Safety and efficacy of C-arm CT laser-guided percutaneous renal pelvic catheter drainage under DSA in the treatment of hydronephrosis caused by pelvic malignancy / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of C-arm CT laser-guided puncture combined with digital subtraction angiography (DSA)for percutaneous renal pelvic catheter drainage in the treatment of hydronephrosis caused by pelvic malignancy.Methods:A retrospective analysis was performed on the data of 56 patients with ureteral obstruction caused by pelvic malignancy admitted to the Affiliated Cancer Hospital of Zhengzhou University from February 2020 to August 2021, including 10 males and 46 females. The mean age of the patients was (54.0±10.1)years old. The causes were colorectal cancer (7 cases), bladder cancer (3 cases), cervical cancer (36 cases), endometrial cancer (3 cases), ovarian cancer (2 cases), pelvic metastasis of gastric cancer (4 cases) and pelvic sarcoma (1 case). There were 71 sides of renal pelvis dilation in 56 patients, with the degree of dilation ranging from 1.2cm to 5.0cm.The degree of hydronephrosis was mild on 36 sides, moderate on 27 sides, and severe on 8 sides. Preoperative blood urea nitrogen(9.90±6.22)mmol/L and creatinine (155.80±146.83)μmol/L.During the puncture and catheter drainage, the patient was placed in the prone position, the C-arm CT scan was used to plan the puncture path, and the laser positioning of the DSA flat panel detector was used to determine the skin puncture point. With local anesthesia, the puncture direction of the puncture needle was adjusted to make the skin puncture point, the tail of the puncture needle, and the laser fixation point present a state of "three-points in one-line" when the patient stopped breathing temporarily at the end of expiratory breath in a non-fluoroscopic state, so as to achieve the preset puncture angle. Subsequently, pyelocentesis was completed according to the planned puncture depth. After successful pyelocentesis, percutaneous external renal drainage tube insertion or ureteral stents were performed under DSA. The number of renal pelvis puncture, puncture time, radiation dose, deviation of external renal drainage tube insertion angle from puncture angle, as well as postoperative hemoglobin changes, renal function recovery and complications were recorded.Results:In this group, 56 cases of 71 sides of renal pelvis puncture and catheter drainage were successfully completed, and the success rate of the operation was 100.0% (71/71). The success rate of the first needle puncture was 97.2% (69/71). Those who failed the first needle puncture succeeded in the second puncture during the operation. The puncture time of renal pelvis was (1.9±1.8) min.The intraoperative radiation dose was (2.7±1.5) mSV. The external drainage tube of the renal pelvis was placed on 53 sides, and the external drainage tube was placed on 29 sides with the same angle as the preset angle, and 24 sides with a deviation within 3°.On the first day after operation, there was no significant difference in hemoglobin compared with that before operation, urea nitrogen (5.31±1.99) mmol/L and creatinine (62.25±16.72) μmol/L were re-examined after operation, and the differences were statistically significant compared with those before operation ( P=0.008, P=0.002). No serious surgery-related complications occurred in any patient. Conclusion:C-arm CT laser-guided puncture combined with DSA percutaneous renal pelvic catheter drainage could be safe and effective in the treatment of ureteral obstruction caused by pelvic malignancy.

Standardized treatment of chronic radiation-induced bowel injury / 中华胃肠外科杂志

Radiation-induced bowel injury is a common complication of radiation therapy for pelvic malignancy. Given the huge number of patients diagnosed with pelvic malignancy, the number of patients diagnosed with radiation-induced bowel injury increased year by year, which put a great burden on the clinical diagnosis and treatment of radiation-induced bowel injury. In particular, chronic radiation-induced bowel injury, which is manifested in the process of prolonged, repeated and progressive aggravation, seriously affects the physical and mental health of patients and makes clinical diagnosis and treatment difficult. However, due to insufficient attention and understanding from doctors and patients, standardized diagnosis and treatment of radiation-induced bowel injury still have a long way to go. Radiation-induced bowel injury is self-limited but irreversible. During diagnosis, we should pay attention to overall evaluation of the stage of disease based on clinical symptoms, endoscopic examination, imaging examination, pathology and nutritional risk. The treatment methods include health education, drug therapy, enema therapy, formalin local treatment, endoscopic treatment and surgical treatment, etc. The treatment decision-making should be based on clinical symptoms, endoscopic or imaging findings to alleviate the clinical symptoms of patients as the primary goal and to improve the long-term quality of life of patients as the ultimate goal.

