Surgical management of renal neoplasm extending into the inferior veno cava / 中华泌尿外科杂志

Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.

Clinical efficacy of sunitinib as post-operative adjuvant therapy in patients with high-risk renal cell carcinoma / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of sunitinib as post-operative adjuvant therapy in patients with high-risk renal cell carcinoma (RCC).Methods A total of 60 patients with resected,histologically confirmed clear cell RCC were enrolled in this study.Patients received orally sunitinib either at a dose of 50 mg on treatment schedule (once daily for 4 weeks followed by 2 weeks off) or at a dose of 37.5 mg once daily for three 6-week cycles from 1 month after surgery.Results All the 60 patients tolerated Sunitinib treatment well and no patient discontinued treatment due to adverse events.Most adverse events were grade Ⅰ to Ⅱ.The most frequently reported adverse events were neutropenia (56.7％),thrombocytopenia (53.3％),leucopenia (48.3％),hand-foot syndrome (46.7％) and hypertension (36.7％).The most frequently reported grade 3 or 4 toxicities were thrombocytopenia (25.0％),neutropenia (15.0％),hand-foot syndrome (11.7％) and leucopenia (8.3％).The majority of adverse events occurred within the first 1-2 cycles of sunitinib treatment,and was ameliorated 1 month after 3 cycles finished.No irreversible adverse event was observed.As of April 5,2012,no recurrence occurred in patients except one death due to cerebrovascular accident unrelated to treatment,with both 6-month and 9-month disease-free survival rate of 100％.Conclusions Myelosuppression occurred less frequently in high-risk RCC patients treated with sunitinib as operative adjuvant therapy than in advanced RCC patients,with a better benefit trend.However,long-term follow-up data are needed to further confirm the efficacy of sunitinib in the adjuvant setting.

Tendency of dyslipidemia in the early stage after renal transplantation: multicenter investigation in Beijing region / 中华器官移植杂志

Objective To investigate the current dyslipidemia profiles and correlation with etiological factors in early stage post-transplantation, and the impact of lipid metabolic disorder on renal function. Methods The clinical data of 1032 renal allografts from eight hospitals in Beijing between 2004 and 2008 were collected and evaluated retrospectively. Before and at the 1st, 3rd, 6th and 12th month post-transplantation, the changes in blood total cholesterol (TC), triglycerides (TG),low density lipoprotein (LDL)-cholesterol and high density lipoprotein (HDL)-cholesterol were analyzed. The difference in the blood lipid disorder at different stages stratified by time and different age group, the effects of immunosuppressive agents on blood lipid, and the impact of blood lipid disorder on the blood creatinine were studied. Results Except HDL-cholesterol, TC, LDL-cholesterol and TG levels were increased gradually at the first year, especially LDL-cholesterol and TG. The TC and LDL-choleaterol abnormalities were obviously related with age (P<0. 01 ). The effect of Tacrolimus (Tac)-based immunosuppressive regimen on the lipid metabolic disorder was less than cyclosporine (CsA). At the first year, there was no significant difference in blood creatinine between lipid-lowering treatment and non-lipid-lowering treatment (P>0. 05). For the recipients not subject to lipid-lowering treatment and their TG level higher than the normal at the first month after operation, the creatinine level at the first year was significantly higher than in those with normal TG level (P< 0. 05). Conclusion The lipid metabolic disorder following renal transplantation is a common complication after the first transplant year, and was related with age and immunosuppressive agent regimen. Tac-based immunosuppressive regimen has little effects on the blood lipid metabolism.

Retrospective clinical analysis on recipients of more than 10 years after renal transplantation / 中华器官移植杂志

Objective To summarize the clinical data of renal transplants survived with graft function more than 10 years and the adverse events during this period, and to discuss the main strategies for the long-term survival Methods Survival rate of renal transplants simultaneously survived with graft function > 10 years and grafts was counted respectively in total 1003 renal transplant recipients at our hospital before Dec. 31,1998 retrospectively. Their relevant survival,adverse events and initial post-operative immunosuppressive regimens were recorded simultaneously.Results As of Dec. 31, 2008, the 10-year survival rate of recipients was 62. 7% (629/1003), and recipients with graft function accounted for 85. 37 % (537/629). Of them, 94. 75 % (596/629) recipients received cyclosporine A (CsA) -based immunosuppression plus other antiproliferative immunosuppressive agents. Post-transplantation adverse events included coronary heart diseases in 57 cases (9. 06 %), liver damage in 32 cases (5. 09 %), malignancy in 29 cases (4. 61% ), diabetic mellitus in 25 cases (3. 97 %), apoplexy in 16 cases (2. 54 %), severe bone marrow depression in 14 cases (2. 23 %), femur head necrosis in 7 cases (1.11%), lower-extremity thrombosis in 3 cases (0. 48 %), sudden deafness in 2 cases (0. 32 %). There were 690 survival patients and 49 deaths including 19 (38. 78 %) due to cardiocerebral vascular accidents, 10 (20. 41%) due to malignancy, 9 (18. 37 %) due to hepatic failure, 4 (8. 16 %) due to infection, 3 (6. 12 %) due to treatment abandonment, 2 (4. 08 %) unknown reasons and 2 (4. 08 %) accidental deaths. Conclusion Long-term survival after renal transplantation is associated with the primary medication of CsA as the main immunosuppressive regimen. The non-immunologic factors such as the prevention and cure of cardioeerebral vascular diseases and the early finding of liver functional abnormality and tumor are the main points focused during follow-up.

