经尿道电切输尿管口处浅表性膀胱肿瘤的异议

报告经尿道膀胱肿电瘤电切术治疗近输尿管口处或覆盖输尿管口的浅表性膀胱肿瘤７２例。结果７２例均一次手术成功。无出血等并发症。随访６１例，均无原位肿瘤复发。提出ＴＵＲＢＴ后有可能发生输尿管口狭窄、闭锁和膀胱－输尿管反流，但发生率很低，且无因返流而造成上尿路肿瘤细胞种植及肾功能损害病例。认为该部位浅表性膀胱肿瘤仍应按照Ｂａｒｎｅ＇ｓ原则行ＴＵＲＢＴ。     

浅表性膀胱肿瘤术后膀胱灌注治疗方案的选择

浅表性膀胱肿瘤 ( STCC)是泌尿系常见肿瘤 ,其治疗目的有 3个 :第 1 ,消除肿瘤 ;第 2 ,预防复发 ;第 3,防止肿瘤浸润或转移。目前治疗膀胱肿瘤主要采取膀胱部分切除术和经尿道膀胱肿瘤切除术。 STCC的特点之一为多中心性和多发性。由于再次复发可能不在原来位置 ,故手术不可能达到第2、第 3个目的。因此 ,大多数学者主张术后采用不同方式的辅助治疗 ,其中重要的一环就是定期行膀胱腔内灌注化疗 ,后者为 STCC患者最有力的保护措施。常用的膀胱腔内灌注制剂有阿霉素 ( ADM)、丝裂霉素 C( MMC)、噻替哌 ( TSPA)、羟基喜树碱( HCPT)…     

回肠膀胱术后输尿管回肠代膀胱吻合口闭锁的微创治疗

目的：探讨回肠膀胱术（Bricker术）后输尿管回肠代膀胱哟合口闭锁微创治疗的远期疗效。方法：回顾性分析我院2008年1月-2011年6月年治疗的12例Bricker术后输尿管回肠代膀胱吻合口闭锁患者的临床资料,经膀胱镜及磁共振水成像及泌尿系彩超明确诊断,采用顺行结合逆行方式行膣内钛激光切开,术中先经皮。肾顺行插入F5输尿管导管至输尿管远端,注入亚甲蓝,经代膀胱在膀胱软镜下向输尿管遥端穿刺,见有蓝色液体流出后,钬激光切开该处建立通道。术后留置F7号双J管4-6周拔除,并定期随访肾积水情况。结果：8例一次手术成功,2例改开放手术,1例一期行经皮肾穿刺造瘘术,待肾功能恢复后再行微创手术治疗成功,1例孤立伴有慢性肾功能不全,行经皮肾造瘘长期留置造瘘管引流。9例行微创治疗的患者术中无大出血的并发症,随访6-18个月,平均12个月,治愈6例,好转2例,无效1例,总有效率为88．9％。结论：微创经皮肾穿刺顺行输尿管软镜联合电子膀胱镜,并用钬激光治疗Brieker术后输尿管-肠段吻合口闭锁安全,有效,可作为替代开放手术,减少创伤,减轻患者痛苦。     

输尿管口附近膀胱肿瘤的手术处理

目的　总结输尿管口附近膀胱肿瘤的手术治疗经验。　方法　需行输尿管再植的膀胱肿瘤患者 4 2例 ,随机分为两组 :A组 2 0例 ,绕输尿管口膀胱壁舌状切除结合改良Huctch Ⅱ输尿管移植 ;B组 2 2例 ,膀胱外寻找并离断输尿管 ,膀胱部分切除术后将输尿管再植于膀胱。对两组手术时间、手术失血量、术后引流量、近期并发症、膀胱输尿管返流、输尿管梗阻及肿瘤复发率进行对比分析。　结果　A组手术时间 (6 0 .5± 18.5 )min、手术失血量 (30 .7± 12 .4 )ml、术后引流量 (5 0 .6± 17.8)ml;B组手术时间 (15 0 .9± 2 2 .4 )min、手术失血量 (2 2 0 .5± 2 8.2 )ml、术后引流量 (2 80 .6± 5 8.9)ml;以上三项指标两组之间差异有显著性意义 (P <0 .0 0 1)。近期并发症A组 2例 ,B组 8例。两组间比较差异有显著性意义 (P <0 .0 5 ) ;膀胱输尿管返流、输尿管梗阻及肿瘤复发率两组比较差异无显著性 (P >0 .0 5 )。　结论　绕输尿管口膀胱舌状切除结合改良Huctch Ⅱ输尿管移植手术效果良好 ,手术并发症少 ,操作简单 ,值得推荐。     

