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Objective To investigate the correlation between ITPKB mutation's variant allele frequency (VAF) and prognosis of diffuse large B-cell lymphoma (DLBCL). Methods This study included 155 patients with DLBCL initially diagnosed in the People's Hospital of Xinjiang Uygur Autonomous Region from June 2014 to December 2020. Paraffin-embedded tumor tissue specimens were obtained, and tumor tissue DNA was extracted. A total of 475 hotspot genes including ITPKB were detected by the next generation sequencing to analyze the relationship of the VAF of high-frequency mutant gene with progression-free survival (PFS) and overall survival (OS). Results The mutation frequency of ITPKB was 18.71%. The PFS was significantly shorter in the patients with ITPKB mutations than in those without mutations (37 months vs. 108 months; HR=1.643, 95%CI: 0.920-2.934, P=0.093). The R-language based web tool was used to find the best VAF cutoff to differentiate prognosis. The patients were divided into two groups (VAF High vs. VAF Low+Wt) according to their VAF values. The optimal VAF threshold for ITPKB was 27.48% (HR=3.480, 95%CI: 1.70-7.13, P=0.00027). Multivariate Cox analysis was conducted using clinical indicators such as age, gender, COO classification, IPI, and LDH, and the results showed that PFS was associated with high ITPKB VAF (≥28%) (HR=3.592, 95%CI: 1.738-7.425, P < 0.001) which was an independent adverse predictor of PFS. Conclusion The high load of ITPKB mutation is an independent risk factor for the PFS of patients with DLBCL, and the VAF of ITPKB mutation has a prognostic predictive value for patients with DLBCL.
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Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.
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Objective:To investigate the safety and feasibility of the CHESS endoscpic ruler (CHESS ruler), and the consistency between the measured values and the interpretation values by endoscopic physician experience.Methods:From January 2021 to January 2022, a total of 105 liver cirrhosis patients with portal hypertension were prospectively enrolled from General Hospital, Xixia Branch Hospital, Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region (29 cases), and the First People′s Hospital of Yinchuan (25 cases), General Hospital of Ningxia Medical University (18 cases), Wuzhong People′s Hospital (10 cases), the Fifth People′s Hospital of Ningxia Hui Autonomous Region (10 cases), Shizuishan Second People′s Hospital (6 cases), Yinchuan Second People′s Hospital (5 cases), and Zhongwei People′s Hospital (2 cases) 8 hospitals. The clinical characteristics of all the patients, including gender, age, nationality, etiolog of liver cirrhosis, and Child-Pugh classification of liver function were recorded. A big gastroesophageal varices was defined as diameter of varices ≥5 mm. Endoscopist (associated chief physician) performed gastroscopy according to the routine gastroscopy procedures, and the diameter of the biggest esophageal varices was measured by experience and images were collected, and then objective measurement was with the CHESS ruler and images were collected. The diameter of esophageal varices of 10 randomly selected patients (random number table method) was determined by 6 endoscopists (attending physician or associated chief physician) with experience or measured by CHESS ruler. Kappa test was used to test the consistency in the diameter of esophageal varices between measured values by CHESS ruler and the interpretation values by endoscopic physician experience.Results:Among 105 liver cirrhosis patients with portal hypertension, male 65 cases and female 40 cases, aged (54.8±12.2) years old, Han nationality 82 cases, Hui nationality 21 cases and Mongolian nationality 2 cases. The etiology of liver cirrhosis included chronic hepatitis B (79 cases), alcoholic liver disease (7 cases), autoimmune hepatitis (7 cases), chronic hepatitis C (2 cases), and other etiology (10 cases). Liver function of 32 cases was Child-Pugh A, Child-Pugh B 57 cases, and Child-Pugh C 16 cases. All 105 liver cirrhosis patients with cirrhotic portal hypertension were successfully measured the diameter of gastroesophageal varices by CHESS ruler, and the success rate of application of CHESS ruler was 100.0% (105/105). The procedure time from the CHESS ruler into the body to the exit of the body after measurement was (3.50±2.55) min. No complications happened in all the patients during measurement. Among 105 liver cirrhosis patients with cirrhotic portal hypertension, 96 cases (91.4%) were recognized as big gastroesophageal varices by the endoscopists. Totally 93 cases (88.6%) were considered as big gastroesophageal varices by CHESS ruler. Eight cases were recognized as big gastroesophageal varices by the endoscopist, however not by the CHESS ruler; 5 cases were recognized as big gastroesophageal varices by the CHESS ruler, but not by the endoscopists; 4 cases were not recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler; 88 cases were recognized as big gastroesophageal varices both by the endoscopists and CHESS ruler. The missed diagnostic rate of big gastroesophageal varices by the endoscopists experience was 5.4% (5/93), and the Kappa value of consistency coefficient between the measurement by the CHESS ruler and the interpretation by endoscopists experience was 0.31 (95% confidence interval 0.03 to 0.60). The overall Kappa value of consistency coefficient by 6 endoscopists measured by CHESS ruler in big gastroesophageal varices diagnosis was 0.77 (95% confidence interval 0.61 to 0.93).Conclusion:As an objective measurement tool, CHESS ruler can make up for the deficiency of subjective judgment by endoscopists, accurately measure the diameter of gastroesophageal varices, and is highly feasible and safe.
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Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.
