低成本两孔胸腔镜手术治疗原发性气胸

目的探讨一种简单、微创、经济的腔镜方法治疗自发性气胸。 方法收集2011年10月至2016年2月胸腔镜手术治疗自发性气胸84例,其中两孔胸腔镜肺大疱结扎54例(试验组),三孔胸腔镜肺大疱切割缝合器楔形切除30例(对照组)。试验组,根据胸壁不同厚度把肺大疱拉近操作孔或拉至操作孔或拉出操作孔用手直接结扎/缝扎后做机械摩擦的胸膜固定术;对照组按常规进行,用切割缝合器行肺楔形切后做机械摩擦的胸膜固定术。 结果两组患者的临床效果差异无统计学意义(P>0.05),试验组的住院费用低于对照组[(16 747.30±2 586.41) 元 vs (21 088.54±6 005.68)元,P<0.05]。 结论两孔胸腔镜下肺大疱用手缝扎/结扎技术治疗自发性气胸简单、微创、经济。     

慢性乙型肝炎病毒感染者恩替卡韦抗病毒治疗前后血清高尔基体蛋白GP73的变化

目的观察慢性乙型肝炎病毒感染患者恩替卡韦（ETV）抗病毒治疗前后血清GP73浓度的变化,探讨血清GP73水平对CHB病情进展和疾病转归的影响。 方法2012年1月至2014年10月于解放军第一八〇医院就诊的慢性乙型肝炎病毒（HBV）感染者1 150例,其中慢性HBV携带者（HBV-C）100例,CHB 550例,HBV相关肝硬化（LC）250例、原发性肝细胞癌（HCC）250例。选择同期50名健康体检者作为对照。采用ELISA法检测血清GP73浓度。入组患者中在知情同意基础上行肝组织活检的30例CHB患者肝组织标本进行免疫组织化学染色检查,探讨血清GP73浓度与肝组织GP73表达的相关性。550例CHB患者中共200例接受ETV抗病毒治疗1年以上,观察治疗前及治疗后1个月、3个月、6个月、9个月和12个月血清GP73浓度的变化。 结果慢性HBV感染者血清GP73水平显著高于对照组（F =191.60、P = 0.000）,且随着病情的进展,血清GP73浓度在HBV-C [（47.21 ± 17.69）ng/ml]、CHB [（101.56 ± 67.18）ng/ml]、HCC [（195.01 ± 104.22）ng/ml]和LC [（225.71 ± 99.37）ng/ml]中持续升高,各组间,差异均具有统计学意义（q_{HBV-C vs CHB} = 7.82,P = 0.000;q_{CHB vs HCC} = 15.85,P = 0.000;q_{HCC vs LC} = 2.63,P = 0.009）。经过相关性分析,血清GP73含量与慢性HBV感染者病情严重程度呈正相关（r = 0.576、P = 0.000）。30例CHB肝组织标本中,肝组织GP73表达呈弱阳性、中度阳性和强阳性的分别为6例（20.00%）、16例（53.33%）和8例（26.67%）。随着肝组织GP73表达程度的加重,其血清GP73浓度亦同步升高（F = 7.285、P = 0.003）。经过相关性分析,血清GP73浓度与肝组织GP73表达程度呈正相关（r = 0.592、P = 0.001）。200例CHB患者已接受ETV抗病毒治疗1年以上,随着病情的恢复,血清GP73浓度在ETV抗病毒治疗1、3、6、9和12个月后逐渐下降,分别为（97.26 ± 42.52）ng/ml、（68.21 ± 33.65）ng/ml、（58.57 ± 29.52）ng/ml、（51.76 ± 25.39）ng/ml和（53.37 ± 21.62）ng/ml,与治疗前血清GP73浓度[（113.09 ± 48.91）ng/ml]比较,差异均具有统计学意义（t_{1月后vs治疗前} = 3.45,P = 0.001;t_{3月后vs治疗前} = 10.69,P = 0.000;t_{6月后vs治疗前} = 13.50,P = 0.000;t_{9月后vs治疗前} = 15.74,P = 0.000;t_{12月后vs治疗前} = 15.79,P = 0.000）。血清GP73浓度在ETV抗病毒治疗3个月内下降幅度最大,与病情缓解及丙氨酸氨基转移酶复常相符合。 结论血清GP73水平与慢性HBV感染者疾病进展密切相关。接受ETV抗病毒治疗后血清GP73浓度的下降,提示肝脏炎症损伤的缓解。血清GP73可用于慢性肝病的预后监测指标。     

Expression of aquaporin 1 in primary renal tumors: a prognostic indicator for clear-cell renal cell carcinoma

Background

Aquaporin 1 (AQP1) is a water channel expressed in many epithelial tissues and endothelium, including the proximal nephron of the kidney.

