ABSTRACT
Objective To explore the correlation between the incidence of foodborne diseases and meteorological factors in Jinan, and to provide targeted measures for the prevention and control of foodborne diseases. Methods Data from the reporting systems of two sentinel hospitals for active surveillance of foodborne diseases from 2013 to 2021 in Jinan were collected. The meteorological data in the same period in Jinan were also collected. The generalized additive model was used to explore the nonlinear relationship between meteorological factors and the incidence of foodborne diseases, and threshold function analysis was use to perform subsection regression. Results The incidence of foodborne diseases was positively correlated with daily average temperature (rs=0.23), relative humidity (rs=0.05), and daily average wind speed (rs=0.01), and negatively correlated with daily average air pressure (rs=-0.19). Based on the GAM results and segmented regression analysis of meteorological factors, it was found that when the daily average temperature was below or above the threshold of 24.63°C, for every 1°C increase in daily average temperature, the incidence of foodborne diseases correspondingly increased by 0.04% and 0.18%. When the daily average wind speed was above the threshold of 2.26 m/s, the incidence of foodborne diseases decreased by 0.36% for every 1 m/s increase in the daily average wind speed. Conclusion Nine years of observation and data analysis have shown that meteorological factors such as daily average temperature, relative humidity, air pressure, and wind speed are related to the incidence of foodborne diseases. These findings suggest that meteorological factors may be important factors leading to foodborne diseases, which provides an important scientific basis for formulating effective prevention and control measures.
ABSTRACT
Objective To understand the epidemiological and etiological characteristics of foodborne diseases in Jinan City, and to provide targeted measures for the prevention and control of foodborne diseases. Methods Data were collected from the reporting system of two sentinel hospitals for active surveillance of foodborne diseases in Jinan City from 2013 to 2021, and pathogens were detected in stool/anal swab samples of the cases. Constituent ratio was used for enumeration data, and χ2 test was used for comparison of detection rates. Results A total of 5,417 cases of foodborne diseases were reported in the two sentinel hospitals in Jinan from 2013 to 2021, and most of them were children aged 0-5 years (48.57%). The high incidence period of foodborne diseases was from May to August (53.72%). The main clinical symptoms were digestive system symptoms. Meat and meat products accounted for the largest number of suspected exposed foods (13.89%), and home-made food was the main exposure source (45.83%). The total detection rate of pathogens was 38.40%, mainly Escherichia coli (24.22%), and the detection rate of norovirus was 17.76%. There was a significant difference in the detection rate of pathogenic bacteria before and after the establishment of Healthy City (χ2=107.22, P <0.001). Conclusion The high-risk population for foodborne diseases is children aged 0 to 5 years old. Summer and fall are the high incidence seasons, with E. coli and norovirus as predominant pathogens. It is necessary to continue to strengthen the monitoring of foodborne diseases in high-risk seasons and infants, improve the food safety awareness of high-risk groups, increase monitoring sentinel hospitals, and expand the coverage. In addition, relevant departments should take corresponding prevention and control measures to reduce the occurrence of foodborne diseases.
ABSTRACT
【Objective】 To compare the feasibility, safety, and efficacy of robot-assisted and open radical nephrectomy for complex kidney neoplasm >8 cm in diameter. 【Methods】 Clinical data of 24 patients with large kidney neoplasm undergoing robot-assisted radical nephrectomy (9 cases, 37.5%) and open radical nephrectomy (15 cases, 62.5%) during Nov.2015 and Aug.2019 were retrospectively analyzed. The surgical parameters, perioperative complications and follow-up outcomes were compared between the two groups. 【Results】 All operations were successful. Compared with the robot group, the open group had a higher incidence of clinical symptoms (93.3% vs.44.4%, P=0.015) and larger maximum tumor diameter (124 mm vs.95 mm, P=0.021). There were no significant differences in other preoperative characteristics between the two groups. The robot group had less intraoperative blood loss (100 mL vs.800 mL, P=0.006) and lower blood transfusion rate (0% vs. 60.0%, P=0.007) than the open group. During the median follow-up of 50 (range: 25-67) months, 4 patients in the open group and 1 in the robot group developed new metastases, and 4 patients in the open group died due to advanced tumor stage. 【Conclusion】 Robot-assisted radical nephrectomy is safe in the treatment of complex and large renal tumors, and causes less intraoperative blood loss than open surgery.
