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Objective To investigate the clinical therapeutic effect of sigmoid neobladder after laparoscopic radical cystectomy in the treatment of invasive bladder cancer .Methods 21 patients with invasive bladder cancer accepted sigmoid neobladder after laparoscopic radical cystectomy and pelvic lymphadenectomy .The postoperative complications and clinical therapeutic effect were analyzed .Results All surgeries were completed successfully .The operation time was (245 ±125) min,blood lost was (98 ±45) mL.All the 21 patients were followed up for 3-24 months,mean of 12 months.Both side mild hydronephrosis in 6 cases (28.6%) and unilateral hydronephrosis in 1 case(0.5%).Average bladder reservoir was (548.8 ±221.6)mL,the maximum bladder pressure during the new bladder urine storage period was (2.26 ±0.24) kPa,the maximum bladder pressure during voiding period was (6.18 ±0.29) kPa,volume of residual urine was (87 ±52) mL.The mean maximum uroflow rate was (83.2 ± 5.6)mL/s.The continence of micturition was 90.4% in day-time and 76.1% in night-time.1 case had urethral stricture and got better after the urethral dilatation .Conclusion The sigmoid neobladder after laparoscopic radical cystectomy has more reliable results,without serious postoperative complications and patients with high quality of life after operation.This operation may be applied in clinical practice .
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Objective To compare the clinical efficacy of subinguinal microsurgical and single -port laparoscopic high ligation in the treatment of varicocele.Methods 218 patients with varicocele were enrolled in this study.According to the digital table,they were randomly divided into two group.148 cases were treated by subinguinal microscopic varicocelectomy(microscopic group),70 cases were treated by single -port laparoscopic high ligation varicocele(single -port laparoscopic group).Postoperative follow up was 3 -24months.The operative duration,length of hospital stay,hospitalization expense,postoperative complications and semen quality parameters were compared between the two groups.Results There were statistically significant differences in operative duration and hospitalization expense between the two groups(all P 0.05).In the 218 followed -up patients,the sperm concentration and motility (grade a + b sperm)all significantly improved,which of the microscopic group and single -port laparoscopic group preoperation were (19.1 ± 8.2)×106 /mL,(18.2 ±7.9)×106 /mL and (22.7 ±7.8)%,(21.6 ±8.9)% respectively,which at 3 -6 months after operation were (56.2 ±10.8)×106 /mL,(45.8 ±12.9)×106 /mL and (58.8 ±9.7)%,(44.6 ±10.7)%, there were statistically significant differences compared with preoperation (t =6.227,9.579,all P <0.05 ). Conclusion The surgical methods in the treatment of varicocele can improve the quality of patients,but microscopic group is obviously better than single -port laparoscopic group in improvement of semen quality parameters,safety, patient -based compliance and economy.
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Objective To summarize the clinical experience and analyze the efficacy of transurethral plasma needle electrode en bloc resection for bladder cancer.Methods From February 2015 to August 2016,a total of 26 patients,including 21 males and 5 females,with bladder cancer received transurethral plasma needle electrode en bloc resection of bladder tumor.Their age ranged from 42 to 75 years,mean (56 ± 13) years.The size of tumor ranged from 1 to 4 cm,mean (2.3 ± 1.6) cm.The solitary tumor was found in 19 cases and multiple tumors were found in 7 cases,including 2 tumors in 5 cases,3 tumors in 2 cases.In 6 cases,the tumor located in the lateral bladder wall.All the pre-operative biopsy showed the urethelial carcinoma in all cases,No bladder extravasion or upper urinary tumor was noticed in the CTU before surgery.By using the electrode needle tip inserted into the bladder mucosa,blunt release or cut the tumor bases until the deep muscularis or the serosal layer,complete removal of the tumor.The specimen was removed from the bladder and sent to the pathological examination.The operation time,the volume of blood loss during operation,surgical complications,pathological diagnosis and the wounds recovery were recorded and analyzed.Results All surgeries were undergone successfully.Totally 35 tumors were resected with diameter of 1.0-4.0 cm,mean (2.3 ± 1.6)cm.The estimated blood loss was less than 10 ml.The operative duration ranged from 20 to 50 min,mean (30 ± 16)min.The duration for removing the single tumor ranged from 5 to 25 min.No obturator nerve reflex were observed during surgery.No blood loss and complications occurred after operation.All patients received 30 mg pirarubicin bladder instillation chemotherapy immediately and no adverse reaction was noticed.Postoperative pathological stages of enrolled cases were distributed as 33 cases of T1G1 staging,2 cases of T1G3 staging.No positive margin was observed.3 months after operation,cystoscopy showed that the wound healed well.A total of 26 cases followed up for 3-10 months (mean 6.0 ± 2.3 months).No one developed recurrence.Conclusions Transurethral plasma needle electrode en bloc resection of bladder tumor would reduce the incidence of complications and obturator nerve reflex.It can provide sufficient specimens for histological diagnosis.
