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Objective To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder,and to summarize the experiences.Methods The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed.All patients were male,aged 33 to 77 years,with an average of 64.4 years.Body mass index ranged from 18.0 to 31.8 kg/m2,with an average of 23.2 kg/m2.One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor,with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma.No case underwent neoadjuvant therapy,and all cases were clinically staged as cT2a-3b N0-2 M0.Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed.The specific procedures were described as follows.After bladder resection,the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve,with the proximal part retaining 15 cm lumen as the input loop,and the distal part of 40 cm ileum being folded in 1∶1 ratio.The folded intestinal segment was made into a allantoic sac by using a linear incision closure device,forming a “ρ” shape with the input loop,bilateral ureters and the input loop.Anastomosis of wall,distal end of allantoic and urethra was performed.Record the perioperative data such as operation time,estimated bleeding,postoperative recovery,complications,and follow-up results.Result All of the 11 cases underwent successfully operation,and no cases were transferred to open surgery.The operation time ranged from 320 to 440 minutes,with an average of 357.1 minutes.The estimated amount of bleeding ranged from 100 to 300 ml,with an average of 207.1 ml.The total time of intestinal tract procedure was 80-100 minutes,with an average of 89.3 minutes,and the time of allantoic preparation was 14-19 minutes,with an average of 16.1 minutes.The pain score was 2-5 points at 4 hours after operation,with an average of 3.8 points,and 1-4 points at 24 hours after operation,with an average of 2.3 points.Postoperative exhaust time ranged from 2.5 to 3.5 days,with an average of 3.0 days.Catheter removed 21 days after operation,with 9 cases of urinary incontinence,including mild in 6 cases,moderate in 2 cases and severe in 1 case,with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks.Postoperative hospital stay ranged from 7 to 13 days,with an average of 10.4 days.The drainage removal time was 4-11 days,with an average of 6.7 days.Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma,3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma.The tumors invade the prostate in adenocarcinoma patient,with left (3/13) and right (1/9) positive lymph nodes.One case of high-grade invasive urothelial carcinoma had both left (2/11) and right (1/9) positive lymph nodes,and the other cases were negative.The margin were negative in all patients.Pathological staging was pT2a-4a N0-2 M0.Postoperative adjuvant chemotherapy with gemcitabine + cisplatin regimen were performed in 9 patients.The follow-up period ranged from 3 to 29 weeks,with an average of 17.4 weeks,the patients with adenocarcinoma died of multiple organ failure at the 13th week after operation,and the other cases have no recurrence or metastasis.Dual J-tube was removed in 9 cases in the last follow-up,and the new bladder volume was estimated 300-350 ml,with residual urine of 0-43 ml and 19 ml of average.There is no stone formation in the new bladder.No hydronephrosis or ureteral dilatation aggravated.Conclusions Totally laparoscopic radical cystectomy plus ρ shape orthotopic ileal neobladder simplify the procedure of making allantoic storage and shorten the procedure time.The patients suffered less pain and recovered quickly after operation.It is a safe and feasible surgical procedure based on this study.
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Objective@#To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder, and to summarize the experiences.@*Methods@#The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed. All patients were male, aged 33 to 77 years, with an average of 64.4 years. Body mass index ranged from 18.0 to 31.8 kg/m2, with an average of 23.2 kg/m2. One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor, with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma. No case underwent neoadjuvant therapy, and all cases were clinically staged as cT2a-3bN0-2M0. Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed. The specific procedures were described as follows. After bladder resection, the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve, with the proximal part retaining 15 cm lumen as the input loop, and the distal part of 40 cm ileum being folded in 1∶1 ratio. The folded intestinal segment was made into a allantoic sac by using a linear incision closure device, forming a "ρ" shape with the input loop, bilateral ureters and the input loop. Anastomosis of wall, distal end of allantoic and urethra was performed.Record the perioperative data such as operation time, estimated bleeding, postoperative recovery, complications, and follow-up results.@*Result@#All of the 11 cases underwent successfully operation, and no cases were transferred to open surgery. The operation time ranged from 320 to 440 minutes, with an average of 357.1 minutes. The estimated amount of bleeding ranged from 100 to 300 ml, with an average of 207.1 ml. The total time of intestinal tract procedure was 80-100 minutes, with an average of 89.3 minutes, and the time of allantoic preparation was 14-19 minutes, with an average of 16.1 minutes. The pain score was 2-5 points at 4 hours after operation, with an average of 3.8 points, and 1-4 points at 24 hours after operation, with an average of 2.3 points. Postoperative exhaust time ranged from 2.5 to 3.5 days, with an average of 3.0 days.Catheter removed 21 days after operation, with 9 cases of urinary incontinence, including mild in 6 cases, moderate in 2 cases and severe in 1 case, with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks. Postoperative hospital stay ranged from 7 to 13 days, with an average of 10.4 days. The drainage removal time was 4-11 days, with an average of 6.7 days. Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma, 3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma. The tumors invade the prostate in adenocarcinoma patient, with left (3/13) and right (1/9) positive lymph nodes. One case of high-grade invasive urothelial carcinoma had both left (2/11) and right (1/9) positive lymph nodes, and the other cases were negative. The margin were negative in all patients. Pathological staging was pT2a-4aN0-2M0. Postoperative adjuvant chemotherapy with gemcitabine+ cisplatin regimen were performed in 9 patients.The follow-up period ranged from 3 to 29 weeks, with an average of 17.4 weeks, the patients with adenocarcinoma died of multiple organ failure at the 13th week after operation, and the other cases have no recurrence or metastasis. Dual J-tube was removed in 9 cases in the last follow-up, and the new bladder volume was estimated 300-350 ml, with residual urine of 0-43 ml and 19 ml of average. There is no stone formation in the new bladder.No hydronephrosis or ureteral dilatation aggravated.@*Conclusions@#Totally laparoscopic radical cystectomy plus ρ shape orthotopic ileal neobladder simplify the procedure of making allantoic storage and shorten the procedure time. The patients suffered less pain and recovered quickly after operation.It is a safe and feasible surgical procedure based on this study.
