discuss the feasibility of laparoscopic renal surgery following kidney rupture.Methods Two patients with left kidney rupture were treated laparoscopiclly at our institution in the last 4 years. 1 operated 7 days after hemorrhage and another operated immediately. Both of them performed retroperitoneal laparoscopic nephrectomy. Results The operations succeeded, the operating time being 100～120 min, the blood loss 200～300 mL. There were no postoperative complications in all cases. Conclusion Laparuscopic exploration and extirpation offer a viable measure to treat kidney rupture.
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Objective To study the factors associated with post-operattve renal function injury after laparoscopic nephron-sparing surgery(LNSS)for tumors. Methods Fifty consecutive patients were enroned in a prospective protocol and underwent LNSS.Preoperative and postoperative renal scintigraphic scan was performed in all patients. 99 Tcm-diethylenetetraminepentacetic acid scan was performed in all patients.Linear correlation and multivariate regression model were used to analysis the factors associated with postoperative renal damage.Twenty consecutive patients associated with risk factors were followed-up.These data in GFR were monitored at the preoperative,1 week and 3 months after operation.The duration Warm ischemia was recorded. Results In selected patients,assessed by renal scintigraphy,the function of the operated kidney was reduced by a mean of 24%.Linar correlation analysis showed that there was positive correlation between the age,tumor size,duration of warm ischemia and postoperative renal function injury.Furthermore,multivariate Legression analysis revealed that the duration of warm ischemia was the independent risk factor of postoperative renal damage.Twenty consecutive patients were included in this protocol.There was a significant difference between vessel clamp time≤30 min and vessel clamp time＞30 min.Renal scan data did not reveal any significant decrease in GFR in the affected kidney at 3 months after surgery for the patients whose yesscl clamp time less than 30 min.Renal function damage could not recover in the patients over 70 years with longer than 30 min warm ischemia or with longer than 60 min warm ischemia. Conclusions This paper evaluated renal function on the affected side before and after surgery by measuring renal function with renal scintigraphy using99 Tcm-DTPA.Risk factors for renal dysfunction in the affected kidney after LPN are age over 70 years with more than 30min warm ischemia time,and a warm ischemia time longer than 60 min.