ABSTRACT
【Objective】 To compare the clinical efficacy of robot-assisted and open surgery in the treatment of renal carcinoma with inferior vena cava cancer thrombus, and to analyze the safety and feasibility of robot-assisted radical nephrectomy. 【Methods】 Clinical data of 55 patients surgically treated for renal carcinoma with Mayo Ⅰ-Ⅲ inferior vena cava tumor thrombus during Dec.2015 and Dec.2021 were retrospectively analyzed. Based on the operation methods, the patients were divided into the robotic surgery group (n=36) and open surgery group (n=19). The perioperative data, oncological results and survival of the two groups were compared. 【Results】 All operations were successful. The median operation time was 176 (IQR:137-234) min, and grade Ⅲ and above complications occurred in 9(16.4%) cases. The robotic surgery group had lower intraoperative blood loss [300 (IQR:200-625) mL vs.1 000 (IQR:600-1 184) mL] and blood transfusion ratio [(20/36) vs. (18/19)] than the open surgery group, but higher postoperative hemoglobin level[109(98-120) g/L vs. 90(84-100) g/L]. During a median follow-up of 26 (IQR:19-39) months, 19(34.5%) patients developed new metastases and 12(21.8%) patients died. The postoperative tumor-specific survival (HR=0.39, 95%CI:0.13-1.16, P=0.090) and overall survival (HR=0.71, 95%CI:0.22-2.23,P=0.554) were not significantly different between the two groups. 【Conclusion】 There are no significant differences in the incidence of postoperative complications, tumor-specific survival and overall survival between robot-assisted and open surgery for Mayo Ⅰ-Ⅲ inferior vena cava tumor thrombus, but the intraoperative blood loss in robotic group is lower than that in the open surgery group.
ABSTRACT
【Objective】 To explore the influencing factors of planned robot-assisted partial nephrectomy (RAPN) converted to radical nephrectomy (RN). 【Methods】 Clinical data and operation records of 488 patients planned for RAPN in our hospital during 2015 and 2020 were retrospectively collected. The patients were divided into converted and unconverted groups, and relevant clinical data of the two groups were compared. The causes and influencing factors for conversion were analyzed. 【Results】 Among the 488 patients, 14 (2.9%) converted to RN. The causes included: ①complicated tumor anatomy and surgical difficulties; ②local advanced renal tumor suspected during operation; ③severe intraoperative hemorrhage. Univariate analysis showed that R. E. N. A. L score (P<0.001), E value (P<0.001), N value (P<0.001), L value (P<0.001), renal hilum position (P<0.001) and T stage (P=0.002) were influencing factors of conversion. 【Conclusion】 Causes for the conversion of RAPN to RN include complicated tumor anatomy, suspected local advanced renal tumor and severe intraoperative hemorrhage. The R. E. N. A. L score, E value, N value, L value, renal hilum position and T stage are influencing factors.
ABSTRACT
【Objective】 To investigate the recurrence of patients with renal cell carcinoma (RCC) after robot-assisted partial nephrectomy (RAPN), and to explore the related factors of recurrence. 【Methods】 Clinical data of 367 RCC patients who underwent RAPN during 2015 and 2020 in our hospital were retrospectively collected. Patients were divided into recurrence group and non-recurrence group. The related factors of recurrence and 5-year cumulative recurrence rate of RCC and clear cell renal cell carcinoma (ccRCC) in the recurrence group were analyzed. 【Results】 The median follow-up was 48 (IQR:38-60) months. Recurrence occurred in 9 patients, with a 5-year cumulative recurrence rate of 97.5%. For RCC patients, univariate analysis showed that tumor size, T-stage, R. E. N. A. L. score, R value, N value, and operation time were significantly associated with postoperative recurrence (P<0.05), while multivariate analysis showed that N value (HR=15.75, 95%CI:2.00-124.17, P=0.009) was an independent related factor. For ccRCC patients, univariate analysis showed that hypertension, tumor size, T-stage, R. E. N. A. L. score, N value, operation time and WHO/ISUP grade were significantly associated with postoperative recurrence (P<0.05), while multivariate analysis showed that WHO/ISUP grade (HR=4.99, 95%CI:1.04-24.01, P=0.045) was an independent related factor. 【Conclusion】 The 5-year cumulative recurrence rate of RCC patients after RAPN is 2.5%. N value and WHO/ISUP grade are the independent related factor of recurrence of RCC and ccRCC, respectively.