经尿道电切治疗近输尿管口浅表膀胱肿瘤37例报告

目的：探讨经尿道电切治疗近输尿管口浅表膀胱肿瘤的可行性及疗效。方法：采用经尿道电切治疗近输尿管口浅表膀胱肿瘤患者37例,在快速切除肿瘤时一并切除输尿管口,发现出血时电切环压在出血的血管断端上,作点状电凝止血。结果：本组37例全部治疗成功,疗效满意。随访29例,未发生输尿管口狭窄、闭锁和较严重的膀胱输尿管反流,无一例发生因反流而造成上尿路肿瘤细胞种植及肾功能损害。结论：经尿道电切治疗近输尿管口浅表膀胱肿瘤是可行的,疗效满意,可以代替膀胱部分切除输尿管再植术。     

输尿管口附近膀胱肿瘤的手术改良

目的总结输尿管口附近膀胱肿瘤的手术治疗经验，以期为膀胱肿瘤手术治疗提供参考。方法膀胱肿瘤经尿道作标准电切至深肌层，再用腹腔镜行输尿管膀胱壁潜行抗逆流吻合再植术。结果9例手术均获成功，手术时间为130—200min，术中出血60-100mL，患者均于术后72h下床活动，术后住院时间为11—16d，术中、术后无并发症。结论输尿管口附近膀胱肿瘤的改良手术与传统手术相比同样效果满意，腹腔镜输尿管膀胱再植术是一种安全、有效的微创手术方法，实用性较强，有望取代开放手术。     

截断式输尿管末端切除治疗输尿管口周围肿瘤

目的 探讨经尿道切除输尿管口周围膀胱肿瘤的有效方法。方法回顾性分析2021年1月至2021年10月期间中国人民解放军总医院泌尿外科医学部收治的15例接受截断式输尿管末端切除术患者的临床资料。所有肿瘤边缘距离输尿管口均在0.5 cm以内。所有患者均行β刀截断式输尿管末端切除术,术后定期随访。统计并分析手术时间、出血量、闭孔神经反射发生率、膀胱肿瘤复发、肾积水情况等。结果 15例患者均顺利完成手术,手术时间10～32 min,平均(21.1±6.2)min,均未发生闭孔神经反射及围手术期出血。患者术后均留置6F输尿管支架管,术后1个月应用膀胱镜拔出。术后病理均为非肌层浸润性尿路上皮癌,其中低级别12例、高级别3例,肿瘤基底部及切缘均为阴性。患者均接受6～15个月的随访,平均(10.7±3.3)个月,未见上尿路积水和输尿管、肾盂肿瘤及膀胱肿瘤复发。结论 截断式输尿管末端切除术治疗输尿管口周围膀胱肿瘤具有手术解剖清晰、切除范围精准、并发症少的特点,在彻底切除肿瘤的基础上能够保留输尿管膀胱壁内段的形态和功能,是治疗输尿管口周围膀胱肿瘤安全、有效的新术式。     

经尿道电汽化术治疗浅表性膀胱肿瘤

本院至今共治疗浅表性膀胱肿瘤100余例1999年1月至2001年1月,应用经尿道膀胱肿瘤电气化术(TVBt)治疗浅表性膀胱癌41例,随访3个月至2年,效果良好.报告如下.     

浅表性膀胱肿瘤局部联合灌注治疗的进展

在尿路上皮性肿瘤中，移行卜皮细胞癌占92．8％，其中75％～80％为浅表性膨阶移行细胞癌。其术后复发率高达30％～90％。虽然大多数复发肿瘤仍为浅表性，但有3o％以上有加重（分级、分期）趋势“‘。膀眈内灌注化疗药物或免疫制剂可防治复发，易使局部达到有效药物浓度直接作用于肿瘤细胞，尤其是联合用药，既减少了用药量，又减轻了因药物全身吸收对正常组织的损害。现将其治疗进展综述如下。1化疗药物的联合应用化疗抗癌药物具有细胞毒性，目前用于膀脱灌注的化疗药物有懂智赈（Thiotepa，TT）、丝裂霉素C（MMC）、阿霉素（Dexorubici…     

经尿道电气化术治疗浅表性膀胱肿瘤

目的总结经尿道电气化术治疗浅表性膀胱肿瘤的方法。方法应用气化电极对55例浅表性膀胱肿瘤患者行经尿道膀胱肿瘤电气化术（TVBT）。结果治愈44例（治愈率80％），有效55例（有效率100％），TVBT出血少，手术视野清晰，去除肿瘤效果满意，易操作，同时能降低膀胱穿孔的发生率，提高手术的安全性。结论TVBT疗效与经尿道膀胱瘤电切术（TURBT）相当，操作简便。     

