荧光原位杂交技术检测膀胱尿路上皮癌尿液的临床应用研究

目的：评价荧光原位杂交技术（fluorescence in situ hybridization,FISH）检测膀胱尿路上皮癌患者尿液的应用价值。方法：收集我院2007年10月-2009年4月期间77例膀胱尿路上皮癌患者、43例非尿路上皮癌的血尿患者（通过膀胱镜检查排除尿路上皮癌）和泌尿系良性疾病患者的晨尿,同时行FISH检测和尿脱落细胞学分析,再结合病理结果将两种方法进行比较。FISH检测使用荧光标记DNA探针混合物与细胞核上3、7、17号染色体着丝粒和9p16位点进行杂交。结果：FISH总的敏感度和特异度分别为89．6％和95．3％,G1-3各级的敏感度分别为76．1％、90．9％、100％,Ta、Tis、T1、T2-4各期的敏感度分别为55．6％、100％、88．9％、97．4％。尿脱落细胞学分析总的敏感度和特异度分别为37．7％和93．0％,G1-3各级的敏感度分别为0％、33．3％、78．3％,Ta、Tis、T1、T2-4各期的敏感度分别为11．1％、100％、14．8％、56．4％。结论：FISH比尿脱落细胞学提高了膀胱癌患者检测的敏感度,而特异度两者相近。FISH使低级别浅表型膀胱癌的准确率明显提高,几乎能检测出所有高级别的浸润型膀胱癌。相对于尿脱落细胞学,FISH检测更佳。     

Argon beam coagulation for post-tonsillectomy hemostasis.

OBJECTIVE: The study goal was to evaluate the effectiveness of argon beam coagulation (ABC) in the prevention of post-tonsillectomy hemorrhage. ABC provides monopolar coagulation by arcing ionized argon gas to the target tissue; it is not a laser. METHODS: Two consecutive studies were performed as follows. In the first, a retrospective analysis of post-tonsillectomy bleeding in 344 patients was conducted. Final tonsil fossa hemostasis was achieved with ABC (257 patients) or with electrocoagulation (EC) (87 patients). In the second, a prospective, randomized, patient-blind study of post-tonsillectomy bleeding was conducted in 88 patients. Final hemostasis was achieved using ABC in one fossa and EC in the other fossa, with the sides chosen at random. RESULTS: Post-tonsillectomy hemorrhage was defined as the expectoration of fresh blood, as opposed to blood-streaked saliva. The rates of bleeding for the 2 studies were as follows. In study 1 for EC, 20% for adults, 6.5% for children, and 10.3% for total; for ABC, 4.7% for adults, 0.6% for children, and 1.9% for total. In study 2 for EC, 19.2% for adults, 1.6% for children, and 6.8% for total; for ABC, 7.7% for adults, 0.0% for children, and 1.1% for total. The rates of hospital admission for observation or reoperation to treat the bleeding in study 1 for EC were 8% for adults, 6.5% for children, and 6.9% for total; for ABC, 1.2% for adults, 0.6% for children, and 0.7% for total. Corresponding rates for study 2 for EC were 15.4% for adults, 1.6% for children, and 5.7% for total; for ABC, 3.8% for adults, 0.0% for children, and 1.1% for total. CONCLUSION: ABC is more effective than EC for hemostasis after tonsillectomy. The costs of ABC use vs the savings achieved from reduced bleeding are discussed.     

Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II--Clinical aspects and recommendations

We reviewed the incidence, risk factors, and clinical features of thromboembolic and ischemic events associated with diagnostic cerebral angiography, endovascular treatment of aneurysms using coils or balloons, angioplasty and stent placement to treat extracranial carotid artery stenosis, and embolization of arteriovenous malformations using glue or other embolic agents. We performed a cumulative analysis to determine the frequency and characteristics of these events and a subset analysis (whenever possible) to determine the benefits of various strategies for complication avoidance. Of the 1,547 patients who underwent Guglielmi detachable coil treatment, thromboembolic events were observed for 127 (8.2%), consisting of asymptomatic events for 12 patients, transient ischemic attacks for 29, and strokes for 86. The outcomes for the 86 patients with strokes were categorized as full recovery for 15, good recovery for 27, partial recovery for 19, no recovery for 11, death for 12, and undetermined outcome for 2. Of the 834 patients who underwent carotid angioplasty and stent placement, thromboembolic events were observed for 73 (8.8%), consisting of transient ischemic attacks for 26 patients and strokes for 47. The outcomes for the patients with strokes were categorized as full recovery for 20, good recovery for 15, partial recovery for 6, no recovery for 2, and death for 4. High rates of thromboembolic events were also observed with balloon occlusion of aneurysms (11%) or parent arteries (19%) and carotid angioplasty alone (5.9%). Arteriovenous malformation embolization was associated with an ischemic event/procedure rate of 9.4%. High rates of thromboembolic and ischemic complications, with subsequent morbidity and death, are associated with most endovascular procedures. Further research and the formulation of standard preventive guidelines may help to reduce these risks and improve the overall success of these procedures.     

