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Objective:To present our initial experience with robot-assisted laparoscopic prostatectomy (RALP) for complicated cases.Methods:Clinical and pathological data from 4 complicated prostate cancer cases,who underwent RALP from October to November in 2015,were analyzed retrospectively.All the cases were conducted transurethral plasmakinetic enucleation of prostate and hormonal therapy before RALP.Results:All surgeries were done successfully.The age,baseline prostatic special antigen,clinical tumor stage,operation time and estimated blood loss were 58-70 years,6.04-70.15 ng/mL,T2bT3b,210-360 min and 50-250 mL,respectively.No blood transfusion was needed.All surgical margin were negative.Conclusion:Although previous transurethral surgeries and hormonal therapies may increase the difficulty for operations,RALP is still appropriate for the complicated cases of prostate cancer.
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Objective: To investigate the clinical effect of total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer. Methods: Total cystectomy and W-shaped orthotopic ileal neobladder were performed on 29 male patients and 3 female patients. Atfer the cystectomy, 35-40 cm terminal ileal segment was isolated to make W-shaped orthotopic ileal neobladder. Bilateral uretero-ileal anastomoses were constructed by nipple technique, urethral stump was sutured to the lowest portion of the ileal pouch. Results: All surgeries were completed successfully. Patients were able to void by increasing the abdominal pressure, daytime continence rate was 87.5% and nighttime continence rate was 78.1%. The mean neobladder capacity was 410.6 mL and the mean postvoid residual urine was22.7 mL at 6 months. After the surgery, ileal neobladder leakage occurred in 3 (9.4%) patients, mild ileus occurred in 2 (6.3%) patients, ileo-urethral anastomosis stricture developed in 1(3.1%) patient, and dysuria occurred in 3 (9.4%) patients because of the mucus.HTe complications were treated properly and satisfactory results were obtained. Erection was preserved in 5 of the 9 male patients with normal erectile function, and normal sexual function was preserved in 1 female patient who underwent uterus-sparing cystectomy. HTe mean follow-up was 15 months.One patient died of distant metastasis and pneumonia, while other patients survived without tumor. Conclusion: Total cystectomy and W-shaped orthotopic ileal neobladder have the advantages of voiding through the native urethra, satisfactory continence, low complication rates of upper urinary tract damage and electrolyte imbalance. W-shaped orthotopic ileal neobladder may be considered as the ifrst option of urinary diversion atfer cystectomy. Postoperative management should focus on complications and follow-up.
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OBJECTIVE@#To compare the safety and efficacy of prone and modified recumbent positions on minimal invasive percutaneous nephrolithotomy.@*METHODS@#A total of 62 patients with upper urinary calculi were grouped into two groups, one of which consisted of 27 patients who underwent the minimal invasive percutaneous nephrolithotomy with modified recumbent position, and the other 35 patients with prone position. There was no significant statistical difference in the age, gender and complications between the two groups before surgery (P>0.05). Duration of and blood loss during surgery, complications in the perioperative period, and the length of postoperative hospital stay were all recorded. The data were analyzed by SPSS 13.0.@*RESULTS@#Surgery was successful in all cases. There was no failure to puncture nor need to resort to open surgery. Average operation duration for the modified recumbent position group was (85.1± 25.3) min vs (97.2±30.6) min for the prone position group. Mean blood loss during the operation was (117.5± 49.7) mL vs (149.3±53.1) mL. There were no severe complications during and after surgery in the modified recumbent position group. In the prone position group, s one patient suffered pneumothorax during the operation and two suffered selective renal artery embolization because of massive hemorrhaging following the operation. There were significant differences in blood loss during surgery, in complications during the perioperative period, and in length of postoperative stay in hospital (P<0.05) between the two groups.@*CONCLUSION@#The patients are safer and more easily tolerate the minimal invasive percutaneous nephrolithotomy in the modified recumbent position than in the prone position, though the treatment efficacy of these two kinds of operation is similar. It is recommended that the modified recumbent position should be used generally in the percutaneous nephrolithotomy.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Kidney Calculi , General Surgery , Minimally Invasive Surgical Procedures , Methods , Nephrostomy, Percutaneous , Methods , Posture , Prone Position , Supine Position , Ureteral Calculi , General SurgeryABSTRACT
Objective To establish a set of teaching evaluation index system for clinical practice which can embody education cocept of modern nursing,accord with reform direction of nursing education, and is scientific,reasonable and easy to operate. Methods Teaching evaluation index system for clinical practice was preliminarily established using literature data, theoretical analysis, expert evaluation,collective argument by evaluator and who were evaluated. Results 32 first-order indices,169 second-order indices and value assignment of weight were confirmed after establishment of teaching evaluation index system, which was satisfying to the evaluator, who were evaluated and nursing students. Conclusions The evalu-ation index satisfy the requirement of teaching quality evaluation for practice,the degree of approval, coordi-nation and reliability is relatively high, so it can be used for teaching quality evaluation for nursing practice.
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Objective To afford the basis for the application of Sinomenine(SIN) in the proposal for organ transplantation, the expression of TGF-? 1 was explored in inborn WistarSK kidney transplantation model. Methods Forty-eight recipients were divided into 4 groups at random:group 1 being used as control and treated with 0 9% natrii chloride(3ml?kg -1 ?d -1 ,ip), group 2 treated with SIN(30mg?kg -1 ?d -1 ,ip),group 3 treated with CsA(2 5mg?kg -1 ?d -1 ,ip),group 4 treated with SIN(30mg?kg -1 ?d -1 ,ip) combined with CsA(2 5mg?kg -1 ?d -1 ,ip).Allografts of 6 recipients from each group were harvested at day 6 before end stage rejection for histological studies. The synergistic effects of SIN combined with CsA were assessed by COX proportional hazards model. The quantitative methods of immunohistochemistry were used for analysis on expression of TGF-? 1.Results Control recipients rejected their allografs at day 9 post-operation, the average life time was 7 83?9 75 days. Treated with either SIN(30mg?kg -1 ?d -1 ,ip) or subtherapeutic doses of CsA(2 5mg?kg -1 ?d -1 ,ip) allografts survival was mininally prolonged. Combined treatment with SIN and subtherapeutic doses of CsA led to a significant prolongation of graft survival(group 4), more than 18 days. The expression of TGF-? 1 was enhanced significantly in group 2 and group 3.No synergistic effect of SIN combined with CsA on expression of TGF-? 1 was observed. Conclusion The therapeutic value of SIN in rat kidney allograft model suggests that this safe chinese medicine has remarkable efficacy of anti-acute rejection in rat kidney transplantation. It shows significant synergistic effect with sub-therapeutic CsA. The immunosuppressive efficacy of SIN is probably based on enhancing express of TGF-? 1. No synergistic effect of SIN and CsA on expression of TGF-? 1 indicates low danger of fibrosis of allografts. SIN will be a hopeful chinese medicine for immunosuppressive treatment in organ transplantation.