先天性漏斗胸的微创外科治疗

目的：探讨微创手术治疗先天性漏斗胸的临床疗效及美容效果。方法：采用胸腔镜辅助或胸骨后肋软骨离断、部分切除，TC4钛合金钢板胸骨后支撑矫正治疗24例漏斗胸患儿。结果：达到畸形胸廓矫正和胸壁外表及完整性美观美容。结论：微创手术是治疗先天性漏斗胸的理想的美容手术方式。     

Recurrence pattern for superficial bladder cancer

AIM: Patients with superficial bladder tumors sometimes have long recurrence-free intervals. We evaluated whether patients with long recurrence-free periods had subsequent recurrences. We also clarified how these patients should be followed. MATERIALS AND METHODS: We enrolled 244 patients with superficial bladder cancer (62 pTa and 182 pT1) treated by transurethral resection of bladder tumor (TURBT) and adjuvant chemotherapy with pirarubicin. Median follow up was 75.5 months. Patients were stratified by the length of their recurrence-free interval. RESULTS: Recurrences occurred in 124 patients (50.8%). Of 185 patients who did not have a recurrence for the first 3 years, subsequent recurrences occurred in 65 patients; in more than half the first recurrence developed after 5 years or more. Ta tumors had a low recurrence rate (14.5%) with the first recurrence often developing after a long recurrence-free period. Of 40 patients who remained recurrence-free for 3 years or more after at least one recurrence occurred, 16 patients (40%) had subsequent recurrences. Furthermore, most of these patients who remained free of recurrence for more than 5 years eventually had a recurrence. The overall progression rate was 15.6%, and this did not relate to the length of the recurrence-free interval. CONCLUSION: When patients did not have a recurrence for the first 3 years, tumors subsequently often recurred, even in pTa tumors. In patients with at least once recurrence, subsequent recurrences appear to occur irrespective of the length of the recurrence-free period. Thus, we recommend that all patients with superficial bladder tumors be followed for as long as possible.     

Minimally invasive ureteral stent retrieval

PURPOSE: We developed a minimally invasive (noncystoscopic) method for retrieving ureteral stents. MATERIALS AND METHODS: A total of 30 consecutive patients underwent placement of a ureteral stent with a stainless steel bead attached to its distal end. The stent was later removed by a urethral catheter with a rare earth magnet attached to its proximal end. RESULTS: In 29 of the 30 patients the stent with the attached bead was removed without difficulty or patient discomfort. The single failure occurred in a patient with a large median prostate lobe. CONCLUSIONS: Minimally invasive, nonendoscopic ureteral stent retrieval was achieved in 97% of patients. The attractive force of the magnet for the bead was sufficient to attract and extract the stent. No adverse effects of the procedure or the stainless steel bead were noted. This magnet retrieval system is a feasible, simpler and less invasive alternative to cystoscopic retrieval of ureteral stents.     

Minimally invasive percutaneous cystolithotomy: an effective treatment for bladder stones in infants aged <1 year

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To present our experience with minimally invasive percutaneous cystolithotomy (MPCCL) for the treatment of bladder stones in infants aged <1 year.

PATIENTS AND METHODS

From 1 January 2003 to 31 October 2008, 15 boys with a mean (range) age of 8.2 (3.0–11.5) months underwent MPCCL. The mean (range) stone diameter was 1.4 (0.9–2.2) cm. Ten infants had a solitary stone while five had more than one stone. MPCCLs were performed under general anaesthesia. A 16 F peel‐away sheath was introduced as a working tract after dilatation with percutaneous nephrolithotomy dilators (8–16 F) under fluoroscopic control. After dilatation, an 8–9.8 F ureteroscope was introduced into the bladder, and the stones were fragmented with a shock wave lithotriptor. After the MPCCL, a 14 F suprapubic catheter was left in situ and fixed to the skin, and removed 1 or 2 days after MPCCL. The urethral catheter was removed 2 or 3 days after MPCCL. The absence of stone fragments on plain X‐ray/ultrasonography was considered as a ‘stone‐free’ status.

RESULTS

All infants were stone‐free after one MPCCL; no recurrent stones developed. The mean MPCCL procedure time was 25 min and intraoperative blood loss was scant. Perioperative complications were few. The mean hospital stay was 2.8 days.

CONCLUSION

MPCCL is a safe and effective treatment option for bladder stones in infants, reducing postoperative complications and shortening hospital stay.     