Total reconstruction of the hypopharynx and cervical esophagus: a 20-year experience.

We have reviewed 145 patients who underwent 148 total reconstructions of the hypopharynx and cervical esophagus between 1970 and 1989. The types and numbers of reconstruction included 45 deltopectoral (DP) flaps, 35 musculocutaneous (MC) flaps, 19 colon interpositions, 23 gastric transpositions, and 26 free jejunal transfers. Median hospitalization was 51 days for DP flaps, 24 days for MC flaps, 28 days for colon, 30 days for gastric, and 14 days for jejunum. Median resumption of oral intake was 92 days for DP flaps, 19 days for MC flaps, 12 days for colon, 13 days for gastric, and 9 days for jejunum. Functional failure, defined as the inability to maintain adequate nutrition without tube feedings, was 40% for MC flaps, 42% for colon interposition, 17% for gastric transposition, and 20% for free jejunal transfer. Microvascular free jejunal transfer has become our method of choice for reconstruction of the hypopharynx and cervical esophagus. Gastric transposition is an alternative when resection of the thoracic esophagus is necessary.     

Computer processing of genetic patient data]

A code form for genetic patient data has been devised for computer purposes. This form provides for the clinical and laboratory diagnosis of genetic diseases. A Hewlett-Packard 2100 computer is used for storage and retrieval of the data. Three programmes are currently in use for the retrieval of data, namely programme RETREV, for retrieval of individual patient records; programme STAT9A, for the classification of chromosome results of patients referred with similar clinical diagnoses; and programme STA12A, for classification of chromosome abnormalities and for correlation with the indication for referral and other data. The possibilities for expansion of the programmes are discussed.     

Prospective Analysis of Accuracy of Positron Emission Tomography,Computed Tomography,and Endoscopic Ultrasonography in Staging of Adenocarcinoma of the Esophagus and the Esophagogastric Junction

Background: Exact preoperative staging of esophageal cancer is essential for accurate prognosis and selection of appropriate treatment modalities.Methods: Forty-two patients with adenocarcinoma of the esophagus or the esophagogastric junction suitable for radical esophageal resection were staged with positron emission tomography (PET), spiral computed tomography (CT), and endoscopic ultrasonography (EUS).Results: Diagnostic sensitivity for the primary tumor was 83% for PET and 67% for CT; for local peritumoral lymph node metastasis, it was 37% for PET and 89% for EUS; and for distant metastasis, it was 47% for PET and 33% for CT. Diagnostic specificity for local lymph node metastasis was 100% with PET and 54% with EUS, and for distant metastasis, it was 89% for PET and 96% for CT. Accuracy for locoregional lymph node metastasis was 63% for PET, 66% for CT, and 75% for EUS, and for distant metastasis, it was 74% with PET and 74% with CT. Of the 10 patients who were considered inoperable during surgery, PET identified 7 and CT 4. The false-negative diagnoses of stage IV disease in PET were peritoneal carcinomatosis in two patients, abdominal para-aortic cancer growth in one, metastatic lymph nodes by the celiac artery in four, and metastases in the pancreas in one. PET showed false-positive lymph nodes at the jugulum in three patients.Conclusions: The diagnostic value of PET in the staging of adenocarcinoma of the esophagus and the esophagogastric junction is limited because of low accuracy in staging of paratumoral and distant lymph nodes. PET does, however, seem to detect organ metastases better than CT.     

