经尿道等离子电切术和耻骨上前列腺摘除术治疗良性前列腺增生的疗效评价

目的 评价经尿道等离子前列腺电切术和耻骨上前列腺摘除术治疗良性前列腺增生的疗效.方法 回顾分析117例前列腺增生患者用经尿道前列腺电切术(TUPKRP)和耻骨上前列腺摘除术(SPPC)的临床疗效,比较两组的手术时间、术中出血量、住院时间、疗效及并发症等情况.结果 TUP-KRP组比SPPC组手术时间短、出血量少、住院时间短、留置导尿管时间短,两组手术后患者主、客观症状均明显改善.结论 TUPKRP组疗效与SPPC组接近,但创伤小,术后恢复快,住院时间短,作为一种腔内微创手术可以取代SPPC手术治疗BPH.     

经膀胱途径精囊肿块切除术(附5例报告)

目的:探讨经膀胱途径在精囊疾病外科治疗中的应用。方法:本组5例男性患者,年龄45～69岁,平均51岁。临床症状:3例主要表现为尿频、尿急、排尿不畅等下尿路症状,其中1例同时伴有排便不畅,大便变细。1例因血精就诊,1例因下腹部及会阴部隐痛不适,B超检查发现右侧精囊肿块入院。病程2～18个月,平均9个月。经直肠指检、直肠B超、盆腔CT及MRI等检查诊断为左侧精囊肿块2例,右侧3例,肿块长径3～10cm,平均5cm。5例均行经膀胱途径精囊肿块切除术。结果:5例手术均获得成功,平均手术时间75min,平均出血量140ml,术后平均住院时间10d。病理报告:精囊囊肿伴感染2例,精囊囊腺瘤1例,精囊低度恶性分叶状肿瘤1例,前列腺组织1例。随访时间3～72个月,术后症状消失或明显改善。复查B超及CT未见复发。结论:经膀胱途径精囊肿块切除术,手术切口小,视野清晰,操作简便,易于开展,是精囊疾病外科治疗的有效方法。     

耻骨上经膀胱单孔机器人前列腺癌根治术的初步尝试

目的:总结耻骨上经膀胱单孔机器人辅助腹腔镜前列腺癌根治术的初步经验。方法:选择3例前列腺癌患者,完成单孔机器人辅助腹腔镜耻骨上经膀胱入路前列腺癌根治术。直视下建立并将单孔通道置入膀胱。手术过程包括沿前列腺边界环形切开膀胱颈,沿前列腺包膜分离并切除输精管、精囊,结扎前列腺侧韧带,不缝扎阴茎背深静脉复合体(DVC),离断前列腺尖部,切断尿道,行尿道膀胱颈吻合。结果:3例患者手术均由耻骨上经膀胱入路在单孔机器人辅助腹腔镜下完成。前列腺体积分别为16 mL、22 mL、43 mL。手术时间分别为90 min、120 min、150 min。术中出血量分别为50 mL、150 mL、200 mL。术中不留置膀胱造瘘管及伤口引流管,术后7～9 d拔除导尿管。拔管后患者完全控尿。结论:耻骨上经膀胱单孔机器人前列腺癌根治术对早期前列腺癌患者安全、有效,值得进一步推广。     

耻骨上经膀胱前列腺摘除术45例中西医结合临床观察

目的：探讨耻骨上经膀胱前列腺摘除术的中西医结合治疗临床效果。方法：随机选取来我院行耻骨上经膀胱前列腺摘除术患者45例,术后经由中西医结合对症治疗,观察患者术后并发症及治疗效果。结果：45例患者术后排尿均恢复正常,膀胱痉挛不同程度出现;3例尿培养呈阳性,对症治疗好转;2例出现尿道狭窄,尿道扩张后恢复正常;2例出现假性尿失禁,对症治疗后好转。结论：精细的手术、及时的处理、中医药的干预能有效减少前列腺手术术后并发症。     

Same problem,different approaches: transvesical and extravesical laparoscopic vesicovaginal fistula repair—case report