经尿道等离子体双极电切治疗浅表膀胱肿瘤160例

目的探讨经尿道等离子体双极电切术治疗浅表膀胱肿瘤(PKRBt)的安全性与有效性。方法用英国Gyrus公司的经尿道等离子体双极电切系统行浅表膀胱肿瘤切除术160例。肿瘤分级G1为121例,G2为39例。患者男性118例,女性42例,年龄31~89岁,平均59.7岁。多发肿瘤41例,单发119例,膀胱侧壁有肿瘤分布者53例。结果经尿道膀胱肿瘤等离子体双极电切术手术时间5~48min,平均(16±14)min,无经尿道电切综合征;53例侧壁肿瘤切除时,28例发生闭孔神经反射,2例导致各1处膀胱穿孔。随访1~12个月,17例复发,8例再行PKRBt,9例改行根治术。结论PKRBt是一种安全、有效的手术方式。闭孔神经反射是PKRBt的常见并发症之一。     

Minimally invasive extravesical ureteral reimplantation for vesicoureteral reflux

PURPOSE: We designed a new extravesical ureteral reimplantation technique with a minimally invasive approach from skin to ureterovesical junction with less perivesical tissue manipulation to avoid extensive bladder denervation. MATERIALS AND METHODS: Between July 1996 and December 2000, 37 boys and 52 girls 1.2 to 10.8 years old (mean age plus or minus standard deviation 3.8 +/- 2.5) (113 ureters) were treated with minimally invasive extravesical ureteral reimplantation. Vesicoureteral reflux was graded I to V in 8, 12, 43, 29 and 21 cases, respectively. The technique involves an approximately 10 to 15 mm. incision passing through the small triangular gap of the aponeurosis of the external abdominal oblique muscle and transversalis fascia to the point of the ureterovesical junction. The surgical field was exposed with mini-retractors and fine dissecting instruments were used to avoid unnecessary tissue manipulation. RESULTS: At postoperative followup 1 patient had persistent grade II reflux and 2 had moderate hydronephrosis and hydroureter, which resolved after 18 months. No patient returned due to voiding inefficiency or for pain control after discharge from the outpatient setting. CONCLUSIONS: This new technique can be easily used for vesicoureteral reflux with the advantages of simple intervention for surgeons, especially those with inguinal herniorrhaphy and antireflux surgery experience, and less wound discomfort for patients. The whole procedure can be performed on an outpatient basis. However, the decision to use this technique should be based on individual consideration.     

Minimally invasive laparoscopic neobladder

PURPOSE: To our knowledge orthotopic reconstruction after laparoscopic radical cystectomy has not been described in the human. After anatomical and surgical studies on cadavers we developed an original technique and performed the first laparoscopic radical cystectomy with pelvic lymphadenectomy and ileal orthotopic neobladder reconstruction in a patient. MATERIALS AND METHODS: Our technique has 3 steps, namely laparoscopic pelvic clearance, external reconstruction and laparoscopic reconstruction. After cystoprostatectomy and lymphadenectomy were completed via laparoscopy we removed the surgical specimens through a 5 cm. supraumbilical incision. Through the same incision an ileal loop was extracted from the abdominal cavity, isolated, detubularized and partially reconfigured. Intestinal continuity was restored extracorporeally. All intestinal loops were inserted back into the abdomen and pneumoperitoneum was started again. The ureteroileal (nipple valve) and urethroileal anastomoses were formed via laparoscopy and the neobladder was then completed with an intracorporeal running suture. RESULTS: Operative time was 450 minutes and blood loss was 350 ml. Postoperatively pain was minimal. The patient was ambulatory, regained bowel activity on postoperative day 2 and began food intake 2 days later. He was discharged home on postoperative day 7 with an indwelling catheter, which was removed after 7 days. Histopathological examination showed organ confined bladder cancer without margin invasion. CONCLUSIONS: To our knowledge we report the first case of laparoscopic radical cystectomy with ileal orthotopic reconstruction. This original technique combines the advantages of minimally invasive laparoscopy with the speed and safety of open surgery.     

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随着近年来微创外科的发展,重症急性胰腺炎(SAP)的治疗方式发生了很大的变化。传统开腹坏死组织清创手术由于其并发症发生率和病死率较高,促进了内镜、影像学、腹腔镜等微创技术在SAP治疗中的应用不断增加。由于缺少前瞻性随机对照研究,难以规范SAP微创治疗模式。各种微创治疗手段也还存在一定的局限性,尚不能完全替代传统开放手术。因此,目前应加强多学科协作,动态、个体化地合理选择治疗方式。