The clinical application of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy / 中华泌尿外科杂志

Objective To discuss the effect and value of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy as urinary diversion after radical cystectomy.Methods The clinical data of 12 cases(7 males and 5 females)with bladder cancer during January 2016 and September 2017 were retrospectively analyzed.The median age was 77 years (range 75-83),and the course of the disease was 5 days to 2 years.11 cases had gross hematuria,5 cases had frequent and urgent urination,1 case had lower abdominal pain,and 1 case had no obvious clinical symptoms.9 cases had a history of transurethral prostatic resection.8 cases had a complication of hypertension,5 cases had a complication of diabetes,7 cases had a complication of cardiovascular and cerebrovascular diseases,and 6 cases had a complication of anemia.The ASA level was 3 in 9 cases and was level 4 in 3 cases.All the patiants were diagnosed of bladder urothelial carcinoma by biopsy.There were 8 cases with T3 tumor and 4 cases with T4.All the patients underwent laparoscopic radical cystectomy under general anesthesia,and wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy was used for urinary diversion.Take a segment of 3-5 cm wide pedicle omentum,which is covered from the distal end of the ureter to the end,and use a 4-0 absorbable line to fix the omentum and ureteral outer membrane,and then perform ureterocutaneostomy.The incidence of postoperative anastomotic stenosis,hydronephrosis and wound infection were observed.Results All the operations were performed successfully without obvious operative complications.The mean operating duration was125 (95-217) mins,estimated volume of blood loss 120 (50-600)ml.5 days after surgery,1 patient developed incision infection,which was cured by strengthening anti-infection drug therapy and wound dressing.No complications such as urinary fistula,intestinal fistula and peripheral hernia occurred.No death was reported during perioperative period.Single J tube was removed 1-3 months after surgery.Within a follow-up of 12 (3-23) months,1 case died of cerebral infarction 3 months after surgery,1 case occurred papilla light constriction without special treatment,no ureteral stenosis and necrosis cases and there were no cases of hydronephrosis.All the patients were satisfied with the quality of life after surgery.Conclusions Wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy is simple,safe and effective as urinary diversion after radical cystectomy.

Experience in management of high-risk patients of benign prostatic hyperplasia treated with transurethral resection of prostate / 中华泌尿外科杂志

Objective To investigate the experience in management of the high risk benign prostatic hyperplasia (BPH) patients in order to improve the safety of the operation.Methods The high-risk factors of 115 patients with BPH who had been treated with transurethral resection of prostate (TURP) were analyzed.The blood pressure of hypertensive patients should be controlled below 140/90 mm Hg.The patients with myocardial infarction should be in stable condition for more than 6 months.Smoking cessation,oxygen inhalation,and pulmonary function training should be carried out during the perioperative period in patients with chronic obstructive pulmonary disease,correct expectoration methods and rational use of antibiotics were also needed to improve the maximum amount of pulmonary ventilation to more than 70％.The blood-glucose of diabetic patients should be controlled below 8 mmol/L by insulin.Catheter was indwelled in patients with chronic obstructive renal insufficiency for more than 2 weeks so that the blood Cr could be below 130 μmol/L.Anticoagulant therapy should stop at least 5 days before surgery.Patients were encouraged to have physical training early after surgery and to have ankle stretch movement when they recovered form anesthesia,and pressure cycle drive therapeutic apparatus were also used to prevent deep venous thrombosis.Results All the patients tolerated TURP safely.Operation time was 30 to 60 min,the weight of the resection prostate tissue was 12 to 37 g,blood loss was 80 to 150 ml,and catheterization time was 3 to 7 days.The overall incidence of complications was 1.7％.There were 2 cases with deep venous thrombosis,who recovered after anticoagulant therapy.There were no pulmonary infection,bleeding,TUR syndrome,and other complications.Conclusion Correct analysis and effective management of the perioperative risk factors in high-risk BPH patients treated with TURP can improve the safety of the operation and reduce the complications.