ABSTRACT
The mainstay of treatment for renal cell carcinoma with inferior vena cava (IVC) thrombus is complete surgical excision, which can be facilitated by appropriate preoperative evaluation and detailed planning. The level of tumor thrombus, the presence or absence of thrombus and the invasion of vein wall are important variables affecting surgery. For cases complicated with adherent or invasive tumor thrombus, en bloc resection of the IVC with or without venous reconstruction represents a special decision-making. This review will describe the evolving surgical techniques and key points of robotic-assisted radical nephrectomy with IVC thrombectomy.
ABSTRACT
Objective:To summarize and analyze the current application status of oral mucosal graft (OMG) technique in the repair of ureteral strictures in China, and clarify the feasibility, safety and effectiveness of this technique.Methods:The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China, including 49 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 32 cases in Affiliated Seventh Medical Center of PLA General Hospital, 3 cases in The Second Hospital of Anhui Medical University, 6 cases in The First Affiliated Hospital of Zhengzhou University, 56 cases in Peking University First Hospital, 3 cases in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 cases in Shanghai Sixth People' s Hospital, 4 cases in General Hospital of Estern Theater Command, 4 cases in Lanzhou University Second Hospital, 2 cases in Guizhou Province People 's Hospital, 2 cases in Peking University People' s Hospital, 5 cases in Jinzhou First People's Hospital, 5 cases in The First Affiliated Hospital of Wannan Medical College, 1 case in Shandong Provincial Hospital. In this study, 127 patients (72.6%) used lingual mucosal patches, 32(18.3%) labial mucosa, and 16(9.1%) buccal mucosa. The surgical approach for OMG ureteral reconstruction was mainly minimally invasive, with robot-assisted laparoscopy in 84 patients (48.0%), traditional laparoscopic surgery in 87 patients (49.7%), and open surgery in only 4 patients (2.3%). There were 133 males and 42 females with an average age of (35.0±17.2) years. The mean body mass index (BMI) and stenosis length were (23.1±4.1) kg/m 2 and (4.7±1.8) cm, respectively. The stricture was located in the left ureter in 116 patients, right ureter in 58 case and bilateral ureter in 1 case. The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients, congenital stricture in 55(31.4%)patients, failed ureteroplasty in 29(16.6%)patients, history of extracorporeal shock wave lithotripsy in 13(7.4%)patients, radiotherapy history in 3(1.7%)patients and other causes in 6(3.4%)patients. Strictures were mainly located in the upper ureter, accounting for 61.7% (108/175 cases), followed by 36.0% (63/175) at the ureteropelvic junction and 2.3%(4/175)in the middle ureter. According to the surgical methods, the patients were divided into robot-assisted laparoscopic surgery group ( n=84), traditional laparoscopic surgery group ( n=87)and open surgery group ( n=4). Subgroup analysis of patients in robot-assisted laparoscopic and traditional laparoscopic surgery groups was performed. There were no significant difference in preoperative data between the two groups except for age (32.0±18.3) years vs.(37.0±15.9)years, P=0.040], BMI[(22.5±4.3)kg/m 2 vs. (23.7±3.6)kg/m 2, P=0.028], and etiology of stenosis [endoscopic injury, 34(40.5%) vs. 53(60.9%), P=0.012]. Preoperative hydronephrosis and stricture length were assessed by CTU and ureterography. Ureterography 7-9 weeks after surgery showed patency of the reconstructed segment, or no recurrence of hydronephrosis was judged as success. Evaluate the operation method, operation time, success rate, length of OMG in repairing ureteral stricture between laparoscopic and robot-assisted groups. Results:The overall success rate of oral mucosal graft repair surgery reached 97.7%(171/175). The success rate of ureteral reconstruction in the two groups were 96.4%(81/84)and 98.9%(86/87), respectively ( P=0.351), and the difference was not statistically significant. There was no significant difference for operation time, intraoperative blood loss, and mean oral mucosal length between the robotic and laparoscopic groups[(244.7±85.8) min and (222.7±83.5)min ( P=0.116), (58.9±38.6) ml and (68.4±45.5) ml ( P=0.217), (5.0±2.0) cm and (4.6±1.5) cm ( P=0.350)], respectively.Postoperative complications were reported in 23 (13.1%) patients, such as fever, urinary leakage, lymphatic leakage, infection, but only 2 (1.4%) cases patients had complications of Clavien-Dindo score ≥ Ⅲ. The two patients developed urinary stricture after surgery with failed conservative treatment, and no urinary stricture occurred following endoscopic treatment.The short-term (three months after surgery)incidence of complications in the site where the oral mucosa was taken, such as difficulty in opening mouth, pain, and swelling, was 12.0% (21/175), and there was no significant difference for oral complications between patients harvesting different length of mucosal graft. Conclusions:Ureteroplasty with oral mucosal graft is a safe, feasible and reliable technique for ureteral reconstruction. At present, minimally invasive technology is the main surgical approach for ureteroplasty, and there is no significant difference in operation time and success rate between robotic surgery and laparoscopic surgery.