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Objective To investigate the clinical effect of prenatal B ultrasound in the diagnosis of fetal hydronephrosis.Methods 105 pregnant women with advanced hydronephrosis in the Department of Ultrasound of our hospital were selected as the research subjects from November 2013 to September 2015.Grignon classification was performed according to the first B ultrasound results,including 2 cases of level Ⅴ,3 cases of level Ⅳ,6 cases of level Ⅲ,30 cases of level Ⅱ and 64 cases of level Ⅰ.The hydronephrosis was reexamined by ultrasonography within the postnatal 24h.Meanwhile,the B ultrasound reexamination was performed in the postnatal 1,3,6 and 12 months.The change of hydronephrosis was observed.Results Among 105 cases of fetal hydronephrosis,64 cases of kidneys at level Ⅰ were improved in the postnatal 6 months,including 46 cases during 1 month and 16 cases during 3 months;30 cases of kidneys at level Ⅱ were improved during 6 months,including 24 cases during 3 months;6 cases of kidneys at level Ⅲ were progressing;Among 3 cases,2 cases of hydronephrosis at level Ⅳ underwent the surgery and 1 case was progressing;2 cases of hydronephrosis at level Ⅴ underwent the surgery.98 cases of hydronephrosis were physiological (93.33％).2 cases of hydronephrosis progression at level Ⅲ required to follow up.MRU examination suggested no surgical indication at present;1 case belonged to the hydronephrosis progression at level Ⅳ.The family members asked to be reviewed.Conclusion The fetal hydronephrosis can be classified accurately through the prenatal B ultrasound examination.The prenatal B ultrasound examination is the best method for the diagnosis and prognosis of fetal hydronephrosis.
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Objective To investigate the micro -channel percutaneous nephrolithotomy under ultrasound guidance in clinical studies of renal calculi in non -dilated collecting system.Methods Clinical data of 126 patients with renal calculi in non -dilated collecting system treated by ultrasound -guided percutaneous nephrolithotomy microchannel were retrospectively analyzed.Ureteroscopy up to the renal pelvis or ureter segment,zebra guide wire was placed along the guide wire indwelling ureteral catheter end connected to the blood transfusion needle while external saline suspension 100cm.Ultrasound -guided puncture target cup,established 16 -18F channel percutaneous nephro-lithotomy,ureteroscopy downlink percutaneous nephrolithotomy lithotripsy.The clinical data of operation time,stone clearance rate,blood loss,complications were analyzed.Results 124 patients with successful puncture,puncture fail-ure in two patients,conversion to open surgery.118 cases of successful implementation of a single -channel stone, nine cases of postoperative residual stones was found,again two stone surgery in 6 cases,3 cases refused surgery again;six cases were due to stones larger load,operation time exceeded 2h,to 2 stage of stone surgery in 4 cases, 2 cases changed to standard channel.Operation time was 30 -150min,average 78min.A stone clearance rate was 87.3%,summarize stone clearance rate was 95.2%(118 /124).Postoperative hemoglobin level decreased to (16.0 ± 7.6)g/L,7 patients with postoperative bleeding more blood transfusion 400 -800mL,none embolization.4 cases of postoperative fever,septic shock in 1 case,1 case of pneumothorax.Conclusion The micro -channel percutaneous nephrolithotomy under ultrasound guidance in the treatment of renal calculi in non -dilated collecting system is safe and feasible,it is the preferred method of treating renal calculi in non -dilated collecting system.
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Objective To compare the efficacy of three endoscopic surgery in impacted upper ureteral calculi treatment.Methods 218 patients with impacted upper ureteral calculi were treated with minimally invasive percutaneous nephrolithotomy (MPCNL),transurethral ureteroscope lithotripsy(URL)and retroperitoneal laparoscopic urerolithotomy (RLU)respectively.The operation safety,efficacy and complication were compared in the three groups.Results In the MPCNL group,URL group,RLU group one success rate of lithotripsy were 100.00%,85.19%,100.00% respec-tively.The mean operative time were (76.35 ±16.20)min,(46.26 ±15.30)min,(89.20 ±19.60)min respectively. Decreased hemoglobin values were (22.24 ±8.63)g/L,(4.15 ±1.89)g/L,(10.68 ±4.55)g/L respectively.The stone -free rates of one month postoperation were 96.32%,79.59%,100.00%.Length of hospital stay were (8.56 ± 2.13)d,(6.58 ±1.76)d,(9.79 ±2.14)d,respectively,the differences were statistically significant(t/χ2 =36.916, 27.629,all P <0.05).Conclusion MPCNL and URL for impacted upper ureteral calculi is safety and has good efficacy and less complications,but the MPCNL is recommended the first choice,some cases can try URL.