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Objective:To determine the impact of body mass index (BMI) on perioperative and oncological outcomes after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion.Methods:Clinical data of bladder cancer patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion in Zhejiang Provincial People's Hospital from January 2017 to January 2020 were retrospectively analyzed. Patients were divided into three groups according to BMI, including 61 cases in normal group (<25.0 kg/m2), 52 cases in overweight group (25.0-29.9 kg/m2) and 33 cases in obese group (≥30.0 kg/m2). In the normal group, the median age was 73.6(59, 79), including 45 male(73.8%), with 51 cases(83.6%) of ASA score 0-2, 10 cases (16.4%)of 3 or higher, and 10 cases (16.4%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 34 cases (55.7%), hypertension in 19 cases (31.1%), diabetes in 10 cases (16.4%), heart disease in 12 cases (19.7%), and abdominal surgery in 6 cases (9.8%). In the overweight group, the median age was 69.7(60, 78), including 38 male (73.1%), with 25 cases (48.1%)of ASA score 0-2, 27 cases (51.9%) of 3 or higher, and 9 cases (17.3%) undergoing received neoadjuvant chemotherapy. Past medical history included smoking in 30 cases (57.7%), hypertension in 20 cases (38.5%), diabetes in 10 cases (19.2%), heart disease in 9 cases (17.3%), and abdominal surgery in 5 cases (9.6%). In the obses group, the median age was 69.9(61, 78), including 21 male(63.7%), with 20 cases (60.6%)of ASA score 0-2, 13 cases(39.4%) of 3 or higher, 9 cases (27.3%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 18 cases (54.5%), hypertension in 17 cases (51.5%), diabetes in 19 cases (57.6%), heart disease in 7 cases (21.2%), and abdominal surgery in 4 cases (12.1%). After statistical comparison among the three groups, it was found that the proportion of patients with hypertension and diabetes in the obesity group and overweight group was higher than that in the normal group (all P<0.05), but there was no significant difference in other factors (all P>0.05). During the surgical process, robot-assisted radical cystectomy and bilateral pelvic lymph node dissection were performed firstly. The scope of lymph node dissection was divided into standard range and expanded range, and the diversion was divided into orthotopic neobladder and ileal bladder. During the orthotopic neobladder process, 40-50 cm ileum at the distance of 15 cm away from ileocecum was obtained by stapler, and then the U-shaped neobladder was made, and the new bladder was anastomosed with urethra and bilateral ureter. For ileal bladder, the ileum was cut off 15cm away from the ileocecum with stapler to obtain the 15 cm ileum to prepare the ileal conduit and restore the continuity of the ileum. The bilateral ureteral spacing 3cm was implanted on the ileal conduit. In the normal group, standard range lymphatic dissection was performed in 20 cases (32.8%), enlarged dissection in 41 cases (67.2%), orthotopic neobladder in 22 cases(36.1%), and ileal conduit in 39 cases (63.9%). In the overweight group, standard range lymphatic dissection was performed in 12 cases (23.1%), enlarged dissection in 40 cases (76.9%), orthotopic neobladder in 26 cases (49.1%), and ileal conduit in 26 cases (50.9%). In the obesity group, the standard range of lymphatic dissection was performed in 7 cases (21.2%), enlarged dissection in 26 cases (78.7%), orthotopic neobladder in 7 cases (21.2%), and ileal conduit in 26 cases (78.8%). There was no significant difference among the three groups (all P>0.05). Compared the operation time, intraoperative blood loss, postoperative exhaust time, postoperative time of taking solid food, postoperative hospital stay, postoperative complications (according to the Clavien-Dindo grading system, postoperative complications are reported inⅠ-Ⅱ grade as mild complications and above Ⅲ grade as serious complications) and pathology results in three groups. Results:All cases successfully underwent robotically without conversion or major intraoperative complications. The operation time in overweight and obsess group were longer than that of normal group with RARC or orthotopic neobladder [310(250, 350) min, 370(310, 420) min, 250(230, 310) min, ( P<0.05)], but there was no significant difference in RARC and ileal conduit[270(220, 300) min, 280(230, 300) min, 240(220, 290)min, P>0.05]. The estimated blood loss in overweight and obsess group was more than that in normal group [230(150, 450)ml, 310(250, 600)ml, 190(100, 350)ml, P<0.05], but there was no difference in blood transfusion rate [4(7.7%), 2(6.1%), 5(8.2%), P>0.05]. The exhaust time [2(1, 3) days, 2(1, 4)days, 2(1, 4)days], postoperative solid food intake time [4(3, 5)days, 4(3, 6)days, 4(3, 6)days] and the hospital stay[10(5, 16)days, 10(6, 17)days, 12(6, 20)days] were not different in three groups(all P>0.05). The mild complication rates in 90 days were significant higher in overweight and obsess groups[28 (53.8%), 16(48.5%), 20(32.8%), P<0.05], but the total and severe complication rates were not significantly different. The incidences of urinary system complications and incision complications in obese and overweight patients were significantly higher than those in normal group ( P<0.05). There was no significant difference in the incidence of gastrointestinal complications and ureteral anastomosis-related complications (stricture or urinary leakage)( P>0.05). There was no significant difference in the number of dissected lymph node, positive lymph node, positive rate of incisional margin and postoperative pathological stage among three different BMI groups(all P>0.05). Conclusion:Robot-assisted radical cystectomy combined with intracorporeal urinary diversion is a safe and effective method for the treatment of overweight, obese and even morbidly obese patients with bladder cancer. The recovery of intestinal function and the oncological results are not affected by body mass index. However, laparoscopic radical cystectomy for overweight and obese patients, especially for orthotopic neobladder, has the risk of long operation time, large amount of intraoperative bleeding and increased risk of minor postoperative complications.