Influence of decortication of the recipient graft bed on graft integration and tissue neoformation in the graft-recipient bed interface

The objective of the present study was to assess the influence of decortication of the posterior elements of the vertebra (recipient bed) and the nature of the bone graft (cortical or cancellous bone) on graft integration and bone, cartilage and fiber neoformation in the interface between the vertebral recipient bed and the bone graft. Seventy-two male Wistar rats were divided into four experimental groups according to the presence or absence of decortication of the posterior vertebral elements and the use of a cortical or cancellous bone graft. Group I—the posterior elements were decorticated and cancellous bone used. Group II—the posterior elements were decorticated and cortical graft was used. Group III—the posterior elements were not decorticated and cancellous graft was used. Group IV—the posterior elements were not decorticated and cortical graft was used. The animals were killed 3, 6 and 9 weeks after surgery and the interface between the posterior elements and the bone graft was subjected to histomorphometric evaluation. Mean percent neoformed bone was 40.8% in group I (decortication and cancellous graft), 39.13% in group II (decortication and cortical graft), 6.13% in group III (non-decorticated and cancellous graft), and 9.27% in group IV (non-decorticated and cortical graft) for animals killed at 3 weeks (P = 0.0005). For animals killed at 6 weeks, the mean percent was 38.53% for group I, 40.40% for group II, 10.27% for group III, and 7.6% for group IV (P = 0.0005), and for animals killed at 9 weeks, the mean was 25.93% for group I, 30.6% for group II, 16.4% for group III, and 18.73% for group IV (P = 0.0026). The mean percent neoformed cartilage tissue was 8.36% for group I, 7.46% for group II, 11.1% for group III, and 9.13% for group IV for the animals killed at 3 weeks (P = 0.6544); 6.6% for group I, 8.07% for group, 7.47% for group III and 6.13% for group IV (P = 0.4889) for animals killed at 6 weeks, and 3.13% for group I, 4.06% for group II, 10.53% for group III and 12.07% for group IV (P = 0.0006) for animals killed at 9 weeks. Mean percent neoformed fibrous tissue was 11% for group I, 6.13% for group II, 26.27% for group III and 21.87% for group IV for animals killed at 3 weeks (P = 0.0008); 7.67% for group I, 7.1% for group II, 9.8% for group III and 10.4% for group IV (P = 0.7880) for animals killed at 6 weeks, and 3.73% for group I, 4.4% for group II, 6.67% for group III and 6.8% for group IV (P = 0.0214) for animals killed at 9 weeks. The statistically significant differences in percent tissue formation were related to decortication of the posterior elements. The use of a cortical or cancellous graft did not influence tissue neoformation. Ossification in the interface of the recipient graft bed was of the intramembranous type in the decorticated animals and endochondral type in the non-decorticated animals.     

冠状动脉旁路移植术后评分系统的初步探讨

目的 探讨适合冠状动脉旁路移植术后的风险评估系统.方法 2007年10月至2008年4月,对1028例心脏外科监护室收治的行冠状动脉旁路移植术(CABG)病人,采用多器官衰竭评分系统(MODS)、序贯衰竭评分系统(SOFA),以及自行制定心脏外科术后评分系统(PSCS)进行评分,比较3个系统对心脏手术后死亡风险评估的敏感性和特异性.结果 在判别分析中,分别比较3个系统当日分值、最大分值、3日内最大分值、第3日与第1日分值差值的ROC曲线下面积,MODS系统分别为0.602、0.847、0.838、0.767,SOFA系统分别为0.571、0.830、0.814、0.779,PSCS系统分别为0.821、0.929、0.919、0.780,各时段PSCS系统的ROC曲线下面积均大于MODS和SOFA系统.在校正分析中,采用Hosmer-Lemeshow拟合优度分析,分别比较3个系统x2值、P值、总体正确率.上述3个数值MODS系统分别为6.763、0.454、98.1%,SOFA系统分别为4.101、0.848、98.0%,PSCS系统为1.687、0.975、98.3%.结论 PSCS系统在CABG术后死亡风险评估的敏感性和特异性优于MODS和SOFA系统.     

