塞来昔布超前镇痛在经腹前列腺切除术中的应用

目的研究术前口服塞来昔布辅助经腹前列腺切除术后硬膜外自控镇痛（PCEA）的效果。方法40例行经腹前列腺切除术的患者被随机分为两组。术前30min分别口服塞来昔布200mg和维生素C100mg，术后行硬膜外自控镇痛。于术后1、4、8、16、20和24h行VAS评分，并记录PCEA药物用量、按压次数、实进次数和D／D比值，于术后8、16和24h评估下肢运动神经阻滞程度，在术后24h由患者对术后镇痛的总体印象进行评估。结果两组患者的一般情况和术后各时间点的生命体征、VAS评分比较，差异无显著性（P〉0.05）。与C组比较，V组术后4、8、16、20和24h的镇痛药剂量、按压次数、实进次数高（P〈0．05），两组各时间点D／D比值比较，差异无显著性（P〉0.05）。两组患者改良Bromage评分均为0分，差异无显著性（P〉0．05）。两组患者膀胱痉挛发生率和对术后镇痛的总体印象比较，差异无显著性（P〉0．05）。V组有2例（10%）发生恶心、呕吐，而C组无，差异无显著性（P〉0.05）。结论塞来昔布可明显减少经腹前列腺切除术后PCEA的用药量，增加镇痛效果，适于辅助术后硬脊膜外自控镇痛。     

经皮膀胱肿瘤电切术治疗膀胱癌15例分析

目的：探讨经皮膀胱肿瘤电切术的临床应用价值。方法：采用经皮膀胱肿瘤电切术治疗15例男性表浅性膀胱肿瘤患者。结果：均一次手术成功，无膀胱穿孔等并发症发生，术后病理检查均为表浅性膀胱癌(移行细胞癌Ⅰ—Ⅱ级)，术后电切创面及周边位置随机活检未发现肿瘤残留，平均随访18个月，均无原位复发，异位复发3例，其中l例于术后6个月检出，2例于术后9个月检出。结论：对于经传统尿道电切术无法完整切除的膀胱肿瘤，可选择性地通过经皮膀胱肿瘤电切术可达到良好的治疗效果。     

Abdominal complications following ultrasonically guided percutaneous transvesical collection of oocytes for in vitro fertilization

Ultrasonically guided transvesical oocyte aspiration is a safe and efficient method in most in vitro fertilization (IVF) units. It entails very rare severe complications, even though transvesical punctures performed may unintentionally pierce the bowel or even major blood vessels. Nevertheless, mild complications are rarely noted and reported. During a 9-month period 140 ovum pickups were performed: 102 by transabdominal ultrasound-guided puncture and 38 by means of laparoscopy. In the former group, abdominal pain (11.6%), exacerbation of previous pelvic inflammatory disease (2.9%), mild hemoperitoneum (2.9%), urinary tract infections (5.8%) and transient macroscopic hematuria (5.8%) occurred following the procedure. In the latter group, abdominal pain followed in 7.8%; no urinary tract complications were noted in women undergoing laparoscopic ovum aspiration. In spite of the fact that ultrasonically guided transvesical oocyte collection is an atraumatic method with rare complications, they should be reported in order to draw attention to their not-so-rare occurrence and with the aim of their prevention.     

不完全隔离腺窝的耻骨上前列腺切除术(附81例报告)

目的 :探讨改进止血方法、不完全隔离腺窝的耻骨上前列腺摘除术 (TVP)的止血效果和预防膀胱颈口梗阻 (BOO)的作用。方法 :采用缝扎前列腺动脉支 ,不完全隔离腺窝 ,不作膀胱造瘘的改良TVP手术方法治疗前列腺增生症 (BPH) 81例。结果 :81例术中出血 80～ 2 5 0ml,平均 110ml;术后尿液转清时间为 12～ 4 8h ,平均为 2 1h ;全部病人术后排尿正常 ,无BOO和尿失禁并发症 ;国际前列腺症状评分 (IPSS)由术前 30 2± 1 5减至术后 8 6± 1 5 ,生活质量评分 (QOL)由术前 6 0± 0 5减至 1 6±0 5 ,5 1例病者做了尿流率检测 ,最大尿流率 (Qmax)由术前的 (6 4± 1 6 )ml s增至术后 (17 1± 2 0 )ml s,平均尿流率 (AFR)由术前 (3 2± 1 0 )ml s增加至术后 (10 8± 2 0 )ml s ,手术前后四项指标差别均有显著性意义 ,均为P <0 0 5。结论 :改良止血方法、不完全隔离腺窝的耻骨上前列腺切除术能有效防止出血和预防术后BOO ,是一种安全简便 ,疗效满意的治疗方法。     

Transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney morcellation: a proof of concept study

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Until now, the transvaginal approach has been the only method of removing larger specimens from the abdominal cavity using natural orifice transluminal endoscopic surgery. There has been no means of extracting larger specimens in men and the means are restricted even in women, particularly in young women. The present study shows that the difficulty of large specimen retrieval can be overcome, irrespective of the diameter of the chosen port, through natural orifices using morcellation.

OBJECTIVE

• ? To show, in a porcine model, the feasibility of a complete transvesical natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with kidney extraction after morcellation through the same port.

MATERIALS AND METHODS

• ? Transvesical nephrectomy and morcellation were performed in six pigs at Minho University, Braga, Portugal after institutional review board approval.
• ? The transvesical port and the cystotomy were created under the guidance of a ureteroscope, while the remaining steps were done under the guidance of an operating telescope.
• ? Dissection of the renal vessels and kidney was performed using dissection grasping forceps and a vessel sealing system (LigaSure^?; Covidien, Mansfield, MA, USA) and morcellation was done using a Piranha^? morcellator (Richard Wolf, Knittlingen, Germany).

RESULTS

• ? There were no complications related to the creation of transvesical access.
• ? The image provided by the telescope was superior to that of the ureteroscope, especially underwater. Morcellation was quick and effective, with the support of a fixing needle through the abdominal wall, designed to fix the kidney, after laceration of a bowel loop occurred in the first experiment.
• ? It was found that technical improvements are needed to ensure safety of NOTES morcellation.

CONCLUSIONS

• ? Kidney morcellation after nephrectomy, using a natural orifice exclusively, is feasible.
• ? Despite technical limitations, this proof of concept study can be regarded as a potential step towards the application of NOTES in urology.