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Objective:To explore and compare the perioperative result and complications of robot-assisted radical cystectomy with intracorporeal and extracorporeal urinary diversion.Methods:Clinical data of bladder cancer patients undergoing robot-assisted radical cystectomy with ileal conduit in Zhejiang Provincial People's Hospital from January 2015 to March 2020 were retrospectively analyzed. Eighty-two patients underwent extracorporeal urinary diversion (ECUD group), and 122 underwent intracorporeal urinary diversion (ICUD group). In the ECUD group, the median age was 70(61, 76)years old, including 67 male (81.7%), the median BMI was 26.1(24.3, 28.5), 67 cases(81.7%) was ASA score 0-2, 15 cases (18.3%)was 3 or higher, 15 cases (18.3%) were high risk non-muscular invasive bladder cancer. 67 cases (81.7%) were muscular invasive bladder cancer. 16 cases (19.5%) received neoadjuvant chemotherapy. Past medical history included smoking in 35 cases (43.2%), hypertension in 31 cases (37.5%), diabetes in 17 cases (21.3%), heart disease in 13 cases (15.7%), and abdominal surgery in 15 cases (17.8%). In the ICUD group, the median age was 68 (62, 75), 95 male (77.9%), the median BMI was 25.6 (23.4, 27.8)kg/m 2, 105 cases(86.1%) was ASA score 0-2, 17 cases (13.9%)was 3 or higher, 29 cases (24.9%) were high risk non-muscular invasive bladder cancer, and 93 cases (75.1%) were muscular invasive bladder cancer. There were 22 cases (18.0%) undergoing neoadjuvant chemotherapy. Past medical history included smoking in 58 cases (47.3%), hypertension in 44 cases (32.6%), diabetes in 33 cases (22.8%), heart disease in 28 cases (26.7%), and abdominal surgery in 17 cases (14.2%). No significance was detected in characteristics between the two groups. For ileal bladder making and ureteral implantation method in ICUD group, 15 cm ileum was taken using stapler at the 15 cm from ileocecum to make ileal conduit and restore the continuity of the ileum. The proximal end of the ileal conduit was closed. The bilateral ureteral were implanted 3 cm apart on the ileal bladder. F6 single J tube was placed into both of the ureters to drain urine. For ECUD group, the subumbilical 5 cm incision was taken to enter the abdominal cavity. The ileocecum was found and the terminal ileum was taken out of the body. A segment of 15 cm in length ileocecum 15 cm away from the cecum was cut off with a linear cutting stapler and the blood vessels of arterial arch were ligated, then a small opening at the same ileum position was cut. The continuity of the ileocecum was restored. The ileal conduit was irrigated, and the bilateral ureters were placed into a single J tube and anastomosed to the ileal conduit 3 cm apart. The operation time, intraoperative blood loss, postoperative exhaust time, postoperative feeding time, postoperative hospital stay, postoperative incision pain score, postoperative readmission rate, peri-operative mortality, postoperative complications and pathology results were compared between the two groups. Results:All cases were successfully performed robotically without conversion or major intraoperative complications. There was no significant difference in operation time between ICUD group and ECUD group [260(230, 310) min and 235(220, 290) min, P=0.078]. The estimated blood loss in ECUD group was more than that in ICUD group [300(200, 400) ml and 150(100, 300), P=0.037], but there was no difference in blood transfusion rate between the two groups [7(8.6%) and 9(7.4%), P=0.196]. The exhaust time [4(2-6) days and 2(1, 3) days] and postoperative solid food feeding time [7(4, 9) days and 4(3, 5) days] in the ECUD group were longer than those in the ICUD group (all P<0 05). The exhaust time[4(2-6)day and 2(1, 3)day] and solid food feeding time[7(4, 9)day and 4(3, 5)day] in ECUD group were longer than those in ICUD group. There was no significant difference in postoperative hospital stay between ECUD group and ICUD group[8(5, 11)day and 6(5, 9)day, P=0.212]. Clavien-Dindo Ⅰ-Ⅱ grade was defined mild complication, Ⅲ grade or above was defined serious complication, early complication was defined within 30 days after operation, and late complication was defined 30-90 days after operation. The overall early postoperative complication rate were 19.6%(24) and 34.2%(28)(ICUD vs.ECUD), the mild complications rate were 13.9%(17) and 25.6%(21)(ICUD vs.ECUD), and the late severe complication rate were 4.1%(5)and 10.1%(8)(ICUD vs.ECUD). ICUD group were significantly lower than those of ECUD group (all P<0.05). There was no difference in the early severe complication rate [5.7%(7) and 8.5%(7)], the total late complication rate [15.6%(19) and 16.1%(13)], and the late mild complication rate [11.5% (14) and 6.0% (5)] (all P>0.05). There was no significant difference between ICUD group and ECUD group, in term of the number of lymph nodes dissected [21(14, 25) and 19(15, 24)], the positive rate of lymph nodes [10.7%(13) and 10.0%(8)], the positive rate of surgical margin [3.3%(4) and 4.8%(4)] and postoperative pathological stage T 1-T is [25(20.3%) and 14(17.1%)], and T 2-T 3 [97(79.7%) and 68(82.9%)]. The number of patients with postoperative incision pain (pain score >5) was 43 (35.6%) in ICUD and 46 (56.5%) in ECUD( P< 0.05). The 30-day and 90-day readmission rates were 1.6% (2/82) and 4.9% (6/82) in ICUD group, and 1.2% (1/122) and 9.8% (8/122) in ECUD group, respectively. There was no peri-operative mortality in both groups. Conclusions:Robot-assisted radical cystectomy with ileal conduit is a safe and repeatable method for the treatment of muscular invasive or high-risk non-muscular invasive bladder cancer. Complete intracorporeal bladder reconstruction is feasible and has the advantages of less intraoperative bleeding, faster postoperative intestinal function recovery and less complications.
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Objective:To explore the value of liver stiffness and spleen stiffness measured by two-dimensional shear wave elastography (2D-SWE) in predicting high-risk varices (HRV) with compensated cirrhosis patients.Methods:Seventy patients with compensated cirrhosis who attended the First Hospital of Lanzhou University from November 2019 to April 2022 were recruited. All patients underwent examinations of liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) by 2D-SWE. Binary logistic regression was used to analyze the risk factors affecting the occurrence of HRV. The diagnostic performances of LSM, liver stiffness (by 2D-SWE)-spleen length-to-platelet (LSPS) score, and SSM in predicting HRV were compared.Results:SSM was not technically feasible in 6/70 (8.6%) patients due to small volume of spleen.Among 64 patients with compensated cirrhosis, 30/64 (46.9%) were HRV. Binary multivariate Logistic regression analysis showed that SSM and platelet counts were independent influencing factors for predicting HRV, with OR values of 1.126 ( P=0.006) and 0.971 ( P=0.039), respectively. The area under the receiver operating characteristic curve (AUC) of LSM, LSPS score, and SSM were 0.660, 0.828 and 0.858, respectively. The AUCs of SSM and LSPS score were significantly higher than that of LSM ( P<0.05), but there was no statistical difference between SSM and LSPS score ( P=0.608). Conclusions:LSM and SSM measured by 2D-SWE have high success rate. SSM and LSPS score have high value in predicting HRV in patients with compensated cirrhosis, and the diagnostic performances of the above two methods are significantly higher than that of LSM.