伴或不伴黄韧带骨化的胸椎和胸腰段椎间盘突出症的术式选择

目的 探讨伴或不伴黄韧带骨化的胸椎和胸腰段椎间盘突出症的术式选择.方法 2004年6月至2009年12月,手术治疗伴或不伴黄韧带骨化的胸椎和胸腰段椎间盘突出症患者31例,男22例,女9例;年龄24～71岁,平均54岁;病变节段T4～L2.根据Anand和Regan临床分类:2度1例,3a度2例,3b度3例,4度6例,5度19例;Frankel分级:B级2例,C级6例,D级11例,E级12例.18例不伴黄韧带骨化者行前路手术,采用椎体后缘切除、椎体后侧开槽或椎体次全切除减压并植骨内固定.13例伴有明显黄韧带骨化者行后路半关节突和全椎板切除减压术,未切除前侧突出的椎间盘.结果 前路术后发生硬膜囊撕裂1例,神经根袖损伤1例,肋间神经痛3例,肺不张1例,取髂骨区麻木2例.后路术后发生椎管内血肿1例,脑脊液漏2例,切口感染1例,肺部感染1例.随访6～48个月,平均18个月.末次随访时Frankel分级:C级3例,D级7例,E级21例;Anand和Regan分类:1度2例,2度1例,3a度1例,4度2例,5度10例,15例无明显症状.X线片示内固定均无失败,植骨融合良好.结论 胸椎和胸腰段椎间盘突出以脊髓前侧压迫为主者可选择前路椎体后侧开槽或椎体次全切除减压植骨融合术,伴黄韧带骨化导致脊髓前后侧压迫者可行后路半关节突和全椎板切除减压术.     

Standardization and comparability of CASA instruments.

Thirty human semen specimens were analyzed using a standard manual method, then videotaped and reanalyzed using two different computer-aided sperm analysis (CASA) instruments (the HTM system, Hamilton-Thorn Research, Danvers, MA, and the CTS system, Motion Analysis Corp., Santa Rosa, CA). Videotaped specimens were analyzed by CASA for 5 frames for sperm concentration (CON) and percent motility (MOT), and for 15 frames for kinematic variables (straight-line velocity, VSL; curvilinear velocity, VCL; linearity, LIN; and amplitude of lateral head displacement, ALH). Machine parameter settings for the two instruments were matched as closely as possible. CASA values were compared with each other for all measures and with manual results for sperm count and the percentage of motile sperm. Results show: 1) HTM and CTS average values for CON are not different from manual measures for the 5- or 15-frame analysis, but slight differences are seen between CTS and HTM; 2) average values for MOT for the 5-frame analysis are higher than the 15-frame analysis for both instruments, but the average manual measurement for percent motility is much higher than any CASA value; 3) average VSL and LIN are slightly higher for HTM than CTS, but pair-wise comparison shows a high degree of concordance between the instruments; and 4) the mean values for VCL and ALH are equal for the two instruments, and there is a close concordance for the pair-wise comparison for VCL; however, pair-wise comparison of ALH reveals significant differences between the instruments. Overall, the differences seen between these instruments are slight, and are probably not biologically or clinically significant.     

SOLUBILITY OF HALOTHANE IN EQUINE TISSUES AT 37{degrees}C

The solubilities of halothane at a concentration of 0.77% v/vin 5% carbon dioxide in air at 37°C were determined fora variety of equine tissues. The mean values for the tissue/gaspartition coefficients for visceral tissue taken from 36 horseswere 5.42 for whole brain, 4.82 for grey matter, 7.41 for whitematter, 4.18 for myocardium, 2.76 for lung, 8.51 for liver,3.21 for kidney, 2.66 for gastrointestinal tract, 1.77 for bloodand 2.45 for spleen. The mean coefficients for eight differentmuscles taken from 23 horses ranged from 2.43 for extensor carpiradialis to 4.91 for psoas major. The values obtained were,with the exception of liver and brain, consistently lower thanvalues in the literature for rabbit, dog, man and ox. Statisticalanalysis indicated that the condition of a horse was importantin determining the solubility of halothane in its liver andmuscles. The type and sex of a horse appeared to be importantonly in respect of the solubility of halothane in the gastrointestinaltract. ^*Present address: Department of Medical Sciences, College ofVeterinary Medicine, University of Florida, Gainesville, Florida32610, U.S.A.     

Endoscopic Thoracic Sympathectomy: At What Level Should You Perform Surgery?