ABSTRACT
Objective:To investigate the characteristics of functional limitation and associated factors in patients with rheumatoid arthritis (RA).Methods:Consecutive patients with RA were recruited from August 2015 to June 2019 at Department of Rheumatology, Sun Yat-Sen Memorial Hospital. Demographic and clinical characteristics including age, gender, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) of pain, clinical disease activity index (CDAI), modified total Sharp score were collected. Physical function was assessed by the Stanford health assessment questionnaire disability index (HAQ-DI).Ordered logistic regression was used to analyze the related factors of HAQ-DI.Results:A total of 643 RA patients were finally recruited including 114 males and 529 females with mean age (49.7±12.9) years. There were 399 (62.1%) patients having different degrees of functional limitation, who were classified as mild (293, 45.6%), moderate (73, 11.4%) and severe (33, 5.1%). The prevalence of functional limitation was positively correlated with age and disease activity. The most restricted activity was walking [43.5% (280/643)], followed by gripping [36.1% (232/643)], reaching [35.5% (228/643)], daily activities [33.4% (215/643)], hygiene [33.0% (212/643)], dressing and grooming [29.7% (191/643)] and arising [29.1% (187/643)], and the last eating [18.4% (118/643)]. Multivariate ordered logistic regression analysis showed that age ( OR=1.019, 95% CI 1.004-1.035),pain VAS ( OR=1.820, 95% CI 1.616-2.050), ESR ( OR=1.009, 95% CI 1.001-1.017), CDAI ( OR=1.080, 95% CI 1.059-1.102) and modified total Sharp score ( OR=1.010, 95% CI 1.004-1.015) were associated factors of functional limitation. Conclusion:The majority RA patients have functional limitation. Age, pain and active disease are independent associated factors. Therefore, target treatment and control of pain should be emphasized in RA patients.
ABSTRACT
Objective:To explore the feasibility and safety of robot-assisted retrohepatic inferior vena cava(IVC) tumor thrombectomy for renal tumor patients with a single position.Methods:The clinical data of 6 renal tumor patients with retrohepatic IVC thrombus (5 males and 1 female, mean age of 58 years) who underwent robot-assisted retrohepatic IVC tumor thrombectomy with a single position in First Affiliated Hospital of Zhengzhou University from December 2015 to August 2020 were retrospectively reviewed. Four cases had the renal tumor on the right side and two on the left side. The mean tumor size was 9.6 cm(range 7-13 cm). There were 4 cases of Mayo level Ⅱ and 2 cases of level Ⅲ IVC thrombus with the mean IVC thrombus length of 6.5 cm(range 5-8cm). The "IVC-first, kidney-last" robotic technique was developed to minimize chances of IVC thrombus embolization for retrohepatic IVC thrombus, and a "artery-first, vein-second" robotic operative strategy were developed to minimize chances of intraoperative hemorrhage. The whole procedure (the suprahepatic infradiaphramatic IVC, first porta hepatis and left renal vein control, caval exclusion, tumor thrombectomy, IVC repair, radical nephrectomy) was performed exclusively robotically with a single position.Results:All 6 robotic procedures were successful, without open conversion or mortality. The mean operative time was 210 min(130-320 min), estimated blood loss was 800 ml(300-2 100 ml) and three patients (5%) received intraoperative blood transfusion. The mean time of occlusion of IVC was 21 min (15-43min). Incomplete blocking occurred in two cases(one IVC, one first porta hepatis), and tumor thrombectomy were completed with intraoperative loss. IVC invasion was confirmed intraoperatively in one patient and we staple-transected the IVC without reconstruction. Six patients were all transferred to the intensive care unit for median of 2.1 days (1-4 days) after surgery. The mean time of postoperative drainage was 5 days (4-9 days). Renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients, and all recovered after medical therapy. Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma and 1 case of renal sarcoma, and the 5 cases received targeted therapy. With a median follow-up of 27 months (3-54 months), 3 patients were alive, 1 alive with tumor recurrence, and 2 died of cancer.Conclusions:Robot-assisted laparoscopic retrohepatic IVC thrombectomy with a single position have the advantage of simple procedure, shorter operative time, less trauma and quicker recovery, and it is a feasible and effective method for renal tumor patients with retrohepatic IVC thrombus.