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Objective:To investigate the diagnostic value of independent and combined subtests of the psychometric hepatic encephalopathy score (PHES) in mild hepatic encephalopathy(MHE) of patients with liver cirrhosis, so as to optimize the PHES.Methods:This was a prospective, multicenter and real-world study which was sponsored by the National Clinical Research Center of Infectious Diseases and the Portal Hypertension Consortium. Twenty-six hospitals from 13 provinces, autonomous regions and municipalities countrywide participated in this study, induding Tianjin Third Central Hospital, the Fourth People′s Hospital of Qinghai Province, the Second Affiliated Hospital of Baotou Medical College, the Third People′s Hospital of Taiyuan, the Fifth Medical Center of PLA General Hospital and so on. From October 2021 to February 2022, outpatients and hospitalized patients with liver cirrhosis and no obvious hepatic encephalopathy were consecutively enrolled. All patients received 5 PHES subjects in the same order: number connection test(NCT)-A, NCT-B, digit symbol test(DST), line tracing test(LTT) and serial dotting test(SDT), and the scores were calculated. The total score of PHES <-4 was taken as the cut-off value for diagnosing MHE. Compare the differences in each subtest between MHE group and non-MHE group. Receiver operating characteristic curve(ROC) and area under the curve(AUC) was performed to assess the diagnostic value of independent and combined subtests in MHE. Mann-Whitney U test and DeLong test were used for statistical analysis. Results:A total of 581 patients with liver cirrhosis were enrolled, 457 were diagnosed as MHE, and the incidence of MHE was 78.7%. The results of NCT-A, NCT-B, SDT, LTT, DST of MHE group were 60.00 s(47.01 s, 88.00 s), 90.45 s(69.32 s, 125.35 s), 74.00 s(57.65 s, 96.60 s), 74.72(60.00, 98.61) and 27.00(20.00, 36.00), respectively. Compared those of non-MHE group(34.00 s(29.15 s, 44.48 s), 50.00 s(40.98 s, 60.77 s), 50.00 s(41.07 s, 63.03 s), 46.23(38.55, 59.42) and 42.00(34.00, 50.75)), the differences were statistically significant( Z=12.37, 12.98, 9.83, 11.56, 10.66; all P<0.001). The AUC(95% confidence interval(95% CI)) of subtests of PHES NCT-B, NCT-A, LTT, DST and SDT alone in MHE diagnosis were 0.880(0.849 to 0.910), 0.862(0.828 to 0.896), 0.838(0.799 to 0.877), 0.812(0.772 to 0.851) and 0.788(0.743 to 0.832), respectively. The combination of 2 PHES subtests significantly increased the diagnostic efficacy. Among them the diagnostic efficacy of the combination of NCT-B and LTT was the best, the AUC(95% CI) was 0.924(0.902 to 0.947), the specificity was 91.9% and the sensitivity was 79.2%, which was better than a single PHES subtest (NCT-A, NCT-B, SDT, LTT and DST) and the combination of NCT-A and DST(AUC was 0.879, 95% CI0.847 to 0.910) which was recommended by guidelines on the management of hepatic encephalopathy in cirrhosis, the differences were statistically significant ( Z=3.78, 3.83, 5.57, 5.51, 5.38, 2.93; all P<0.01). Furthermore, compared between the combination of NCT-B and LTT and the combination of 3 subests of PHES, only the diagnostic efficacy of combination of NCT-B, LTT and SDT (AUC was 0.936, 95% CI 0.916 to 0.956) was better than that of the combination of NCT-B and LTT, the difference was statistically significant( Z=2.32, P=0.020). Conclusion:Based on the diagnostic efficacy and clinical feasibility of PHES subtests and their combinations, the combination of NCT-B and LTT is recommended for the diagnosis of MHE.
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To investigate the clinical features and prognostic significance in myelodysplastic syndrome (MDS) patients with DTA (DNMT3A,TET2,ASXL1) mutations. Clinical characteristics of 140 patients diagnosed as de novo MDS at People′s Hospital of Xinjiang Uygur Autonomous Region from September 2015 to December 2019 were retrospectively analyzed. Next-generation sequencing was used to detect 34 related genes in MDS patients. DTA mutations and the correlation with progression-free survival (PFS) and overall survival (OS) in MDS patients were evaluated. Among 140 MDS patients, DTA mutations was detected in 62 (44.3%) patients. And the positive rate of DTA mutations in IPSS-R lower-risk group was 65.4%, significantly higher than that of higher-risk group (31.8%)( P=0.000). Compared with the non-mutated group, patients with DTA mutations had a lower rate of conversion to leukemia (9.7% vs . 29.5%, P=0.004).Survival analysis showed that PFS in patients with DTA mutations was comparable as that in MDS patients without DTA mutations ( P=0.787), but the median OS was significantly shorter (16 months vs . 20 months, P=0.022).According to IPSS-R classification, the median OS in patients with and without DTA mutation was only statistically significant in the higher-risk group (15 months vs. 18 months, P=0.034).Among 62 patients with DTA mutations, 60 (96.8%) had additional gene mutations. DTA mutations were not independent prognostic factors when mutation frequency is greater than 10% were considered in Cox regression model ( P>0.05). DTA mutations often developed in the early stage of MDS, therefore they were more common in IPSS-R lower-risk subgroup which was correlated to the low rate of conversion to leukemia. In conclusion, DTA mutations are not associated with disease progression, but predict unfavorable survival when other add-on genes are mutated.
