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1.
Journal of Peking University(Health Sciences) ; (6): 646-652, 2019.
Article Dans Chinois | WPRIM | ID: wpr-941864

Résumé

OBJECTIVE@#To compare the efficacy and safety of complete transperitoneal laparoscopic nephroureterectomy (CTNU) and traditional retroperitoneoscopic nehroureterectomy (TRNU) for the management of upper urinary tract urothelial carcinoma(UTUC).@*METHODS@#We retrospectively collected the clinical data of UTUC patients who underwent CTNU or TRNU surgery from January 2011 to December 2018 in Peking University First Hospital and Fujian Provincial Hospital, and compared the clinical characteristics, perioperative parameters, and follow-up results between the CTNU and TRNU surgeries.@*RESULTS@#Finally, a total of 266 cases were included, with 94 cases in the CTNU group and 172 cases in the TRNU group. The proportion of left side lesions was bigger in TRNU group when compared with CTNU group (P<0.05). No significant differences were observed in clinical characteristics, such as age, gender, body mass index (BMI), American society of anesthesiologists score (ASA score) and tumor laterality. All surgery procedures were completed. The vascular resparing was performed by reason that left arteria renalis was injured accidently during surgical operation in one case of TRNU group. No serious complications were observed in both CTNU and TRNU groups. In CTNU group, operating time was (202.9±76.7) min, estimated blood loss was (68.4±73.3) mL, drainage duration was (3.9±1.5) d, drainage volume was (181.7±251.5) mL, and postoperative hospital stay was (7.8±4.1) d. In TRNU group, operating time was (203.5±68.7) min, estimated blood loss was (130.2±252.1) mL, drainage duration was (4.3 ±1.6) d, drainage volume was (179.1±167.5) mL, and postoperative hospital stay was (8.2±3.7) d. The estimated blood loss in CTNU group was significantly less than that in TRNU group (P=0.005).The median follow-up time was 39 months (range: 1-88 months). The 5-year overall survival rate (OS), cancer specific survival rate (CSS), intra-vesical recurrence free survival rate (IvRFS), disease free survival rate (DFS) of CTNU group was 75.6%, 86.9%, 73.8%, 57.5%, respectively. The OS, CSS, IvRFS and DFS of TRNU group was 66.3%, 83.5%, 75.9%, 58.6%, respectively.No significant differences were observed in the OS, CSS, IvRFS and DFS between the CTNU and TRNU groups.@*CONCLUSION@#CTNU technique is a safe and effective surgical option, and further prospective randomized controlled trial is needed for further evaluation.


Sujets)
Humains , Carcinome transitionnel , Néphrectomie , Néphro-urétérectomie , Études rétrospectives , Résultat thérapeutique , Tumeurs urologiques
2.
Chinese Medical Sciences Journal ; (4): 244-248, 2008.
Article Dans Anglais | WPRIM | ID: wpr-302662

Résumé

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of steroid or mycophenolate mofetil (MMF) withdrawal from tacrolimus-based immunosuppressant regimen in renal allograft recipients.</p><p><b>METHODS</b>A cohort of 45 patients following cadaveric renal allograft transplantation were randomly divided into 3 groups based on the regimen of combination of tacrolimus, steroid, and MMF: triple therapy group, steroid withdrawal group, and MMF withdrawal group. During 2 years, survival of patients and allografts, clinical acute rejection, adverse events, hepatic and renal allograft function, and blood lipids were monitored to evaluate the safety and feasibility of steroid or MMF withdrawal after renal transplantation.</p><p><b>RESULTS</b>During two-year observation, steroid or MMF was successfully withdrawn from immunosuppressant regimen based on tacrolimus without any clinical acute rejection. Patient and graft survival rates were 100% and all the renal allografts kept excellent function. Some adverse events occurred and there were no significant differences among groups.</p><p><b>CONCLUSION</b>Withdrawal of steroid or MMF in low-immunological-risk renal allografts treated with tacrolimus-based immunosuppressant regimen can be achieved with no increased risk of acute rejection.</p>


Sujets)
Adulte , Sujet âgé , Humains , Adulte d'âge moyen , Association de médicaments , Rejet du greffon , Traitement médicamenteux , Immunosuppresseurs , Utilisations thérapeutiques , Transplantation rénale , Allergie et immunologie , Lipides , Sang , Acide mycophénolique , Utilisations thérapeutiques , Études prospectives , Stéroïdes , Utilisations thérapeutiques , Tacrolimus , Utilisations thérapeutiques , Transplantation homologue , Allergie et immunologie
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