Objective

We measured AQP1 expression in primary renal cell carcinomas (RCCs) and evaluated its significance and prognostic utility.

Design, setting, and participants

We examined AQP1 expression in 559 sporadic renal tumors as well as in 43 normal kidney tissue samples and collected clinicopathologic and prognostic data.

Measurements

AQP1 expression was measured by using real-time quantitative polymerase chain reaction (PCR).

Results and limitations

All normal kidney samples presented substantial AQP1 expression. Among tumor subtypes, AQP1 expression was significantly higher in clear-cell and papillary RCCs, whereas it was lower in chromophobe RCCs, oncocytomas, and collecting-duct carcinomas. In clear-cell RCC, AQP1 was significantly higher in patients without symptomatic presentation or whose tumors were smaller, lower grade, or either lower stage or lacking in microvascular invasion. Von Hippel-Lindau (VHL) tumor suppressor gene mutational status did not affect expression level. Cox univariate and multivariate analyses strongly associated high AQP1 expression with better prognosis in cancer-specific and cancer-free survival tests in all patient cohorts, as well as in cancer-specific survival in a cohort of patients with advanced metastatic RCC. The time-dependent receiver operation characteristic (ROC) analyses, combined with logistic regression models, revealed that the addition of the AQP1 parameter to the University of California Los Angeles Integrated Staging System (UISS) prognostic score can improve the accuracy of predictions of both cancer death and recurrence for all patient cohorts as well as of cancer death for advanced cases within a 5-yr follow-up period in clear-cell RCC. High AQP1 expression was also associated with better outcome in a univariate cancer-specific survival test in papillary RCCs.

Conclusions

AQP1 shows RCC subtype-specific expression, and its expression level provides useful prognostic information for patients with clear-cell RCC.     

The impact of renal surgery on global renal function and non-oncologic morbidity

Nephron preservation has been increasingly prioritized in the treatment of small renal tumors. Radical nephrectomy is now understood as a risk factor for development of chronic kidney disease, which is known to increase the risk of cardiovascular events and all-cause mortality. Indications for nephron-sparing surgery (NSS) have broadened from solitary kidney, bilateral tumors, and hereditary tumor syndromes to essentially all small renal tumors. Laparoscopic NSS has demonstrated excellent cancer control as well as good functional preservation despite the need for warm ischemia. There has been ongoing debate regarding safe parameters for warm ischemia, which are thought to vary with patient factors. Focal ablative therapies have been developed for use in high-risk surgical candidates (eg, radiofrequency ablation, cryoablation) to minimize renal and other treatment-related morbidity. Emphasis on minimally invasive approaches and advances in preventing renal dysfunction and other morbidity after NSS will guide the future of these therapies.     

Effects of timing of dialysis initiation on the prognosis of peritoneal dialysis patients: a retrospective cohort study

