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【Objective】 To investigate the preoperative epidemiological factors affecting the surgical outcomes of transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and to evaluate the clinical predictive value. 【Methods】 Patients undergoing TURP at our hospital during Dec.2018 and Sep.2021 whose pathological examination suggestive of BPH were involved. Before operation, the clinical data, International Prostate Symptom Score (IPSS), quality of life (QoL) score, overactive bladder (OAB) score, prostate-specific antigen (PSA), and urological ultrasound results were collected. After operation, all patients were followed up with telephone call or face-to-face interview, and the IPSS, QoL score and OAB score were examined. Patients were divided into effective and ineffective groups according to the efficacy rubrics. The epidemiological factors affecting the efficacy of TURP were identified with univariate analysis, the independent influencing factors were screened with binary logistic regression, and the diagnostic value of each independent influencing factor was evaluated using receiver operating characteristic (ROC) curve. 【Results】 OAB score (OR=0.749, 95%CI: 0.627-0.895, P=0.001), IPSS-V/S (OR=4.919, 95%CI: 1.617-14.963, P=0.005), history of urinary retention (OR=7.513, 95%CI: 2.289-24.656, P=0.001), and history of urinary incontinence (OR=2.656, 95%CI: 1.015-6.950, P=0.047) were independent influencing factors for poor postoperative outcomes. ROC curve revealed that the area under the ROC curve (AUC) showed that AUC of OAB score, IPSS-V/S, history of urinary retention, and history of urinary incontinence were 0.784 (95%CI: 0.718-0.841), 0.686 (95%CI: 0.614-0.751), 0.713 (95%CI: 0.643-0.777), and 0.723 (95%CI: 0.654-0.786), respectively. ROC curve of the regression model showed that the AUC was 0.888 (95%CI: 0.834-0.930), and the sensitivity and specificity were 93.53% and 67.35%, respectively. 【Conclusion】 Preoperative OAB score, IPSS-V/S, history of urinary retention, and history of urinary incontinence were independent epidemiological factors of poor outcomes after TURP in BPH patients. The diagnostic efficacy ranked from the highest to the lowest as regression model >OAB score>history of urinary incontinence >history of urinary retention>IPSS-V/S.
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Objective To investigate the development trend,safety and clinical effects of laparoscopic radical gastrectomy (LRG) for gastric cancer.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 4 435 patients with gastric cancer who underwent LRG in the Fujian Medical University Union Hospital between January 2008 and December 2017 were collected.There were 3 263 males and 1 172 females,aged (61±11)years,with a range of 12-93 years.According to the operation time,4 435 patients were divided into two periods,including 1 588 patients of the early period (2008-2012) and 2 847 patients of the later period (2013-2017).Observation indicators:(1) the clinicopathological data of patients;(2) intraoperative and postoperative situations;(3) postoperative complications;(4) follow-up and survival situations.Follow-up using outpatient examination,visit to home,mail and telephone interview was performed to detect survival of patients once every 3 months within 2 years postoperatively and once every 6 months after 2 years postoperatively up to June 2018.Survival time was from operation time to the last follow-up,death or deadline of follow-up database such as loss to follow-up or death of other diseases.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by the t test.Measurement data with skewed distribution were represented as M (range).Count data were described as frequency or percentage,comparison between groups was analyzed using the chi-square test.Linear analysis was done using the unitary linear regression.The survival rate and survival curve were respectively calculated and drawn by the Kaplan-Meier method,and Log-rank test was used for survival analysis.Results (1) The clinicopathological data of patients:there were 3 263 males and 1 172 females of the 4 435 patients,accounting for 73.574％(3 263/4 435) and 26.426％ (1 172/4 435),respectively.TNM staging of the 4 435 patients:1 133 cases were detected early gastric cancer (T1 stage) and 3 302 cases were detected advanced gastric cancer including 518,1 431,1 353 in T2,T3 and T4a stages respectively.Linear regression analysis showed a linear correlation between the cases of LRG and operation year (R2 =0.911,P＜0.05) and a gradually increasing in cases of LRG.The sex (male),cases with tumor at upper stomach,middle stomach,lower stomach,＞ 2 regions (tumor location),tumor diameter,cases with undifferentiated and differentiated tumor (pathological types),cases in pT1,pT2,pT3,pT4a stages (pT staging),in pN0,pN1,pN2,pN3a,pN3b stages (pN staging),in Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B,ⅢA,ⅢB,ⅢC stages (pTNM staging) were 1 204,383,302,714,189,(4.8±2.7)cm,361,1 227,382,193,418,595,588,212,255,318,215,325,137,150,172,253,267,284 in patients of the early period,and 2 059,807,530,1 128,382,(4.3±2.6) cm,976,1 871,751,325,1 013,758,1 138,444,505,486,274,616,258,378,322,528,443,302 in patients of the later period,with statistically significant differences between patients of the two periods (x2 =6.411,15.699,t =10.946,x2 =57.801,90.437,26.502,98.773,P＜0.05).(2) Intraoperative and postoperative situations:the volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with Billroth Ⅰ,Billroth Ⅱ,residual stomach Roux-en-Y anastomosis,esophagogastric anastomosis,esophageal Roux-en-Y anastomosis of digestive tract reconstruction,number of lymph nodes dissected,time for initial fluid diet intake,time for initial semi-fluid diet intake,duration of postoperative hospital stay were (120±75)mL,38,599,122,0,32,835,32±13,(4.5±l.7)days,(8.6±2.5)days,(13.0± 7.3) days in patients of the early period,(104±68)mL,17,441,673,21,18,1 694,37±15,(4.1± 1.5)days,(7.9±2.8) days,(12.3±7.6) days in patients of the later period,showing statistically significant differences between patients of the two periods (t=2.169,x2 =26.843,397.185,t=-10.764,2.125,3.347,2.779,P＜0.05).Further linear regression analysis showed a linear correlation between the average number of lymph nodes dissected and operation year (R2=0.826,P＜0.05) and a gradually increasing in average number of lymph nodes dissected.(3) Postoperative complications:690 of 4 435 patients had postoperative complications,with an incidence rate of 15.558％ (690/4 435),including 242 patients of the early period and 448 of the later period,showing no statistically significant difference (x2 =0.191,P ＞ 0.05).Eight patients died of severe postoperative complications,with a death rate of 0.180％ (8/4 435),including 5 of the early period and 3 of the later period,showing no statistically significant difference (x2 =2.485,P＞0.05).Of 4 435 patients,561 had stage Ⅰ-Ⅱ complications,with an incidence rate of 12.649％ (561/4 435),129 had stage Ⅲ-Ⅳ complications,with an incidence rate of 2.909％(129/4 435).There were 196 and 46 patients of the early period with stage Ⅰ-Ⅱ complications and stage Ⅲ-Ⅳ complications,365 and 83 of the later period with stage Ⅰ-Ⅱ complications and stage Ⅲ-Ⅳ complications,showing no statistically significant difference between patients of the two periods (x2 =0.211,0.001,P＞0.05).(4) Follow-up and survival situations:4 250 of 4 435 patients including 1 465 of the early period and 2 785 of the later period were followed up for 1-123 months,with a median time of 37 months.The 5-year cumulative survival rate was 63.9％.The 5-year cumulative survival rate was 91.8％,80.2％ and 39.5％ in the stage Ⅰ,Ⅱ,Ⅲ patients,respectively,showing a statistically significant difference (x2 =810.146,P＜0.05).The 5-year cumulative survival rate was 60.8％ and 66.7％ in patients of the early and later period,respectively with a statistically significant difference (x2 =17.887,P＜0.05).Stratified analysis of TNM staging:the 5-year cumulative survival rates of stage Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B,Ⅲ A,Ⅲ B,Ⅲ C patients in the early period were 92.7％,85.6％,79.4％,74.5％,58.1％,37.6％,18.9％ and 95.6％,90.4％,87.6％,79.5％,52.7％,41.2％,19.5％ in patients of the later period,with no statistically significant difference (x2 =0.414,2.575,2.872,2.119,0.632,0.972,2.212,P＞0.05).Conclusions Surgical volume of the LRG has shown an increasing trend year by year,and the number of lymph nodes dissected and postoperative recovery of patients are improving.LRG is a safe procedure with acceptable clinical efficacy for gastric cancer.