Pelvic exenteration for primary and recurrent malignancies in urology department / 中华泌尿外科杂志

Objective The objectives of present study is to investigate the safety and efficacy of pelvic exenteration (PE) for the treatment of pelvic malignancies in urology department.Methods From April 2010 to December 2014,20 patients with primary or recurrent pelvic malignancy accepted anterior pelvic exenteration (APE) or total pelvic exenteration (TPE) surgery,including 7 males and 13 females,ranged from 35 to 87 years old with an average of 65 years old.Ten case accepted APE and 10 for TPE.The ilium conduit was done in 5 cases for APE and 6 cases for TPE as urinary diversion,cutaneous ureterostomy was done in 5 cases for APE and 4 cases for TPE as urinary diversion.There were 6 cases primary tumor in APE group and 3 primary tumors in TPE.All of the patients had 13 cases of the urinary tract tumor group,and none of the urinary tract tumor group in 7 cases.There were 4 cases received preoperative chemotherapy in the urinary tract tumor group.No case received preoperative radiotherapy.3 cases received preoperative chemotherapy in none of the urinary tract tumor group,3 cased received preoperative radiotherapy.After induction of general anesthesia using a laryngeal mask for airway management.All patients took the abdominal incision,then dissected lymph nodes on both sides of the iliac vessels,freed bilateral ureters to the end of the swollen bladder,separated the peritoneal space.The bilateral vas deferens was cutted and ligated,then isolated and ligated the seminal vesicles between the posterior wall of the bladder and the anterior wall of the rectum.Lateral ligaments of bladder was cuted,then cuted ligament of prostate and puboprostatic ligament,sutured and cut deep vein of penis.Urethra of apex prostate was freed and cuted.Female patients needed to free the uterus and the posterior wall,cut the cardinal ligament and round ligament of uterus,isolate the posterior wall of the uterus to the posterior vaginal wall.Rectal resection adopted Miles operation.And sigmoid colostomy was performed on the left side of the abdominal wall.The perioperative characters,pathological results and patients' survival data were collected and analyzed.Results The average operation time for APE was 3.8 hours and 5.2 hours for TPE (P =0.173).Median length of hospital stay was 17.9 (7-47) days.The median blood loss was 300ml (80-2 500 ml) for APE and 400ml (50-6 000 ml) for TPE (P =0.909).The median follow-up time was 12.5 months (1-41months).The estimated 2-year survival rate for APE was 55.6％ and 45.0％ for TPE (P =0.642).Urinary system tumors group and non urinary system tumors group were analyzed and compared,The median survival time was 28 months and 13 months (P =0.538) in the two groups.The incidence of gastrointestinal complications of urinary system tumors and non-urinary system tumors was 7.7％ and 28.6％,incision complications was 7.7％ and 28.6％.Complications of urinary diversion only occurred in the non urologic tumor group,the incidence was 14.3％.The incidence of transfusion in two groups was 46.2％ and 28.6％.Conclusions Pelvic exenteration (APE and TPE) could be a safe and reliable choice for local advanced primary and recurrent pelvic malignancy.Even for the recurrent malignancies,the survival results of the patients were satisfactory.

A Case of Phlegmon caused by Chronic Pelvic Inflammation mimiking Pelvic Malignancy / 대한산부인과학회잡지

Pelvic inflammatory disease (PID) is a common disease associated with gynecologic infection, occurring mainly in fertile women. We report a case of phlegmon caused by chronic PID mimicking pelvic malignancy in a 39-year-old woman. The patient suffered from chronic pelvic pain, intermittent fever, and dysuria. A palpable lower abdominal mass was associated with progressive weight loss. A pelvic MRI revealed a 9x8x7cm sized, ill-defined soft tissue mass in the right pelvic cavity. On exploratory laparotomy, the pelvic mass was severly adhesed to the small intestine, mesentery, and urinary bladder. An incisional biopsy of the pelvic mass was performed. Histologically, the pelvic mass was composed of inflammed fibrous tissue with granulation tissue proliferation. The patient was treated with metronidazole and ciprofloxacin for two weeks. Fever and abdominal pain were relived. On a follow up abdomino-pelvic CT, the pelvic mass was not visible. Awareness of such an unusual case of chronic PID mimicking pelvic malignancy will facilitate a more accurate diagnostic approach for a variety of pelvic mass lesion.

A Case of Phlegmon caused by Chronic Pelvic Inflammation mimiking Pelvic Malignancy / 대한산부인과학회잡지

Pelvic inflammatory disease (PID) is a common disease associated with gynecologic infection, occurring mainly in fertile women. We report a case of phlegmon caused by chronic PID mimicking pelvic malignancy in a 39-year-old woman. The patient suffered from chronic pelvic pain, intermittent fever, and dysuria. A palpable lower abdominal mass was associated with progressive weight loss. A pelvic MRI revealed a 9x8x7cm sized, ill-defined soft tissue mass in the right pelvic cavity. On exploratory laparotomy, the pelvic mass was severly adhesed to the small intestine, mesentery, and urinary bladder. An incisional biopsy of the pelvic mass was performed. Histologically, the pelvic mass was composed of inflammed fibrous tissue with granulation tissue proliferation. The patient was treated with metronidazole and ciprofloxacin for two weeks. Fever and abdominal pain were relived. On a follow up abdomino-pelvic CT, the pelvic mass was not visible. Awareness of such an unusual case of chronic PID mimicking pelvic malignancy will facilitate a more accurate diagnostic approach for a variety of pelvic mass lesion.