ABSTRACT
Objective:To investigate the prevalence of hypertension and its associated factors in rheumatoid arthritis (RA) patients.Methods:Consecutive Chinese patients with RA were recruited from August 2015 to September 2019 at Department of Rheumatology, Sun Yat-sen Memorial Hospital. Demo-graphic data and clinical data were collected including indicators of disease activity, functional assessment and radiographic assessment, comorbidities and previous medications. Logistic regression analysis was used to evaluate the related factors of hypertension in RA patients.Results:There were 674 RA patients recruited with 82.3%(555/674) female and mean age (50±13) years. The prevalence rate of hypertension was 32.9% (222/674), followed by dyslipidemia (9.9%, n=67), type 2 diabetes (8.8%, n=59), hyperuricemia (8.5%, n=43), fatty liver disease (8.0%, n=54), cardiovascular disease (6.2%, n=42) and chronic kidney disease (3.3%, n=22). Compared with those without hypertension, RA patients with hypertension had advanced age with longstanding disease duration, higher disease activity indicators, worse joint destruction, and higher proportions of comorbidities. Multivariate logistic regression analysis showed that comorbidities including hyperuricemia [ OR=1.977, 95% CI(1.002, 3.900)], dyslipidemia [ OR=1.903, 95% CI(1.102, 3.288)] and fatty liver disease [ OR=2.335, 95% CI(1.278, 4.265)] were risk factors of hypertension after adjustment for age and gender. Conclusion:Hyperten-sion is the most common comorbidity in RA patients which is associated with comor-bidities including hyperuricemia, dyslipidemia and fatty liver disease. Detection and management of hyperten-sion and other cardiovascular disease related comorbidities in RA patients should be emphasized.
ABSTRACT
Robot assisted laparoscopic surgery is a more advanced minimally invasive procedure with distinct advantages over conventional laparoscopic surgery. Since the introduction of Da Vinci robotic equipment in 2006, a large number of robotic surgeries have been performed in China, especially in the field of Urology, and robotic surgery has been widely used in the treatment of adrenal tumor, renal tumor, bladder cancer, prostate cancer, and other diseases. Based on rich experience of more than 3000 cases of robotic surgery in our center, we summarize the status quo of urologic robotic surgery and discuss its development prospect.
