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To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.
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Female , Humans , Breast Neoplasms/surgery , Mastectomy, Segmental , Organs at Risk , Radiotherapy Dosage , Radiotherapy Planning, Computer-Assisted , Radiotherapy, Intensity-ModulatedABSTRACT
Objective To evaluate the clinical efficacy and security of retroperitoneal laparoscopic ureterolithotomy(RLUL) for impacted ureteral calculi after radical cystectomy and ileal conduit.Methods 5 patients with unilateral impacted ureteral calculi after radical cystectomy and ileal conduit received RLUL were selected,and a retrospective study was performed for manner,duration of surgery,complications and length of stay and other indicators,and the treatment effect was evaluated.Results All procedures were successful and the mean operation time was (82.0±27.7)min,the extubation time was (5.4±1.1)d,hospitalization time was (10.0±2.9)d.Postoperative follow up for 6-48 months,there were no obvious complications.Conclusion The RLUL showed satisfactory availability and security for management ureteral calculi after radical cystectomy and ileal conduit.
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Objective To explore the clinical effect of inlay labial mucosa graft urethroplasty (LMGU) forⅠperiod in the complexity hypospadias.Methods According to the digital table,30 patients with complexity hypospadias were randomly divided into control group and observation group,15 cases in each group.The control group took Ⅰ period operation.The observation group received surgery by stages to complete.Routine urinary diversion during operation was performed after bladder puncture and ostomy,and in the control group,the urethra was placed with self-made 10-14F lateral hole silica gel stent,which was extracted out in the middle of the perineum,left or right.After 12-14d removal postoperative,the urination was observed.The catheter in the observation group was removed after 10 d,the urethroplasty is performed 6 months later.The clinical effects of the two groups were compared.Results In the control group,postoperative urinary fistula in 2 cases(13.3%),urethral orifice in 1 case(6.7%).In the observation group,postoperative urinary fistula in 2 cases(13.3%),6 months postoperatively in patients with urinary fistula to repair fistula was successful,urethral mouth narrow pure line incision.The incidence rate of complication of the control group was 20.0%,which of the observation group was 13.3%,the difference was not significant between the two groups(P>0.05).All cases were followed up for 1 to 2 years,did not occur urinary tract stones,hair growth,oral ulcers,such as the limited mouth complications.The penis was straight,beautiful shape.Conclusion Inlay LMGU Ⅰperiod is suitable for multiple surgery led to the lack of local incidence,urethral plate dysplasia and with severe penis abnormalities such as complexity in patients with hypospadias.The postoperative complications,micturition,penile appearance have no obvious differences compared with the stage,it is worthy of clinical popularization and application.
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Objective To assess the clinical diagnosis and treatment of 21-hydroxylase deficiency nonclassic congenital adrenal hyperplasia (NCCAH) complicated by testicular adrenal rest tumors (TART),thus to improve the recognition of the disease.Methods The clinical data of one patient of NCCAH with TART from our department in 2016 were retrospectively studied,and were analyzed combined with related literature,and the diagnosis was established for treatment.Results The patient was a 17 years old boy.At the age of seven began to appear the pubic hair,voice and other secondary sexual performance.More than their big penis development was significantly higher than their peers.At the age of 12 found bilateral testicular gradually enlarged and attendance.Physical examination:bilateral testicular swelling and a sense of nodules,hard texture,epididymis,normal bilateral varicocele.Laboratory exam indications showed increased levels of progesterone(P),adrenocorticotropic hormone(ACTH),17 hydroxyprogesterone(17α-OHP),aaldosterone(ALD),17-hydroxyl corticosteroids(17-OHCS),17-ketone corticosteroids(17-KS).By the ACTH stimulating test,17α-OHP was increased.Bilateral testes MRI:irregular bilateral testes,signal,see in space.Enhanced scan lesions uniform reinforcement,germ cell tumors to row.Adrenal CT:bilateral adrenal hyperplasia.Testicular biopsy:testicular adrenal genital syndrome tumor.Genetic testing:CYP21A2 heterozygous mutations.The above test results were diagnosed of NCCAH 21-OHD with TART.The patient was orally given 10mg/d prednisone 2 time.3 months after treatment,the 17α-OHP,CO and sex hormones returned to normal.Review the adrenal CT showed significant bilateral adrenal shrink,Pa/testis tubercle was narrow,but not obvious.Semen routine still suggested no sperm,considering the TART medical treatment effect was poor.Hence,further line tumor removed,followed up for 3 months without tumor recurrence at present.Conclusion NCCAH complex and varied clinical manifestations and hidden.Not easy to be noticed by patients and clinicians.For the early childhood in pubic hair growth accelerated leading to premature epiphyseal fusion and make the adult height is short stature consideration should be given to the disease.Further lines of sex hormones,adrenal related endocrine examination,genetic testing and ACTH stimulating test,etc.If concurrent bilateral testicular nodules,should consider to merge TART may.Testicular biopsy can be clear.Treatment can choose according to TART classification of glucocorticoid (a hormone steroid) or surgical treatment,concrete scheme should be individualized.