Several interventions are possible on the sympathetic chain and the nomenclature has been confusing. The authors propose a uniform nomenclature for each procedure, mainly, sympathectomy for resection or ablation of the ganglion, sympathicotomy for the transaction of the chain, ramicotomy for the procedure preserving the chain and ganglia and severing the rami, and finally, sympathetic block for clipping above and below the ganglia. They recommend intervention on the T2 ganglia for facial hyperhidrosis and rubor, on the T3 ganglia for palmar hyperhidrosis, and on the T3 and T4 ganglia for axillary hyperhidrosis.     

Dobutamine stress echocardiography,myocardial perfusion scintigraphy,invasive coronary angiography,and post‐liver transplantation events: Systematic review and meta‐analysis

The impact of coronary artery disease on the clinical course of patients enrolled for liver transplantation (LT) has changed over the years as these patients become older and sicker. The purpose of this systematic review and meta‐analysis was to investigate the value of dobutamine stress echocardiography (DSE), myocardial perfusion scintigraphy (MPS), and invasive coronary angiography (ICA) in predicting cardiac events post‐LT in cirrhotic patients. A literature search was conducted using Scopus, Web of Science, EMBASE, MEDLINE (via PubMed), BIREME (regional medical library of the Pan American Health Organization), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews, and OpenGrey Repository ( www.opengrey.eu ) electronic databases. A total of 322 records were retrieved for DSE, 90 for MPS, and 149 for ICA. In the final analysis, 11 records for DSE, 7 for MPS, and 8 for ICA were included. The relative risk and confidence interval for major adverse cardiac events were 30.2 (2.8‐325.4) for DSE, 2.6 (1.09‐6.1) for MPS, and 2.1 (1.0‐2.3) for ICA, while the relative risk and confidence interval for all‐cause mortality was 4.7 for DSE (1.8‐12.0), 2.7 (1.25‐5.9) for MPS, and 1.5 (0.89‐3.2) for ICA. In conclusion, this meta‐analysis found that DSE, MPS, and ICA do not satisfactorily predict increased risk of perioperative MACE or all‐cause mortality among cirrhotic patients listed for LT, among small and heterogenous studies.     

Trends in arthroplasty in Japan by a complete survey, 2014–2017

BackgroundPrecise knowledge of the prevalence and trends of arthroplasty can facilitate the design of medical plans for efficient treatments. The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan provides statistics about the annual number of arthroplasties (knee, hip, shoulder, finger, elbow, and foot/ankle) through health insurance claim numbers for these surgeries. The purpose of this study was to document the annual arthroplasty numbers between 2014 and 2017 in Japan and to analyze their four-year trends, gender differences, age distributions, and regional differences as revealed by the complete survey.MethodsNumbers of arthroplasty surgeries were extracted from the NDB Open Data Japan for 2014–2017. For “knee”, “hip”, “shoulder”, “finger”, “elbow”, and “foot/ankle” arthroplasties, we showed the annual arthroplasty numbers, annual arthroplasty numbers by age group, annual arthroplasty numbers in individual prefectures, and annual arthroplasty numbers per 100,000 population in individual prefectures.ResultsThe annual arthroplasty numbers in 2017 were 146,189 for all joints, 82,304 for knees, 59,029 for hips, 2454 for shoulders, 1551 for fingers, 536 for elbows, and 291 for feet/ankles. For the four years up to 2017, the rate of alteration in the number of arthroplasties was +14% for total arthroplasties, +9% for knees, +21% for hip joints, +97% for shoulders, + 8% for fingers, −10% for elbows, and +25% for feet/ankles. The proportion of females was 70–90% and the peak age was between the late 60s and late 70s for all joints. Variations in arthroplasty numbers per population by prefecture appeared to be small for knees and hips and large for other joints.ConclusionsWe revealed the annual total number of arthroplasties for each joint in Japan using the NDB Open Data Japan for the first time.     