Two macron continuous wave laser and pneumatic lithotripsy treatment of ureteral calculus accompanied with granulation via ureteroscope / 中华泌尿外科杂志

Objective To investigate the therapeutic effects, safety of ureteral calculus accom panied with granulation treated with pneumatic lithotripsy and two-macron laser via transurethral uret eroscopic. Methods From June 2007 to March 2010, 38 cases of ureteral calculus accompanied with granulation were treated with 2 μm laser and pneumatic lithotripsy via ureteroscope. All the patients had middle to severe hydronephrosis. The granulation under the calculus was vaporized with the 2 μm laser, and then the ureteral stone was fragmented with pneumatic lithotripsy. The clinical datum,stone disintegration rate, lithagogue rate and complication were retrospectively analyzed. Results Among 38 cases of ureteral stones, rate of successful fragmentation in a single procedure was 92%(35/38). The operation time ranged from 15 to 45 min, mean (23.0±6.5)min. Estimated the intraoperative blood loss was (7.0±4.5)ml. The postoperative hospitalization time was (5.2±0.6)d. Two upper ureteral stones were pushed back to the renal pelvis and a conversion to extracorporeal shock wave lithotripsy (ESWL) was needed. The insertion of the ureteroscope was failed in 1 case who was accepted open operation finally. Among the 37 cases treated via ureteroscopy, stone clearance rate was about 86% after operation 1 month. Follow-up examinations for 3-15 months (mean 8 months)showed no ureteral stenosis or urinary infection. Conclusion 2 μm laser and pneumatic lithotripsyvia ureteroscope could be a highly effective and safe therapy for treatment of ureteral stone with granulation.

Minimally Invasive Treatment for Ureteral Calculus Accompanied with Granulation: 27 Cases Report / 中国康复理论与实践

@#ObjectiveTo investigate the therapeutic effects, safety of pneumatic lithotripsy and 2 μm laser via transurethral ureteroscope for ureteral calculi accompanied with granulation. Methods27 cases (30 sides) of ureteral calculi accompanied with granulation treated with 2 μm laser and pneumatic lithotripsy via ureteroscope were reviewed. Results28 sides were fragmented successfully in a single procedure. The operation time was 15～45 min (mean 25 min). The intraoperative blood loss was 3～15 ml (mean 5 ml). The postoperative hospitalization time was 3～7 d (mean 5.5 d). 1 upper ureteral stone was pushed back to the renal pelvis and extracorporeal shock wave lithotripsy was needed. The insertion of the ureteroscope was failed in 1 cases, who accepted open operation finally. Double-J tubes were pulled out in all the patients after 1 month, and 26 sides were stone-free. They were followed-up for 3～15 months (mean 8 months), no ureteral stenosis or urinary infection was found. Conclusion2 μm laser and pneumatic lithotripsy via ureteroscope is an effective and safe therapy for ureteral calculi with granulation, especially for those on middle or lower levels.

Percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava / 中华泌尿外科杂志

Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava(IVC). Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MR1, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years (range, 20 to 76 years). Of these patients, 11 had renal ne-oplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus (level 2a) extension and 1 with extension into the subhepatic vena cava (level 1). On the operation day, all patients had a pereutaneous preset of the balloon catheter into the IVC, at the position be-tween hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postopera-tive hospital stay was 12 d (range, 9 to 15 d). Pathological investigation revealed clear cell carcinoma in 6 patients, papillary renal cell carcinoma (RCC) in 3, metastatic hepatocellular carcinoma in 1, an-gioleiomyolipoma in 1 and adrenal leiomyosarcoma in 1. The pTNM stage in 9 patients with RCC was T3b N0 M0 in 8 patients, T3b Nx M1 in I patient. The mean followup was 21±10 months (median follow-up 24 months). Four patients died of lung or liver metastasis, and the recurrence of liver cancer at 6, 9, 15, and 22 months postoperatively. Eight patients have survived for 6 to 35 months (mean 26 months). The postoperative 1-, and 3-year cancer-specific survival rates in 9 patients with RCC were 78% and 67%. Conclusions Percutaneous balloon catheter occlusion technique is a feasible, safe, and effective method for tumor thrombectomy of low retrohepatic (level 2a) or subhepatic (level 1) type in patients with renal or adrenal neoplasm extending into the IVC. Additional experience and con-tinued investigation are warranted.