ABSTRACT
Objective:To analyze the correlation between preoperative parametres and positive surgical margin after robot-assisted laparoscopic radical prostatectomy.Method:From October 2014 to January 2019, the clinical data of 310 patients who underwent robot-assisted laparoscopic radical prostatectomy(RARP) by single surgeon were collected retrospectively. The median age, PSA, f/t PSA and PSAD was 68(62-72)years, 26(13-63) ng/ ml, 0.12 (0.07-0.18) and 0.36(0.20-0.75) ng/ml 2, respectively. There were 115 cases with clinical T 1, 100 with clinical T 2, 41 with clinical T 3, and 15 with clinical T 4. Based on the MRI or ultrasound examination, the median value for the transverse diameter, anteroposterior diameter, vertical diameter, and volume of the prostate is 44(35-50)mm, 45(40-51)mm, 41(36-50)mm, and 76(54-118)ml, respectively. In this study, 84(27%)cases were diagnosed pathologically by transurethral resection of the prostate, and 226(73%)cases by prostate biopsy. The biopsy technique was transrectal ultrasound-guided systematic 12-point biopsy, and additional 1-5 needles were performed in regions with abnormal ultrasound echoes. The median for total number of puncture needles, number and percentages of positive needles were 12(12-13), 9(4-12)and 85%(35%-100%), respectively. Of all the patients, there were 61 cases with Gleason score≤6, 95 with Gleason score=7 and 84 with Gleason score≥8. There were 237(76%)patients undergoing neoadjuvant endocrine therapy. The patients were divided into the negative surgical margin group and positive surgical margin group. The correlation between positive surgical margin and general clinical data, PSA derivates, prostate size (transversal diameter, anteroposterior diameter, vertical diameter, and prostate volume), percentage of positive biopsy cores, Gleason score, method of pathological diagnosis, and endocrine therapy were analyzed. Results:Of all the 310 enrolled patients, the overall positive surgical margin rate was 34.2%(106/310). Univariate analysis showed that tPSA(41.3 ng/ml vs.24.8ng/ml, P=0.029), f/tPSA(0.14 vs.0.10, P=0.004), transversal diameter of prostate(46 mm vs.38mm, P=0.049), percentage of positive biopsy cores(100% vs.58%, P=0.001), and biopsy Gleason score(Gleason score≤6, =7 and ≥8: 14, 31 and 32 cases vs. 47, 64 and 42 cases, P<0.05)exhibited significant correlation with postoperative positive surgical margin. Multivariate analysis showed that transversal diameter of prostate( P=0.026) and percentage of positive biopsy cores( P=0.048) were independent risk factors for positive surgical margin. Conclusions:Transversal diameter of prostate and percentage of positive biopsy cores were independent risk factors, which help to predict the occurrence of postoperative positive surgical margin.
ABSTRACT
Adrenal cortical adenocarcinoma is a rare and often aggressive malignant tumor. For ACC that originated outside the adrenal gland, there are few reports at home and abroad. We report a case of adrenocortical adenocarcinoma that originated from kidney, introduce its diagnosis, treatment and follow-up results in order to provide help for clinical diagnosis and treatment.
ABSTRACT
Androgen deprivation therapy is one of the main therapies for metastatic hormone sensitive prostate cancer. A case of metastatic hormone sensitive prostate cancer was reported, a 55 year old patient was admitted to the hospital due to increased PSA in physical examination. PET-CT examination showed multiple clinical metastases in the left neck, abdominal cavity, retroperitoneal cavity and pelvic cavity. Bone metastases occurred in the right fourth rib and the left sixth and seventh ribs; after 8 months of endocrine therapy and the second generation of anti androgen therapy, the reexamination of imaging examination showed that the prostate lesions, seminal vesicle invasion, bone metastases were all subsided.
ABSTRACT
Pheochromocytoma/paraganglioma(PPGL) was a kind of neuroendocrine tumor that derived from chromaffin tissue, which seems to be an important etiology of secondary hypertension. With the development of molecular detection technology, at least 17 kinds of pathogenic genes of PPGL has been discovered, which is related to 35%-40% PPGL, and about 40% malignant PPGL is associated with SDHB gene mutation. In this study, we reported a case with a novel splicing mutation of SDHB gene induced paraganglioma.
ABSTRACT
Pheochromocytoma/paraganglioma(PPGL) was a kind of neuroendocrine tumor that derived from chromaffin tissue, which seems to be an important etiology of secondary hypertension. With the development of molecular detection technology, at least 17 kinds of pathogenic genes of PPGL has been discovered, which is related to 35%-40% PPGL, and about 40% malignant PPGL is associated with SDHB gene mutation. In this study, we reported a case with a novel splicing mutation of SDHB gene induced paraganglioma.
ABSTRACT
Objective:To report our technique and outcomes of robotic management of complex pheochromocytoma.Methods:Twelve patients with complex pheochromocytoma underwent robot-assisted surgery from May. 2016 to Sep. 2018. Four patients were male and eight patients were female. The mean patient age was 44 (range, 21-66) years. There were seven right adrenal tumors, two left adrenal tumors and three bilateral tumors. The mean tumor size was 7.8 (range, 2.5-16.0) cm. All surgeries were performed by transperitoneal approach. Three patients underwent synchronous surgery for bilateral pheochromocytoma.Results:All procedures were performed successfully without conversion to open surgery. The mean operative time was 108 (range, 50-195) min and mean blood loss was 105 (range, 20-400) ml. The average postoperative indwelling time of drainage tube was four (range, 3-5) days. The mean postoperative hospital stay was 8.5 (range, 5-23) days. Histopathologic examination of specimen revealed pheochromocytoma arising from adrenal gland. There were no recurrences or metastatic events during the follow-up of 5 to 35 months.Conclusion:Robotic assisted surgery is safe and effective for management of complex pheochromocytoma and provides significant advantages with regard to less blood loss and shorter postoperative hospital stay.