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Objective To assess the clinical efficacy of ultrasonography guidance percutaneous nephrolithot-omyⅠ period combining pneumatic ultrasosonic and holmium laser lithotrips of complex renal calculi.Methods Patients were under the general anesthesia in lithotomy position.By cystoscope first to one side retrograde insertion F5 ureteral catheter,the position to prone position was changed.Under ultrasonography guidance puncture target after the success of the calyx,fascia dilator gradually expanded from F8 to F20 channel was established.Then percutaneous nephroscope combining pneumatic ultrasosonic and holmium laser lithotripsy were administrated.Results One sided single channel was 92 cases,one sided dual channel was 11 cases,one sided three -channel was 1 case.On both sides single channel was 13 cases,one side of the dual channel and other side of the single channel was 3 cases.The operation time was (72 ±24)min.Intraoperative bleeding was in 50 -150mL,with an average of 80mL,and there's no intraoper-ative blood transfusion.2 cases of postoperative had secondary bleeding,in which 1 case remitted after non -operative treatment,the other case was treated in DSA downward super selective renal artery embolization to stop the bleeding. Postoperative hospital stay was 7 -14d,with an average of 10d.There were no septic shock,water uptake,water intoxi-cationand complications such as pleural effusion.One week after the CT,stones free rate was 91.7%(110 /120),in which 10 cases of residual stone with diameter <5mm,needn't surgery removed again.They were treated with oral platoon stone drugs,drinking lots of water and a moderate amount of sports such as processing.All cases were followed up for 6 months to 18 months,with no urinary tract infection,stone recurrence and the long -term complications such as perinephric space effusion.Conclusion As long as establish proper percutaneous renal channel,with intraoperative operating norms,combining pneumatic ultrasosonic and holmium laser,ultrasonography guidance percutaneous nephro-lithotomy Ⅰ period clear renal calculi is completely can be done.And it can shorten operation time,and has clear renal calculi with high efficiency,small trauma and less long -term complications.It is safe and effective,and worthy of clinical popularization and application.
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To explore the clinical ,pathological and immunohistochemical features of carcinoma with multi-directional differentiation derived from junction of bladder and prostate .We collected clinical data and tissue samples of three typical cases of carcinoma from our hospital .Routine preparation of slides and immunohistochem-ical methods combined with clinical data and pathological changes analysis were adopted .We found that all 3 ca-ses occurred in the elderly lesions involving the bladder and prostate .Dysuria was the main common symptom .All the cases had a history of chronic inflammation in urethral and prostate gland .The following up data showed that survival time in two of them were no more than 15 months.The third patient without chemotherapy who took drugs of bicalutamide,enantone and pamidronate still was alive after 28 months.The pathological changes of these cases had the common features with diversity .They all showed the structure with nests ,papillary,solid,adenoid,single or syncytial cells .The nuclear of cancer cell was enlarged with hyperchromatic feature .The mitotic figures were easily found.The metaplasia and atypical hyperplasia of prostate were all found .The immunohistochemistry results showed positive results for HCK,LCK,p53,p63,PSA,P504S and negative for vimentin and S -100.The average proliferation index of Ki-67 was 77%.