Prevention and treatment of splenic injury during the urological surgery / 中华泌尿外科杂志

Objective To discuss the cause,treatment and prevention of splenic injury during the urological surgery.Methods The clinical data of 16 cases with splenic injury in operation for renal and adrenal tumors in 496 cases were retrospectively analyzed.Nine cases were left radical nephrectomy,3 cases were left renal hamartoma enucleation,4 cases were left adrenal tumor resection.Damage located at outer edge of the spleen in 8 cases,the splenorenal ligament in 6 cases,and the splenic hilum in 2 cases.In these 16 cases,14 patients spared the spleen (Ⅰ Grade injury 8 cases,Ⅱ grade 6 cases).The injuryed spleen was directly pressed with hemostatic gauze in 3 cases; 5 patients used coagulation,bonding,hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injury used U-shaped suture and coated with fibrin glue,then compressed with hemostatic gauze to stop bleeding; 2 cases of grade Ⅱ injuries with the greater omentum stitched into the seam,sprayed biological glue,were compressed with gelatin sponge; 2 cases of grade Ⅱ injury underwent splenic artery branch ligation.The other 2 cases (1 Ⅱ grade and 1 Ⅲ grade) underwent splenectomy.Results All of the 16 patients were cured and followed up for 6 months to 5 years.There was no delayed bleeding of spleen and splenic dysfunction.One patient died of tumor recurrence 6 months after operation.Conclusions Splenic injury is a common complication during urological surgery,especially the tumor is large or adhered to spleen in the upper pole of left kidney.Once spenic injury occurs,doctors should choose the right treatment plan according to surgical injury,and try to save the spleen.

The safety and efficacy of partial nephrectomy in the treatment of renal tumors / 中华泌尿外科杂志

Objective To report the safety and efficacy of partial nephrectomy (PN) in 56 patients with renal tumors. Methods A retrospective analysis was performed for 56 patients who were treated with PN.Patients were divided into two groups according to the occlusion time.The occlusion time for Group 1 was≤30 min in 28 cases,and Group 2＞30 min in 28 cases.All patients underwent pre-and post-operation 99Tcm-diethylenetriamine pentoacetic acid renal scintigraphy, to determine the renal glomerular filtration rate (GFR).The GFR values, amount of blood loss during operation,operative time,postoperative hospital stay and the complications rate were compared between the two groups prior to surgery and one week and six months post-surgery.All patients were followed-up.Results The average follow-up time was 36 (30-48) months.The overall survival rate and tumor recurrence-free survival rate were 100% and 98%.There was no significant difference between vessel clamp time≤30 min and＞30 min in the amount of intraoperative blood loss,operative time,postoperative hospital stay and complications rate,P values were 0.266,0.487,0.879 and 1.000.The preoperative and 1 week postoperative GFR values of the two groups were (42.9±4.9) and (34.2±4.9),(42.8±5.6) and (30.4±5.2) ml/min.The difference was significant(P=0.007).The GFR values were (41.2±4.3)ml/min at 6 months after surgery for Group 1,compared with that before surgery,but the difference was not significant (P＞0.05).While the GFR values were (38.1±5.0) ml/min for Group 2,and the GFR for Group 2 did not recover to the preoperative level (P=0.001). Conelusions PN for renal tumors could be a safe and effective treatment option.The damage on renal function could be minimal when the renal artery clamping time is controlled to within 30 min.

Trans-activator of transcription protein transduction domain mediated cell membrane penetration of HBcAg / 中华传染病杂志

0bjective To observe the cell membrane penetration of protein transduction domain (PTD)-HBeAg fusion protein in vitro.Methods The sequence of trans-activator of transcription (Tat)-PTD was synthesized and the whole HBcAg gene was amplified by polymerase chain reaction (PCR).Overlap extension PCR was employed to fuse Tat-PTD and whole HBcAg gene.Then the fusion gene was cloned into prokaryotic expression vector pMAL-c2X.The correct vector was transformed into E.coli Rosetta-gamiTM 2(DE3),and the protein was induced by isopropyl β-D-1-thiogalactopyranoside(IPTG).Western blot was used tO identify the protein. Furthermore,the fusion protein PTD-HBcAg was purified by affinity chromatography.HBcAg protein expressed using the same methods was employed as eontr0l.The purified protein was added tO HuH-7 cell culture,then the transduction of PTD-HBcAg and HBcAg in cells were detected by indirect immunofluorescence assay (IFA).Results The fusion protein was effectively expressed in E. Coli and purified by affinity chromatography.Both purified PTD-HBcAg and HBcAg could be recognized by HBeAg monoclonal antibody in Western blot analysis.IFA visualization showed that PTD-HBeAg could be introduced into HUH-7 ceils while HBcAg only could not be detected in cells.Conclusions PTD-HBcAg fusion protein can be expressed effectively and purified in prokaryotic expression system.PTD could mediate HBcAg penetrating eell membrane into the cells.