ABSTRACT
Objective To evaluate the relationship of prostate specific antigen(PSA)related variables and MRI+MRS examination with the results of prostate biopsy.Methods A total of 1227 patients aged(66.1± 7.7) years (range,55-90 years) undergoing prostate biopsy in our hospital from May 2014 to September 2018 were retrospectively analyzed.Two hundred forty-two patients with serum prostate-specific antigen (PSA)in "the grey zone (total PSA =4-10 μg/L)",and having indications for prostate biopsy were selected.According to the results of transrectal ultrasound-guided prostatic biopsy,patients were divided into the prostate cancer group and the benign prostate hyperplasia group.The levels of total PSA (tPSA),free PSA/tPSA ratios (f/t PSA),prostate specific antigen density(PSAD),(f/t) PSA/PSAD,prostate volume (PV) and other relevant data,as well as MRI+MRS test findings were statistically analyzed.Results The positive cancer rate of prostate biopsy was 26.0％ (63/242)in patients with total PSA in "the grey zone",including 56 cases of adenocarcinoma,3 cases of mucinous adenocarcinoma,and 4 cases of stromal sarcoma.Negative prostate biopsy results were found in 179 cases.Two hundred sixteen patients underwent MRI+MRS test before prostate biopsy,among which 81 were positive and 135 were negative.There were significant differences in PSAD,(f/t) PSA/PSAD,PV and MRI + MRS test findings (P =0.001,0.002,0.045 and 0.001)and there was no significant difference in tPSA and free/total PSA ratios(P＞0.05)between the prostate cancer group and the benign prostate hyperplasia group.Conclusions The positive cancer rate of prostate biopsy in patients with total PSA in the gray zone is 26.0％.The PSAD,(f/t)PSA/PSAD,prostate volume and MRI+ MRS examination are very useful for whether or not to perform the prostate biopsy,which can be used to guide the prostate biopsy in patients with total PSA in the "gray zone".
ABSTRACT
Objective To report our experience of retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome.Methods The clinical data of 12 nutcracker syndrome patients (10 males and 2 females;mean age 26 years) who underwent retroperitoneal laparoscopic extravascular stent placement from March 2014 to Febuary 2016 were retrospectively reviewed.The main symptoms were gross hematuria in 8 patients(one with proteinuria)and flank pain was noted in 1 patient.Three male patients had left-sided secondary varicoceles.Ultrasonography and computed tomography showed the left renal vein clamped by the superior mesenteric artery and the aorta.The anteroposterior diameter of the left renal vein in the renal hilum was three-fold than the aortomesenteric area,and the peak velocity ratio of the aortomesenteric area was much faster than the renal hilum.Twelve patients underwent laparoscopic extravascular stent placement under general anesthesia.The preaortic fibrous tissue between the aorta and the superior mesenteric artery was released intraoperatively.Renal vein became fiat when the superior mesenteric artery was elevated.The 6-8 cm extravascular stent was set on the surface of the renal vein to prevent the compression.Results Stenting was successfully accomplished in all 12 patients.Mean operative time was 62 min (50-125 min),estimated blood loss was 35 ml(20-100 ml),and the hospital stay after operation was 8 days (6-12 days).Three patients had a transient orthostatic intolerance,and they were cured by conservative treatment.With a mean follow up of 14 months (5-30 months),symptoms of hematuria and flank pain resolved in 7/8 and 1/1,respectively.Varicoceles were cured in all three patients.One case got partial relief because of recurrent hematuria due to excessive exercise.Ultrasonography showed that extravascular stent was in the right place,and the angle between abdominal aorta and superior mesenteric artery became normal.The inner diameter of left renal vein was decreased,and the narrow segment was diminished in diameter meanwhile the blood outflow was smooth.Conclusions Retroperitoneal laparoscopic extravascular stent placement in the renal vein is a safe and effective approach for nutcracker syndrome.