Objective To analyze the effects of dialysis therapy initiation on the prognosis of peritoneal dialysis (PD) patients. Methods PD patients who were newly catheterization and long-term followed-up in Peking University Shenzhen Hospital from January 1, 2012 to March 25, 2019 were retrospectively analyzed. According to the estimate glomerular filtration rate (eGFR) at the time of patients catheterization, the patients were divided into early-dialysis group [eGFR＞5.5 ml?min-1?(1.73 m2)-1] and late-dialysis group [eGFR≤5.5 ml?min-1?(1.73 m2)-1]. The endpoint events were transferred to other renal replacement therapy (such as hemodialysis, kidney transplantation) or death. Kaplan-Meier method was used to draw survival curve, and log-rank test was used to compare the difference of survival rate between the two groups. Cox proportional hazard model was used to analyze the influencing factors of all-cause death and technical death in PD patients. Results A total of 342 PD patients were enrolled in this study, and there were 165 cases and 177 cases in the early-dialysis and the late-dialysis group respectively. Compared with the early-dialysis group, the proportion of patients with diabetes and men, and the level of hemoglobin, serum calcium and CO2 binding capacity in the late-dialysis group were lower, while the incidence of hypertension, serum phosphorus, blood uric acid and blood urea nitrogen level were higher in the late-dialysis group (all P＜0.05). The median follow-up time was 33(16, 57) months. Kaplan-Meier survival analysis showed that the cumulative survival rate of late-dialysis group was significantly higher than that of early-dialysis group (Log-rank χ2=12.004, P＜0.001). After adjusting for gender, age of catheterization, body mass index (BMI), diabetes mellitus and hypertension, the risk ratio of all-cause death in the early-dialysis group was 1.950 times higher than that in the late-dialysis group (HR=1.950, 95%CI 1.019-3.730, P=0.044). Subgroup analysis showed that the timing of dialysis and the risk of end-point events were not affected by BMI, diabetes stratification and other factors (interactive P＞0.05), but there was interaction between dialysis time and catheter age (interactive P＜0.05). According to the age of catheterization, the risk of all-cause death were higher in the early dialysis group at a young age (≤48 years old) (HR=21.287, 95%CI 2.609-173.665, P=0.004). Conclusions The mortality rate of PD patients is higher in early-dialysis group, which is independent of gender, age, BMI, diabetes and hypertension. The difference is more distinct in low age group.     

The aggressiveness of urinary tract urothelial carcinoma increases with the severity of chronic kidney disease

OBJECTIVE

To assess, in a retrospective cohort, urinary tract urothelial carcinoma (UT‐UC) in patients with various stages of chronic kidney disease (CKD) and their clinicopathological features, as patients with end‐stage renal disease (ESRD) have a higher incidence of UT‐UC, but the relationship between early stages of CKD and characteristics of UT‐UC are less well known.

PATIENTS AND METHODS

The study included 267 patients with pathologically confirmed UT‐UC from January 1994 to December 2006; all had a physical examination (blood pressure), and measurements of laboratory data (serum creatinine, serum haemoglobin) and pathological data. The glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease equation. Patients were divided into three groups by individual GFR (mL/min), i.e. >60 (no/mild CKD), 30–60 (CKD stage 3) and <30 (CKD stage 4/5).

RESULTS

The CKD stages included 81 (30.3%) patients with none/mild CKD, 121 (45.3%) with CKD stage 3 and 65 (24.3%) with CKD stage 4/5. There was a significant and parallel increase in the frequency of UT‐UC as CKD severity increased from none/mild CKD to stage 3 (11% vs 55%), and from CKD stage 3 to 4/5 (55% vs 71%; P < 0.05). Pathologically, the frequency of high‐grade and high T stage UT‐UC in patients with CKD stage 3 (90% and 35%, respectively) and CKD stage 4/5 (91% and 29%, respectively) were significantly greater than in the group with none/mild CKD (P < 0.001). Advanced age and more distant metastasis were independent risk factors for patient survival.

CONCLUSION

The aggressiveness of UT‐UC increased with the severity of CKD, and this might have important clinical consequences.     

显微椎间盘镜治疗腰椎间盘突出症

目的探讨显微内镜腰椎间盘切除术(microendoscopy discectomy,MED)治疗腰椎间盘突出症的疗效. 方法回顾分析MED治疗59例腰椎间盘突出症的临床资料,总结经验教训. 结果 59例随访4～24个月,平均15个月,按Macnab评定标准,优43例,良14例,可1例,差1例,术后出现神经功能障碍,优良率96.6%(57/59). 结论 MED是包容性腰椎间盘突出症的首先治疗方法,严格掌握手术适应证及提高手术技巧是MED成功的关键.     

经蓝碟(LapDisc)手助腹腔镜结直肠癌根治术

目的 探讨手助腹腔镜结直肠癌根治术的临床效果。方法 应用LapDisc手助腹腔镜技术完成27例结直肠癌根治术。结果 手术全部成功，无一例中转开腹。手术时间90～260min，平均140min。术中出血50～200ml，平均110ml。术后无死亡及吻合口漏等并发症。随访6～23个月，平均8．6月，未见切口种植复发。结论 手助腹腔镜结直肠癌根治具有安全、创伤小、术后恢复快及降低标准腹腔镜手术难度等优点，值得临床推广应用。