Two-year experience with rapamycin in kidney transplantation / 中华器官移植杂志

Objective To observe the effects and safety of rapamycin (Rap) in combination with cyclosporine A (CsA) and steroid (Pred) as triple regimen for prevention of acute rejection after renal transplantation.Methods Fifty patients with de novo cadaveric kidney allograft were randomized into two groups. In the study group there were 30 patients treated with Rap, CsA, and Pred, while in the control group there were 20 patients with conventional triple therapy of azathioprine (Aza), CsA, and Pred. Same dosages of CsA and Pred were used in both groups. Any adverse event after treatment was observed and recorded in detail. The laboratory investigations were checked and analyzed periodically.Results The pre-protocol population included 26 patients in study group and 18 patients in control group. The 2-year patient and graft survival rates in both groups were 100 %. The incidence of acute rejection was 3.7 % (1/27) in study group, 25 % (5/20) in control group, respectively. All episodes of acute rejection were reversed by methylprednisolone. The trough levels of CsA kept same in both groups, but CsA dose in study group was lower than that in control group. Blood concentrations of total cholesterol and triglyceride in study group were higher than those in control group. Conclusion Rap is an effective and safe immunosuppressive drug for prevention of acute rejection after renal transplantation. Rap combined with CsA allows reducing the dose of CsA. But its main side effect is hyperlipidemia.

Comparative Study of Greenlight Photos Selective Vaporization and Revolix 2 Micron Continuous Wave Laser Vaporesection for the Treatment of Superficial Bladder Tumor / 中国微创外科杂志

Objective To compare the safety and efficacy of greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection for the treatment of superficial bladder tumor. Methods Under sacral anesthesia or epidural anesthesia,a total of 42 patients with superficial bladder tumor were treated with greenlight photos selective vaporization while the other 42 patients received the RevoLix 2 micron continuous wave laser Vaporesection. The clinical stage of the patients was T1-T2,and the pathology grade was G1-G2. Results The greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection were successfully completed in all of the patients. No patients required blood transfusion. No complications such as obturator nerve reflex,bladder perforation or overhydration occurred. No significant difference was noticed in the operation time [(15.3?10.5) min vs (14.3?6.5) min,t=0.525,P=0.601],catheterization time [(6.3?0.5) d vs (6.3?1.2) d,t=0.000,P=0.999],and postoperative hospital stay [(6.3?3.5) d vs (7.2?2.4) d,t=-1.374,P=0.173]. The patients were followed up for 6 months,during the period the recurrence rate was 11.9%(5/42) and 7.1%(3/42) respectively in the greenlight group and RevoLix group (?2=0.138,P=0.710). Conclusions Both greenlight photos selective vaporization and RevoLix 2 micron continuous wave laser vaporesection are effective and safe for superficial bladder tumor and lead to low rates of postoperative complications and recurrence. Further studies are necessary to evaluate its long-term effect. For T2 and higher grades of bladder tumors,open surgery should be performed.

Analysis of 176 cases of death from kidney transplantation / 中华泌尿外科杂志

Objective To review the cadaveric kidney transplantations at our center in the past 22 years and to analyze the causes and the influencing factors on death in 176 patients who died after renal transplantation. Methods A total of 1 039 patients received cadaveric kidney graftings between October 1977 and June 1999.Patient's mortality was calculated by the Kaplan Meier method.The factors which might lead to patients' death,including age and sex of the donors and recipients,frequency of transplantation,dialysis time and transfusion volume before transplantation,cold ischemic time (CIT),delayed graft fuction (DGF),rejection,immunosuppressive regimen,and post transplant complications,were analyzed by log rank and Cox model. Results Total mortalities of the patient at 1 ,5 ,10 ,and 15 year were 6.9%,19.7%,32.1%,and 34.7%,respectively.The leading causes of patients' death were infection,cardiocerebral vascular diseases,and hepatic failure.The factors of transplant times,dialysis time before transplant,immunosuppressive regimen,chronic rejection,post transplant complications of pneumonitis and cardiocerebral vascular diseases were significant impact on transplant patient death by the analysis of Cox model. Conclusions In this series of 1039 cadaveric kidney transplant patients,the mortality since the first year after transplantation was increased annually by 2.5% during the past 22 years.The leading causes of patients' death are infection,cardiocerebral vascular diseases,and hepatic failure after renal transplantation.Transplant times in which patients receive the procedures,dialysis time before transplant,immunosuppressive regimen,chronic rejection,post transplant complications of pneumonitis and cardiocerebral vascular diseases are significant factors impacting on transplant patients' death.