Scintigraphy in breast cancer

Scintigraphy was evaluated in comparison to clinical and paraclinical methods used in diagnosis of breast tumors. 32 patients with palpable breast tumors were investigated by clinical examination, ultrasound, mammography and scintigraphy. Different radiopharmaceuticals marked with 99mTc were used, having different affinity for the tumoral tissue. A Siemens Diacam gamma camera was used. Patients were submitted to dynamic study of early blood-pool and tissular phase, followed by late static incidences. Regions of interest were compared with similar areas of the contralateral breast. Conclusions were compared to histopathological diagnosis. We have calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each of the investigation methods. The sensitivity was 80% for clinical examination, 100% for ultrasonography, 66% for mammography and 100% for scintigraphy. The specificity was 77% for clinical examination, 50% for ultrasonography, 90% for mammography and 80% for scintigraphy. PPV was 75% for clinical examination, 60% for ultrasonography, 80% for mammography and 82% for mammography. NPV was 82% for clinical examination, 100% for ultrasonography, 71% for mammography and 100% for scintigraphy. Good correlation was found between scintigraphy and histopathology. Ultrasound and mammography also confirmed, in most cases, the clinically suspected diagnosis. Including scintigraphy in the investigation protocol for breast tumors will allow a better assessment of the therapy.     

Results of laparoscopic versus open abdominal and incisional hernia repair.

BACKGROUND: Incisional hernia is a frequent complication of abdominal surgery. The object of this study was to confirm the safety, efficacy, and feasibility of laparoscopic treatment of abdominal wall defects. METHODS: Fifty consecutive laparoscopic abdominal and incisional hernia repairs from September 2001 to May 2003 were compared with 50 open anterior repairs. RESULTS: The 2 groups were not different for age, body mass index, or American Society of Anaesthesiologists scores. Mean operative time was 59 minutes for the laparoscopic group, 164.5 minutes for the open group. Mean hernia diameter was 10.6 cm for the laparoscopic group, 10.5 cm for the open group. Mean length of stay was 2.1 days for the laparoscopic group, 8.1 days for the open group. Complications occurred in 16% of the laparoscopic and 50% of open group. Median follow-up was 9.0 months for the laparoscopic group, 24.5 months for the open group. Recurrence rates were 2% for laparoscopic group and 0% for the open group. CONCLUSION: Results for laparoscopic abdominal and incisional hernia repair seem to be superior to results for open repair in terms of operative time, length of stay, wound infection, major complications, and overall hospital reimbursement.     

Medicolegal aspects of donor safety evaluation

Current Italian statutes concern the safety of organ donors. The law of April 1, 1999 (no. 91), established the fundamental principles for a new structure for organ transplants in Italy and, therefore, for the quality of transplanted organs. The Ministry of Health decree of February 8, 2002, defined organ conditions that preclude the utilization of an organ and identified conditions for suitability of non-optimal organs for some types of transplants or for some recipients. Guidelines from the National Transplant Center establish risk levels, criteria for absolute exclusion, and standard procedures for the evaluation of donor risk and organ suitability for transplant. This article also examines the levels of responsibility of various professionals involved in the harvesting-transplant process.     

Reasons for revision hip surgery: a retrospective review

The purpose of this study was to determine the indications for contemporary revision hip surgery in a consecutive series of patients. We retrospectively reviewed the clinical records and radiographs of 439 revision hip surgeries done between 1996 and 2003. Fifty-five percent of the surgeries were for aseptic loosening, 14% were for instability, 13% were for osteolysis around a well-fixed implant, 7% were for infection, 5% were for periprosthetic fracture, 3% were for conversion of a hemiarthroplasty, 1% was for psoas impingement, 1% was for loose recalled implants, and 1% was for implant fracture. As expected, aseptic loosening was the most common reason for revision surgery. Instability was a common reason for early revision whereas revision for osteolysis around a well-fixed implant was a more common reason for late revision.     

改良自制水囊在泌尿外科后腹腔镜手术中的应用

目的介绍一种安全、实用、快捷建立后腹腔操作空间的方法。方法用无菌手套的中指自制成水囊,以一根5mm直径、10cm长中空金属管,一端固定指套,另一端套上16F红色尿管,可容纳350ml生理盐水,在后腹腔镜手术中建立后腹膜空间。结果成功开展了单纯肾切除126例、肾盂,输尿管切开取石112例、肾囊肿去顶减压术103例,肾肿瘤根治术15例。肾部分切除31例,重复肾输尿管切除术3例,肾盂肿瘤根治术8例,肾盂输尿管成型术11例,肾上腺肿瘤或肾上腺切除术5例共414例后腹腔镜泌尿外科手术。仅一例因手套破裂引起失败,成功率为99.8％。结论自制水囊安全有效,可建立良好的后腹腔空间,避免了在盲视下穿刺损伤组织器官的危险,为后腹腔镜手术的开展进行提供了良好的基础。