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Objective:To investigate the feasibility and safety of the transvesical approach of robot-assisted radical prostatectomy.Methods:From June 2017 to May 2020, 41 patients underwent transvesical approach of robot-assisted radical prostatectomy. The patients’ mean age was 62.5(51-69)years. The mean prostate volume was 36.3(22.0-57.8)ml. The mean preoperative PSA value was 7.3(3.7-12.3)ng/ml. All preoperative Gleason score was less than or equal to 7 points and preoperative TNM stage ranged from T 2a to T 2b . All patients were diagnosed by prostate biopsy before surgery or pathological diagnosis after prostate enucleation. Robot-assisted radical prostatectomy through the longitudinal incision of the bladder neck was used. It was easy to identify and preserve the bladder neck during the operation. The bladder was opened with a small longitudinal incision, and the prostate was removed intrafascial. The pubic prostatic ligament and pudendal artery were fully preserved to achieve complete reduction of the anatomical structure. Results:All the operations were completed by robot-assisted radical prostatectomy with no transition to open surgery. The mean surgery time was 111.3(105-131)min. The mean estimated blood loss was 95.5 (50-220) ml. The mean postoperative hospital stay was 5.2(3-8)d. The time of postoperative catheter removal was 6.3(5-7)d. After 6 to 24 months of follow-up, 35 patients (85.4%, 35/41) received immediate recovery of continence, 4 patients had no urine leakage after 1 week, and 2 patients had no urine leakage after 1 month. All patients had regained continence 6-month postoperatively. No tumor biochemical recurrence (tPSA<0.2 ng/ml).Conclusions:The transvesical approach of robot-assisted radical prostatectomy was a safe and effective surgical technique, which was beneficial in early continence recovery, and also suitable for prostate cancer patients after prostate enucleation.
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Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing portal hypertension in patients with liver cirrhosis. In recent years, the clinical application status of HVPG in cirrhotic portal hypertension has been increasing. HVPG plays an extremely important role in predicting the long‐term prognosis of patients with liver cirrhosis, but its prognostic value in surgical risks for patients with liver cirrhosis has long been ignored. The authors analyze the current clinically commonly used evaluation system for the prognosis of patients with liver cirrhosis and existing problems, and summarize the application status and prospects of HVPG in surgery for patients with liver cirrhosis.
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Objective:To investigate the current status of prevention and treatment of esophagogastric variceal bleeding (EVB) in cirrhotic portal hypertension patients in Ningxia region.Methods:The retrospective and descriptive study was conducted. The clinical data of 820 cirrhotic portal hypertension patients who were admitted to 21 medical centers in Niangxia region from January 2018 to December 2020 were collected, including 85 cases in Ningxia Hui Autonomous Region People′s Hospital, 73 cases in the Fifth People′s Hospital of Ningxia Hui Autonomous Region, 59 cases in the Wuzhong People′s Hospital, 52 cases in the Qingtongxia People′s Hospital, 50 cases in the Guyuan People′s Hospital, 47 cases in the Yuanzhou District People′s Hospital of Guyuan City, 47 cases in the Yinchuan Second People′s Hospital, 40 cases in the General Hospital of Ningxia Medical University, 40 cases in the Tongxin People′s Hospital, 35 cases in the Yinchuan First People′s Hospital, 34 cases in the Third People′s Hospital of Ningxia Hui Autonomous Region, 32 cases in the Zhongwei People′s Hospital, 30 cases in the Lingwu People′s Hospital, 30 cases in the Wuzhong New District Hospital, 30 cases in the Yanchi People′s Hospital, 29 cases in the Ningxia Hui Autonomous Region Academy of Traditional Chinese Medicine, 28 cases in the Shizuishan Second People′s Hospital, 25 cases in the Shizuishan First People′s Hospital, 21 cases in the Haiyuan People′s Hospital, 20 cases in the Pengyang People′s Hospital, 13 cases in the Longde People′s Hospital. There were 538 males and 282 females, aged (56±13)years. Observation indicators: (1) clinical charac-teristics of cirrhotic portal hypertension patients; (2) overall prevention and treatment of EVB in cirrhotic portal hypertension patients; (3) prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Clinical characteristics of cirrhotic portal hypertension patients: of 820 cirrhotic portal hypertension patients, 271 cases were in compensated stage and 549 cases were in decompensated stage. Of the 271 cases in compensated stage, there were 183 maels and 88 females, aged (53±12)years. There were 185 Han people, 85 Hui people and 1 case of other ethic group. The etiological data of liver cirrhosis showed 211 cases of viral hepatitis B, 4 cases of alcoholic liver disease, 8 cases of viral hepatitis C, and 48 cases of other etiology. There were 235 cases of Child-Pugh grade A and 36 cases lack of data. Of the 549 cases in decompensated stage, there were 355 males and 194 females, aged (57±14) years. There were 373 Han people, 174 Hui people and 2 cases of other ethic group. The etiological data of liver cirrhosis showed 392 cases of viral hepatitis B, 33 cases of alcoholic liver disease, 10 cases of viral hepatitis C, and 114 cases of other etiology. There were 80 cases of Child-Pugh grade A, 289 cases of grade B, 170 cases of grade C and 10 cases lack of data. (2) Overall prevention and treatment of EVB in cirrhotic portal hypertension patients: of 271 patients in compensated stage, 38 cases received non-selective β-blocker (NSBB) therapy, 16 cases received endoscopic treatment, 6 cases received interventional therapy. Of 549 patients in decompensated stage, 68 cases received NSBB therapy, 46 cases received endoscopic treatment, 28 cases received interventional therapy. (3) Prevention and treatment of EVB in cirrhotic portal hypertension patients from different grade hospitals: of 271 patients in compensated stage, 181 cases came from tertiary hospitals, of which 28 cases received NSBB therapy, 15 cases received endoscopic treatment, 6 cases received interventional therapy. Ninety cases came from secondary hospitals, of which 10 cases received NSBB therapy, 1 cases received endoscopic treatment. There was no significant difference in NSBB for prevention of EVB between tertiary and secondary hospitals ( χ2=0.947, P>0.05), while there was a significant difference in endoscopic treatment for prevention of EVB between tertiary and secondary hospitals ( χ2=5.572, P<0.05). Of 549 patients in decompensated stage, 309 cases came from tertiary hospitals, of which 22 cases received NSBB therapy, 29 cases received endoscopic treatment, 22 cases received interventional therapy. Two hundreds and fourty cases came from secondary hospitals, of which 46 cases received NSBB therapy, 17 cases received endoscopic treatment, 6 cases received interven-tional therapy. There were significant differences in NSBB and interventional therapy for prevention of EVB between tertiary and secondary hospitals ( χ2=18.065, 5.956, P<0.05). Conclusions:The proportion of receiving EUB prevention in cirrhotic portal hypertension in Ningxia is relatively low. For patients with compensated liver cirrhosis, the proportion of NSBB therapy and endoscopic treatment in the secondary hospitals was lower than that in tertiary hospitals. For patients with decompensated liver cirrhosis, the proportion of interventional treatment in secondary hospitals is lower than that of tertiary hospitals, but the proportion of NSBB in secondary hospitals taking is higher than that of tertiary hospitals.