Vesicovaginal fistulas (VVaFs) are relatively uncommon in developed countries but with devastating consequences for the women suffering them. Conservative management has a low response rate. The surgical repair is a technically demanding procedure. Transvaginal, open transabdominal or laparoscopic (pure or robot-assisted) approaches have been described with similar post-operative results. We report two real-life cases of VVaF after surgery of benign gynaecological conditions, both presenting with continuous urinary incontinence and repaired with laparoscopic surgery. The first case had a simple tract above the trigone and was managed with an extravesical approach. The second is a complex case with multiple fistulous tracts that required a transabdominal-transvesical approach (modified O’Connor technique). Both patients have their fistula closed and are continent after surgery with a mean follow-up of 9 months. Given the lack on evidence for the selection of the best approach, it is important to report the outcomes with the different surgical techniques in both simple and complex fistulae. A pre-operative exhaustive study of the location and number of fistulous tracts is essential, as well as selecting the technique which best allows tissue dissection and tension-free suture to get a successful closure. Therefore, knowledge of several procedures and approaches is mandatory when dealing with this disorder.     

经膀胱和胃联合路径切除猪肾脏的初步尝试

目的探讨联合经膀胱和胃路径进行猪肾脏切除术的可行性,总结操作经验。方法选取3只雌香猪,在输尿管硬镜下剪开膀胱前壁,并置入自制经膀胱Trocar,建立经膀胱路径;在输尿管镜引导下,利用高频针状电刀穿刺胃壁,用球囊扩张后导入胃镜。在胃镜的引导下,经膀胱Trocar放入腹腔镜超声刀、剪刀、钛夹,完成肾切除术。结果成功进行3只雌香猪6个肾脏的切除术,手术时间(132±10.5)min,无明显出血,无明显并发症发生。第1例雌香猪的右肾静脉在用超声刀离断时出现出血,以钛夹处理,后5例肾脏血管处理前均以钛夹阻断后剪刀离断。结论联合经膀胱和胃联合路径可顺利切除猪肾脏,但术后未取出肾脏和关闭膀胱及胃壁穿刺口,仍需进一步研究改进。     

Transvesical robotic radical prostatectomy

OBJECTIVE

To report the technical feasibility of performing transvesical robotic radical prostatectomy (TRRP) in a cadaver.

MATERIALS AND METHODS

TRRP was performed in two fresh male cadavers (prostate volume 46 and 30 mL). In the first procedure we used four laparoscopic transvesical trocars and in the second a single‐port device was placed percutaneously into the bladder. Pneumovesicum was established in both cases and the da Vinci‐S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was used for the TRRP. All steps of the procedure, including dissection of the seminal vesicles and vas deferens, ligation of prostatic pedicles, release of neurovascular bundles, apical dissection, urethral transection, and urethro‐vesical anastomosis, were done transvesically and robotically. Real time transrectal ultrasonography monitoring was used in the first cadaver.

RESULTS

Both procedures were technically successful transvesically with no need for additional ports or conversion to standard laparoscopy. The operative duration for the multi‐port procedure was 3 h and for the single‐port procedure was 4.2 h. Clashing of the da Vinci arms was the primary technical difficulty with the single‐port procedure, but did not occur in the multi‐port procedure.

CONCLUSIONS

TRRP under pneumovesicum is technically feasible using multiple‐port or a single‐port approach in the cadaver. The clinical application of this novel approach is imminent. Further refinement of technique and instruments might lead to an increasing role of percutaneous intraluminal surgery in various surgical disciplines.     

输尿管囊肿的诊断和处理（附17例报告）

目的总结输尿管囊肿的诊治经验。方法对住院手术治疗的17例输尿管囊肿患者临床资料进行分析。结果所有患者均于手术前明确诊断,其中,膀胱镜诊断准确率100%,IVU诊断率84%,B超诊断率63.2%,开放手术13例,经尿道输尿管囊肿切开术4例。17例患者术后随访,疗效确切。结论对囊肿直径≤3.0cm宜行经尿道电切术,而对直径〉3.0cm及合并严重的重复肾、重复输尿管畸形者应采用开放性手术,并行输尿管再植抗返流。