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Objective To approach the clinical curative effect of retroperitoneal laparoscopic adrenalectomy.Methods 120 adrenal tumors patients clinical data of urinary surgery in our hospital were analyzed,who was divided into detection group(80 cases) and control group(40 cases).Results The operation time,bleeding volume,postoperative exhaust time,hospitalization time,incision infection,pulmonary infection,intestinal injury of detection group were lower than those of control group (t =5.59,21.17,26.32,6.01,x2 =7.79,7.79,5.13,all P ＜ 0.05).Conclusion Retroperitoneal laparoscopic adrenalectomy has some advantages:the small incision,less trauma,faster postoperative recovery,less complication,,which was worth of applying.
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Objective To explore the clinical effect of laparoscopic radical nephrectomy by retroperitoneal in 65 cases.Methods 65 patients who received retroperitoneal laparoscopic radical nephrectomy were selected as the observation group,and their clinical data were analyzed.At the same period,S0 patients treated by open operation were selected as the control group.The clinical effect was compared between the two groups.Results The operation time,intraoperative blood loss,hospital stay,incision infection,pulmonary infection,hypercapnia,intestinal injury of observation group were lower than those of control group (t =7.60,8.38,8.83,x2 =8.33,6.19,4.08,4.08,all P ＜0.05).The positive margin rate,local recurrence rate,distant metastasis rate of two groups were not significantly different (P ＞ 0.05).Conclusion Laparoscopic radical nephrectomy by retroperitoneal has advantages of small wound,quicker recovery,less complications and good prognosis,which is worthy of clinical application.
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Objective To evaluate clinical efficacy of retroperitoneal laparoscopic adrenalectomy in patients with adrenal disease.Methods 21 cases of adrenal disease undergoing retroperitoneal laparoscopic adrenalectomy from Jun.2006 to Oct.2010 were retrospectively reviewed.Results All operations were performed successfully except 2 cases were converted to open surgery due to peritoneal rupture,which resulted in difficult exposure of retroperitoneal cavity.The operation time ranged from 55 to 300 minutes,with 90 minutes as the medium.Blood loss volume ranged from 10 to 100 ml during operation (30 ml as the medium ).No blood transfusion was given.No complication such as massive hemorrhage,infection,abdominal visceral injury etc.occurred.19 patients were treated successfully and followed up from 3 to 55 months with 12.3 months as the medium.No tumor recurrence and metastasis was found in the 19 cases.Conclusion Retroperitoneal laparoscopic adrenalectomy has advantages of high safety,less complications and satisfactory efficacy in patients with adrenal diseases.
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Objective To investigate the safety and effectiveness of transurethral bipolar plasmakinefic resection in treating urethral stricture. Methods Totally 46 patients with urethral stricture were treated with transurethral bipolar plasmakinetic resection, and they were followed up for 3～12 months to observe the clinical effects. Results The segments of urethral scar were accurately incised and resected in all the 46 cases,24～26F bougies could pass through the urethra smoothly, and miction should be kept unobstructed. Totally 41 cases were followed up postoperatively, the maximal flow rate(Qmax) was ( 18.6±4.1 ) ml/s, which was obviously ameliorated as compared with that before operation(t=14.25, P＜0.05);sexual function had no obvious changes before and after operation;no serious complications of urethral massive bleeding, urinary incontinence, fistula of urethral diverticulum,urethral perforation, rectal injury, etc. was observed. Conclusion Transurethral bipolar plasmakinetic resection is an effective method for treating urethral stricture, because it has fewer complications, faster postoperative recovery and lower recurrence.