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Portopulmonary hypertension is a rare and serious complication of portal hypertension, which is very easy to miss diagnosis in clinic, and relatively difficult to treat. The authors elaborate in depth of the epidemiology, pathogenesis, diagnosis, treatment and prognosis of portopulmonary hypertension.
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Objective:To explore the feasibility, safety and clinical efficacy of ileum augmentation cystoplasty assisted by Da Vinci robot for the treatment of neurogenic bladder.Methods:Retrospective analysis was performed on the data of 12 patients with neurogenic bladder admitted to Zhejiang Provincial People’s Hospital from March 2017 to November 2018, including 11 males and 1 female, with the mean age of 38(12-67). Preoperative symptoms were urinary incontinence, dysuria, decreased bladder capacity, or increased bladder pressure leading to ureteral reflux. All the 12 patients underwent preoperative intermittent catheterization, including 8 patients with spinal cord injury and 4 patients with spinal cord dysplasia. Preoperative serum creatinine(129.58±44.60)μmol/L and total glomerular filtration rate(61.63±18.04)ml/(min·m 2) were observed in 12 patients. Preoperative urodynamic examination showed the safe bladder volume of (95.67±39.10)ml, bladder internal pressure of(63.30±6.02)cmH 2O(1 cmH 2O=0.098 kPa)at the end of filling period, bladder compliance of(10.24±1.14)ml/cmH 2O, residual urine volume of(152.58±80.89)ml, and urine flow rate of(3.88±3.63)ml/s. Bladder contracture was evident on preoperative cystography. Ultrasound examination showed different degree of hydronephrosis and ureter expansion, in all cases, with ureteral reflux grading Ⅰin 2 cases, grade Ⅱ in 4 cases, grade Ⅲ in 4 cases, grade Ⅳ in 2 cases. All the 12 patients underwent robot-assisted ileum augmentation cystoplasty with 5-point puncture. Transverse incision of the bladder wall before full thickness, according to the amount of bladder and quality to decide 30 cm(normal), longitudinal cut back loops and one point after suture fixation in the bladder wall midpoint, fixed point as starting point, in turn, will be blind to the bladder stitching on both sides, the bilateral ureteral placing a single J tube respectively, evaluation of surgical success rate (including intraoperative bleeding, interception of bowel loops are no damage adjacent viscera, ureter openings with and without damage, impermeability, match insufflate whether unobstructed), postoperative complications, anastomotic fistula, intestinal obstruction, abdominal bleeding), urine dynamics test parameters, and patients’ quality of life. Patients were regularly given anticholinergic drugs(2 mg/d) for 6 months after surgery. Results:All the 12 cases in this group were successfully completed without any transfer to open surgery. The operation time was(120.8±12.0)min. Intraoperative blood loss(84.0±23.2)ml. Postoperative intestinal function recovery time(3.3±1.3) d. Postoperative hospital stay(12.1±3.1)d. Postoperative pelvic drainage tube indwelling time (3.8±1.2) d. Catheter and single J tube were removed 2 weeks after operation. Postoperative follow-up averaged 19.4(3-24) months. At 3, 12, 24 months after surgery, the bladder safety volume was rechecked(435.83±33.56), (450.90±31.09), (462.00±33.72)ml, the bladder internal pressure at the end of filling was(18.60±0.92), (15.70±1.42), (12.96±1.34)cmH 2O, the blood creatinine level was(81.43±21.10), (74.34±15.70), (72.90±15.90)μmol/L, and the bladder compliance was(37.94±4.22), (40.40±3.98), (43.42±4.20)ml/cmH 2O and the total glomerular filtration rate(91.52±9.49), (102.18±5.65), (112.41±6.50)ml/(min·m 2) were significantly improved compared with those before surgery( P<0.001). After 24 months of bladder urination training, 1 patient could basically urinate by herself. Three patients were treated with intermittent urinary catheterization supplemented by automatic urination. The remaining 8 patients were completely dependent on urinary catheter for intermittent catheterization. Postoperative complications such as anastomotic fistula, ileus and abdominal bleeding were not found in 12 patients. Conclusions:Ileum bladder enlargement assisted by robot can effectively expand bladder volume, reduce bladder internal pressure, improve bladder compliance, prevent ureteral reflux and protect renal function.
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Single-docking robot-assisted laparoscopic radical nephroureterectomy is difficult to deal with the distal ureter and bladder. Thirty-two patients with ureter carcinoma underwent single-docking robot-assisted nephroureterectomy in rectus rectilinear cannula placement in our hospital. The advantages include lower surgical difficulty, shorter operation time, less surgical bleeding and damage. This surgical method is a safe and effective minimally invasive treatment for ureter carcinoma.