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Objective To investigate the clinical features of subarachnoid hemorrhagic moyamoya disease and the therapeutic effect of encephalo-duro-arterio-synangiosis (EDAS). Methods The clinical and imaging data of 38 patients with subarachnoid hemorrhagic moyamoya disease admitted to the Department of Neurosurgery,the 307th Hospital of PLA from January 2002 to April 2013 were analyzed retrospectively. Thirty-five patients underwent unilateral or bilateral EDAS (64-sides underwent EDAS,4 patients with aneurysms underwent endovascular embolization first),and 3 patients did not undergo any surgery. Results (1)Subarachnoid hemorrhagic moyamoya disease accounted for 10. 8%(38/353)of all the hemorrhagic moyamoya disease admitted in hospital over the same period,including 37 adults and 1 child. The male to female ratio was 1∶3. 22 (9/29),and the age of onset was 12 to 59 years. The mean age of patients was 39 ± 11 years. Four patients were combined with aneurysms. There were no significant differences in the distribution of Suzuki stage,anterior choroidal artery dilatation and posterior communicating artery dilatation in the remaining 34 patients without aneurysms between the bleeding sides and non-bleeding sides (P>0.05). (2 ) The patients were followed up for 13 -125 months (mean 51 ± 27 months ),two patients had rebleeding,one of them was intraventricular hemorrhage,the other was parenchymal hemorrhage. The postoperative modified Rankin score (mRS)was significantly lower in 35 patients whom were treated with EDAS. Compared with before surgery,there was significant difference (P<0. 05). The re-examination of positron emission tomography (PET)for 16 patients at 3 to 19 months after surgery showed that among the 23 surgically treated hemispheres,the cerebral metabolisms of 17 hemispheres were improved after surgery, and 6 did not have any change after surgery. The re-examination of whole brain digital subtraction angiography (DSA)at 5 to 30 months after surgery in 13 patients showed that revascularizations in 19 of 23 surgical hemispheres were effective. Conclusion Subarachnoid hemorrhagic moyamoya disease often occurs in adults,and women are more common. EDAS can achieve good revascularization effect and improve brain metabolism of patients,and thus relieve the symptoms of cerebral ischemia.
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OBJECTIVE: To evaluate the surgical efficacy of and factors associated with decompressive craniectomy in patients with an internal carotid artery (ICA) territory infarction. METHODS: Seventeen patients (8 men and 9 women, average age 61.53 years, range 53-77 years) were treated by decompressive craniectomy for an ICA territory infarction at our institute. We retrospectively reviewed medical records, radiological findings, and National Institutes of Health Stroke Scale (NIHSS) at presentation and before surgery. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS). RESULTS: Of the 17 patients, 15 (88.24%) achieved a poor outcome (Group A, GOS 1-3) and 2 (11.76%) a good outcome (Group B, GOS 4-5). The mortality rate at one month after surgery was 52.9%. Average preoperative NIHSS was 27.6+/-10.88% in group A and 10+/-4.24% in group B. Mean cerebral infarction fraction at the septum pellucidum level before surgery in group A and B were 33.67% and 23.72%, respectively. Mean preoperative NIHSS (p=0.019) and cerebral infarction fraction at the septum pellucidum level (p=0.017) were found to be significantly associated with a better outcome. However, no preexisting prognostic factor was found to be of statistical significance. CONCLUSION: The rate of mortality after ICA territory infarction treatment is relatively high, despite positive evidence for surgical decompression, and most survivors experience severe disabilities. Our findings caution that careful consideration of prognostic factors is required when considering surgical treatment.