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Objective To explore the appropriate target ranges of blood glucose in intensive insulin therapy (ⅡT) for acute hyperglycemia following traumatic brain injury (TBI).Methods A randomized,open-label and controlled clinical trial was performed on 208 patients,admitted to our hospitals from Junuary 2014 to Sepember 2016.They were divided into ⅡT group (n=156),who were subdivided into slight (10.1-13.0 mmol/L),moderate (7.1-10.0 mmol/L),and strict (4.4-7.0 mmol/L) control blood glucose groups (n=52),and non-ⅡT group (n=52).Survival analysis 6 months after treatment was performed by Kaplan-Meier method.Modified Rankin scale (mRS) scores and Barthel index (BI),Glasgow Outcome scale (GOS) scores,concentrations of lactic acid in cerebrospinal fluid (CSF) and glycosylated hemoglobin,Glasgow coma scale (GCS) scores,Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) scores,Length of staying in intensive care unit (ICU) and incidence of adverse events were compared between the patients from different groups at different treatment times.Results Blood glucose level within 7 d of admission in patients ofⅡT group was in target ranges.The survival rate of patients from slight and moderate control blood glucose groups was significantly higher than that in the non-ⅡT group and strict control blood glucose group 6 months after treatment (x2=4.237,P=0.040;x2=5.621,P=0.018).As compared with those in the non-ⅡT group and strict control blood glucose group,the mRS scores 3 months after treatment were significantly decreased,and GOS scores and BI one,3 and 6 months after treatment were significantly increased in patients from slight and moderate control blood glucose groups (P＜0.05).As compared with that in the non-ⅡT group,and slight and moderate control blood glucose groups,the glycosylated hemoglobin level 7 d after treatment was significantly decreased in strict control blood glucose group (P＜0.05).As compared with those in the non-ⅡT group and strict control blood glucose group,the concentration of lactic acid in CSF 7 d after treatment,APACHE Ⅱ scores 7 and 14 d after treatment,length of staying in ICU and incidence of adverse events were significantly decreased in patients from slight and moderate control blood glucose groups (P＜0.05).The mean value of blood glucose in slight and moderate control blood glucose groups was (8.40±0.39) mmol/L.Conclusion Proper ⅡT improves the outcomes of TBI patients and (8.40±0.39) mmol/L are established as the target ranges in ⅡT for TBI.
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Objective To establish a scald-induced pain model using a constant-temperature electrical scald instrument in rats.Methods Thirty-six pathogen-free male Sprague-Dawley rats, weighing 200-250 g, were randomly divided into 4 groups (n =9 each) using a random number table: control group (group C), scald for 5 s group (group S5), scald for 10 s group (group S10), and scald for 15 s group (group S15).The rats were anesthetized with intraperitoneal chloral hydrate.In S5, S10 and S15 groups, the plantar surface of the left hindpaw of rats were exposed to a constant-temperature electrical scald instrument (85 ℃) for 5, 10 and 15 s, respectively.The plantar surface of the left hindpaw of rats was exposed to an electrical scald instrument (room temperature) for 10 s in group C.At 1 day before treatment (T0),and 1, 3, 5, 7 and 14 days after treatment (T1-5), the mechanical and thermal pain thresholds were measured.Immediately after treatment, and at 24 h after treatment, the total body condition, wound color, and shape of the margin of the wound were observed and recorded.At 24 h after treatment, 3 rats were randomly sacrificed, and the skin from the plantar surface of the left hindpaw was removed for microscopic examination.Results Compared with group C, the thermal pain threshold at T1-2, and the mechanical pain threshold at T1-3 were significantly decreased in group S5, and the thermal pain threshold,and mechanical pain threshold were significantly decreased at T1-4 in group S10 (P＜0.05).The thermal pain threshold ＞ 25 s, and the mechanical pain threshold ＞30 g at T1-5 in group S15.The swelling in foot was bovious, burn blister appeared, and the degree of damage was aggravated in group S10 compared with S5 and S15 groups.Conclusion The scald-induced pain model is successfully established using a constant-temperature electrical scald instrument in rats.