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Molecular target anticancer drugs are commonly used in various forms of cancers. It is a concern that the risk of serious adverse events (SAEs) and fatal adverse events (FAEs) of molecular target drugs are increasing. An up-to-date meta-analysis of all Phase II/III/IV randomized trials of molecular target anticancer drugs was conducted to calculate the increased risk of SAEs and FAEs. A systematic search of PubMed, Web of Science, and Cochrane Library up to April 6, 2017, was conducted. The study enrolled Phase II/III/IV randomized trials of cancer that compared molecular target drugs alone versus placebo or performed single-arm analysis of molecular target drugs. Data on SAEs and FAEs were extracted from the included studies and pooled to compute risk ratio (RR), the overall incidence, and 95% confidence interval (CI). In this meta-analysis, a total of 19,965 and 26,642 patients in randomized 53 and 65 Phase II/II/IV trials were included in the analysis of SAEs and FAEs associated with molecular target anticancer drug, respectively. There were significant differences in the relationship of molecular target anticancer drugs with SAEs (RR = 1.57, 95% CI = 1.35–1.82, P < 0.01, I2 = 81%) and FAEs (RR = 1.51, 95% CI = 1.19–1.91, P < 0.01, I2 = 0%) compared to placebo. The overall incidence of SAEs and FAEs was 0.269 (95% CI = 0.262–0.276, P < 0.01) and 0.023 (95% CI = 0.020–0.025, P < 0.01), respectively. Molecular target anticancer drugs significantly increased the risk of SAEs and FAEs. For patients taking molecular target drugs, efforts are needed to prevent the occurrence of SAEs and FAEs
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Objective@#To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage.@*Methods@#Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate.@*Results@#32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34- ~ 21.15) mmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31- ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) mmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) mmol/L, respectively.@*Conclusion@#The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.
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Objective:To investigate the perioperative and oncological outcomes in patients undergoing laparoscopic radical cystectomy with intracorporealorthotopic neobladder reconstruction.Methods:Clinical data of bladder cancer patients undergoing laparoscopic radical cystectomy(LRC) or robot-assisted radical cystectomy(RARC) with intracorporealorthotopic neobladder reconstruction in Zhejiang Provincial People's Hospital from March 2010 to December 2019 were retrospectively analyzed. There were 166 males and 52 females. The median age was 62 (52, 70) years old. The ASA score was 1-2 in 183 cases (83.9%) and 3 in 35 cases (16.1%). There were 61 cases of hypertension, 28 cases of diabetes, 26 cases of heart disease, 33 cases of history of abdominal surgery, and 3 cases received neoadjuvant chemotherapy. LRC was performed in 82 cases and RARC in 136 cases. The operation was performed by dissecting pelvic lymph nodes from right to left and then cystoprostatectomy. The periureteral blood supply and periperitoneal peritoneum were preserved, and the prostate was resected by intrafascial resection. The 30 cm terminal ileum was used to make a U-shaped new bladder, and then the urethral stump and both sides of the ureter were anastomosed on new bladder without tension. During the operation, two single J tubes were used as ureteral stent.The perioperative and pathological results results were evaluated.Results:The operations of 218 patients were completed successfully and there was no conversion to open operation. The median operation time was 281 (229, 400) ml. Intraoperative blood transfusion was performed in 24 cases (11.0%). Hospital stay was 15 (13, 22) days.Intraoperative complications happened in 11 cases (5.0%). Exhaust time was 2 (1, 3) days. Solid food intake time was 4 (3, 5) days. Total complications within 30 days after operation were 61 cases (28.0%), and total complications within 30-90 days after operation were 81 cases (37.2%). The number of median lymph node dissection in all patients was 19 (14, 24). Positive lymph nodes in 21 cases (9.6%). Positive margin in 6 cases (2.7%). Postoperative tumor pathological stages were T a/T 1/T is stage 48 cases, T 2 stage 134 cases, T 3 stage 36 cases. The median follow-up time of all patients was 33 (20.6, 48.2) months. There were 77 cases of tumor recurrence and 55 cases of death, of which 39 cases were tumor-specific death. The 5-year disease free survival, overall survival , and cancer-specific survival of all patients were 55.4%, 62.4% and 66.4%, respectively. Conclusions:Laparoscopic radical cystectomy and intracorporealorthotopic new bladder reconstruction can be well used in the treatment of muscle invasive or high-risk non-muscle invasive bladder cancer.Laparoscopic intracorporeal bladder reconstruction is feasible with few postoperative complications.
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Objective:To discuss the effect and experience of laparoscopic vesicovaginal fistula repairs though inferior of bladder longitudinal incision.Methods:54 patients were included in this study. Clinical data of patients collected from our hospital since January 2010 to October 2019 who underwent laparoscopic vesicovaginal fistula repair. The median age is 49.5 (8-80) years old. Main complaints were urine flows out through the vagina. 14 cases (25.9%) and 23 cases (42.6%)were post-hysterectomy of benign lesions and gynecological malignant tumors. The symptoms presented at 11 (1-20) days post urinary catheter removal. There were 11 cases (20.4%) of cervical malignant tumors, symptoms presented at 10 (5 to 25) months after radiotherapy. The symptoms of rest of cases 6 (11.1%)presented at 21 (3 to 50) days. One of them had rectal fistula, another had ureteral injury, 6 had bladder contracture, 2 patients had bilateral hydronephrosis. Preoperative CT examination revealed that 4 cases had no obviously hydroureter at upper urinary tract, and 2 cases had mild hydronephrosis in bilateral kidneys. The diameter of the fistula was 0.5-4.0 cm. There were 50 cases of single fistula and 4 cases of multiple fistula. The urine pad test evaluated the degree of urine leakage in patients reveals that 7 and 42 cases with mild and moderate, rest of 5 cases presented with severe result. 37 cases performed with vesico-vaginal fistula repair for the first time; 13 and 2 cases had once and twice vesico-vaginal fistula repair history and there were other two patients had vesico-vaginal fistula repair history for three and four times. All patients underwent general anesthesia under the laparoscopic bladder bottom longitudinal incision bladder vaginal fistula repair, 8 cases performed with Da Vinci robotic assist surgery system. Main steps of the operation include: ①search for bladder and vaginal fistula, assessed the size, number, and location of the fistula; ②To set single J stents in the bilateral ureter; ③Fully separated the bladder and vaginal wall, remove scar tissue, and suture the bladder incision with low or no tension way; ④To use great omentum; for patients with low, complex, and mixed bladder vaginal fistulas, recommend to use bladder wall flaps (6 cases), bladder enlargement (3 cases), and ureteral replantation (6 cases). The clinical data of the patients were collected, and a univariate analysis was performed on the cure rate.Results:The mean of blood boss and duration in operation were (33.3±26.5) ml and 85 (60-240) minutes. Mean of hospitalization was (11.3±8.2)days. The postoperative urinary indwelling time were (20.8±8.3)days. 50 cases were completed recovered and 4 cases failed, the curative ratio was 92.6% (50/54). It revealed that the curative ratio of vesicovaginal fistula repair had correlation with history of surgical interventions before operation. The curative effect was reduced ( P=0.00) when the patient had previous laparoscopic vesicovaginal fistula repairs. Patients with multiple fistulas (≥2) had a lower cure rate than single fistulas ( P=0.00). In addition, patients with fistulas above the triangle of the bladder had a higher cure rate than fistulas outside the triangle of the bladder and the urethra ( P=0.00). There was no statistically significant difference in the cure ratio of Age ( P=0.79), operation time ( P=0.06), intraoperative bleeding ( P=0.78), post-operative hospitalization ( P=0.73), indwelling catheterization time ( P=0.30), and size of fistula ( P=0.31). Conclusions:The operation could be effective with fewer complications procedure, which could fix mixed fistula and bladder contracture at the same time.