Clinical study of Simulect in renal allograft recipients / 中华泌尿外科杂志

Objective To evaluate the efficacy and safety of Simulect for the prevention of acute rejection in renal allograft recipients receiving Neoral-based immunosuppressive regimen. Methods A prospective,multicenter and open-label clinical trial was conducted from March to October 2001.A total of 33 patients [20 men and 13 women; age range,18-63 years;mean age,(42.6?11.6) years] who received first kidney allograft were enrolled.Thirty-two cases had panel-reactive antibody

Caval-atrial venovenous bypass technique in vena caval thrombectomy for renal and adrenal carcinomas with inferior vena cava involvement / 中华泌尿外科杂志

Objective To assess the value of caval-atr ial venovenous bypass technique in resection of tumor thrombus for renal or adr enal carcinomas with inferior vena cava involvement. Methods From Mar.to Aug.of 2000,4 patients with renal or adrenal carcinoma extendi ng into inferior vena cava were admitted and evaluated.Radical nephrectomy and v ena cava thrombectomy were performed with the use of caval-atrial venovenous by pass technique. Results There was no significant change of hemodynamic parameters during vena cava thrombectomy.A part of tumor thrombu s in 1 case was left in situ because of its compact adhesion to the wall of infe rior vena cava.The tumor thrombus in inferior vena cava were completely removed in the other 3. Conclusions Caval-atrial venovenous byp ass technique is a simple and safe method during vena cava thrombectomy.

Diagnosis of prostate carcinoma in 317 Cases / 中华泌尿外科杂志

Objective To review the diagnosis of prostatic cancer in 317 cases encountered between 1969 and 1999. Methods The clinical data of the 317 cases were retrospectively analysed. Results Prostatic cancer constituted 2.2% of the inpatients of the urology department,9.8% of genito urological tumors.In recent 10 years,the new cases of prostatic cancers hospitalized was 4.2 folds more than 20 years before.Since the use of PSA assessment,the diagnosis rate of prostatic cancer especially the T 1 and T 2 cases was significantly elevated (60.2% vs 50.0%). The diagnoses rate of DRE and TRUS was 86.1% and 89.1% whereas if combined with PSA assessment the diagnosis rate of either DRE or TRUS was increased to 99.0%. Serum PSA level was intimately correlated with the grade and stage of prostatic cancer. Conclusions The prostatic cancer inpatients tends to increase.Serum PSA assessment is of important value in detecting early cases of prostatic cancer.PSA,DRE and TRUS are the cardinal means for the screening of prostatic cancer and when used combinedly the diagnosis rate and accuracy are elevated.

The treatment of prostate cancer and the prognostic factor simpacting on survival / 中华泌尿外科杂志

Objective To determine the definite effec ti ve therapy for localized prostate cancer. Methods A data -base of 317 patients with prostate cancer treated with different therapies be tween 1969 and 1999 were analyzed.Overall survival and disease specific survival rates for patients with different stage,grade,and regimen were analysed by Kap lan-Meier method.Predictive factors impacted on disease specific survival were also analyzed by using log-rank test and Cox proportional hazards model. Results Overall survival rates at 5-,10- and 15-year were 7 3.1%,51.8% and 35.3%,corresponding disease specific survival rats of 85.1%、72.9 % and 72.9%,respectively.Disease specific survival rate at 10-year was 100.0% i n 36 patients treated with radical prostatectomy,78.0% in 57 patients treated wi th local radiotherapy.Multivariate analysis by Cox model showed that stage ( RR =2.17,CI 1.43～3.28, P =0.0000) and grade( RR =2.54,CI 1.37～4.68, P = 0. 0003)were significantly impacted on disease specific survival. Conc lusions Radical prostatectomy and local radiation provide effective treatment for patient with organ-confined prostate cancer.Adjuvant hormonal the rapy may effect on patient’s survival.Clinical stage and grade of prostate canc er are independent factors impacting on survival significantly.

STUDY OF Fas AND FasL EXPRESSION IN HUMAN PROSTATIC CANCER / 解放军医学杂志

To explore the role of Fas,FasL in pathogenesis of prostatic cancer (Pca), expression of Fas and FasL in 49 cases of Pca, 22 cases of BPH and 14 cases of normal prostate(NP) was detected by immunohistochemical SP method. The results were as follows: ①Fas, FasL were expressed in all the examined tissues; ②The expression of Fas was strongest in BPH specimens and weekest in Pca tissues ( P 0 05);④The expression of Fas in 17 cases of androgen dependent Pca tissues was more marked than that in 9 cases of androgen independent Pca tissues( P