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Objective:To Investigate the postoperative sexual function outcomes in patients with bladder cancer who underwent robot-assisted radical cystectomy (RARC)or laparoscopic radical cystectomy(LRC)followed by orthotopic neobladder reconstruction.Methods:We performed a retrospective review of 84 bladder cancer patients having undergone laparoscopic radical cystectomy(LRC)and robotic-assisted radical cystectomy(RARC)with≥21 IIEF-5 in our institution from Jan 2014 to Jan 2019. All of them were diagnosed as high grade urothelial carcinoma by biopsy or TURBT. Biopsy of the posterior urethra and bladder neck reveal negative result of tumor invasion. Their PSA level was less than 4.0 ng/ml with negative result of DRE. All patients undergone laparoscopic radical cystectomy and orthotopic neobladder reconstruction by one medical team. 45 patients underwent robotic assistant radical cystectomy(RARC group), and the rest of patients 39 were treated with laparoscopic radical cystectomy(LRC group). In RARC group, the mean age were 53 years old(ranging 50-67 years old)and clinical stage of the tumor was cT 1 in 10 patients, cT 2 in 21 patients and cT 3 in 14 patients. In the LRC group, the mean age were 56 years old(ranging52-65 years old) and the clinical staging of the tumors was 6 patients in cT 1, 23 patients in the cT 2 and 12 patients in the cT 3. The RARC group paid special attention to the protective function of the following surgical details: ①To detect the abdominal organs, reveal the pelvic cavity, observe the blood vessels and ureter, open the perinatal membrane next to the cross of the ureter, along the outer venous veins and closed-hole nerves around the standard or expand the pelvic lymph node cleaning. In this study, the patients who did not have obvious suspected lymph node metastasis were removed within the standard range of the pelvic lymph nodes on both sidesin order to protect the nerves at the pelvic floor as much as possible. ② With the robot 3rd arm lifting the bladder, the peritoneum was opened at the site of seminal vesicle and ampulla of vas deferent duct, which connected to the two sides with the open peritoneum. Along the vasectomy and the sac free, the denonvillier fasica was opened and exposing the back of the prostate. With the third arm pulling down, the umbilical ligament was observe. The peritoneal was opened to the retropubic space so that the prostate region was revealed. Continue to dissect the bladder front space until the pelvic fascia and the osteopathic prostate ligament are exposed. The Hem-o-1oks were used to ligate the bilateral bladder lateral ligaments. The bladder and prostate were removed in the fascia level. The NVB bundle on both sides was kept to the apex of prostate. The urethra was exposed and remove the catheter.With Hem-o-lok clamping, the urethra was dissected in the level of prostatic apex. The distal end of urethral tissue was sent to the rapid freeze pathology examination. In the procedure of prostate removing, parallel prostate fascia excision was considered and pubo-prostatic ligament could be preserved.③ Preserving the bilateral neurovascular bundle (NVB) and try to avoid the damage of NVB. Retaining the bladder lateral ligament neurovascular bundle. Retaining the1.2-1.5 cm urethra and surrounding continent control structure. The cold knife is advocated. Blood vessel clamp can be used to stop bleeding. We compared with operative time, bleeding amount, postoperative hospitalization, IIEF-5 scores and satisfaction of sexual between those groups. Results:All operations were successfully performed without conversion and serious surgical complications. The operative time in the RARC group and LRC group were [(313.5±31.9)min and (276.5±32.3)min, P>0.05] .The intraoperative amount of blood loss and postoperative hospitalization were [(190.1±44.1) ml and (212.3±39.2) ml, P>0.05], [(14.3±2.1) d and (15.2±3.0) d, P>0.05]. There was no significantly difference between the two groups. The median follow-up period of 84 patients was 18 months. The IIEF-5 score of the RARC group was higher than LRC group at 6 months(18.5±1.6 vs.10.6±1.3)and 12 months (18.6±2.4 vs.11.2±1.4) ( P<0.05). In addition, the satisfaction of sexual in the RARC group was relative better than LRC group (both P<0.05) at 6 months[44.4%(20/45)vs.25.6%(10/39)], and 12 months[51.1%(23/45) vs.28.2%(11/39)] post-operation. Conclusion:Robot-assisted radical cystectomy(RARC) and orthotopic neobladder reconstruction revealed relative better recovering in post-operative sexual function and improvements in patient quality of life.