开放术式与经尿道电切术治疗高危前列腺增生症的比较

目的探讨治疗高危前列腺增生症较为安全有效的手术方法。方法在98例高龄高危前列腺增生症患者中,38例行耻骨上经膀胱手术,60例行经尿道腔内手术,术后随访3～6个月,对两组的手术结果进行疗效比较。结果两种术式患者手术后前列腺症状评分（IPSS）、生活质量评分（QOL）、最大尿流率（MFR）、残余尿量（RUV）与术前比较均有显著改善（P〈0．05）,两组资料之间相比差异无统计学意义（P〉0．05）。手术时间两组之间差异无统计学意义。结论经尿道电切组在治疗高危BPH患者中总体疗效优于开放术式组,具有创伤小,出血少,出血时间短,恢复快,并发症少等优点,是治疗高危BPH的理想方法,在广大基层医院有较好的推广价值。     

良性前列腺增生症开放性手术后近期排尿困难的临床分析

目的 探讨良前列腺增生症行耻骨上经膀胱前列腺摘除术后6个月内出现排尿困难的原因、诊治及预防.方法 回顾性分析24例患者的临床资料,对其诊治和预防进行探讨.结果 21例行手术治疗,膀胱颈狭窄9例,后尿道狭窄9例,腺体残留3例.行经尿道膀胱颈切开术9例,开放性手术(膀胱颈、后尿道切开术)9例,经尿道前列腺摘除加膀胱颈后唇切开3例.3例行保守治疗,诊断为逼尿肌无力,经留置气囊导尿管1个月后缓解.随访9～90个月,6个月内无因排尿困难而再次入院者.结论 耻骨上经膀胱前列腺摘除术后再次出现排尿困难者,多于术后6个月内出现,其中大多数需要再次手术.应重视术中的操作技术和术后管理,尽量避免术后近期因排尿困难而再次手术.

Abstract：

Objective To summarize the diagnosis,treatment and prevention of dysuria within 6 months after the suprapubic transvesical prostatectomy. Methods Twenty-four cases were retrospectively reviewed,including the data on the diagnosis, treatment and prognosis. Results Twenty-one of the 24 cases had received surgery. There were 9 cases with bladder neck stricture,9 cases with posterior urethra stricture and 3 cases with of remnant glands. Nine cases received transurethral bladder neck incision, 9 received open surgery ( bladder neck,posterior urethral incision) and 3 received transurethral resection of the prostate (TURP) plus bladder neck incision. The other 3 diagnosed as detrusor weakness were conservatively treated by indwelling catheter and they were improved one months later. None of these patients was readmitted into hospital for dysuria within 6 months after treatment. Conclusion The recurrence of dysuria post prostatectomy mostly ( 75% ) occurred within 6 months after surgery. A majority of these patients need a second surgery. To avoid a second surgery for postoperative dysuria, much attention should be paid to the operating technique and postoperative management.     

预留线关闭猪经膀胱自然腔道内镜手术切口的初步尝试

目的尝试预留线关闭猪经膀胱自然腔道内镜手术(natural orifice transluminal endoscopic surgery,NOTES)切口,探讨其可行性、安全性,总结操作经验,为后续临床应用奠定基础。方法雌香猪5只,全麻下置入自制膀胱鞘至膀胱。在输尿管镜的引导下,穿刺针穿刺膀胱顶前壁到腹下壁,预留2根关闭线,一端在腹壁,一端在尿道。完成经膀胱NOTES手术后将关闭线腹壁端拉至膀胱鞘外打结,拖动尿道端,使腹壁端线结固定在膀胱外壁,然后尿道端打结,由推结器将结推至膀胱内壁,重复推结完成关闭膀胱内切口。采用直视观察和膀胱充水方法检测膀胱切口关闭效果。结果共完成5例猪实验。因动物体质量和体型过大、膀胱切口选择太靠近膀胱颈口及丝线容易起绒等导致前2例失败。后3例顺利完成,手术时间分别为45、30、25 min,切口关闭效果良好。结论预留线关闭经膀胱NOTES手术切口安全可行、操作简单、取材方便,无需特殊手术器械,值得深入研究。     

非那雄胺减少耻骨上经膀胱前列腺切除术中出血的临床研究

目的　探讨术前使用非那雄胺 (finasteride)对耻骨上经膀胱前列腺切除术中出血量的影响。方法　比较分析术前使用非那雄胺与未使用非那雄胺的经膀胱前列腺切除术患者年龄、手术时间、切除前列腺体积、术中出血量、单位体积出血量等。结果　服药组和对照组平均手术时间分别为 61.73min和 66.76min(P >0 .0 5 ) ,平均切除前列腺体积分别为 46.8cm3和 42 .12cm3(P >0 .0 5 ) ,术中平均出血量分别为 13 0 .18ml和 15 2 .3 2ml( P <0 .0 5 ) ,单位体积平均出血量分别为 2 .78ml cm3和 3 .62ml cm3(P <0 .0 5 )。结论　术前使用非那雄胺可抑制前列腺组织中血管生成 ,减弱前列腺剥离后前列腺包膜创面的渗血 ,从而减少耻骨上经膀胱前列腺切除术中出血量     

Expression of ERCC1, MSH2 and PARP1 in Non-small Cell Lung Cancer and Prognostic Value in Patients Treated with Platinum-based Chemotherapy

Purpose: To evaluate the prognostic value of the expression of excision repair cross-complementation groupl (ERCC1), MutS protein homolog 2 (MSH2) and poly ADP-ribose polymerase 1 (PARP1) in non-small-cell lungcancer patients receiving platinum-based postoperative adjuvant chemotherapy. Methods: Immunohistochemistrywas applied to detect the expression of ERCC1, MSH2 and PARP1 in 111 cases of non-small cell lung cancerparaffin embedded surgical specimens. Through og-rank survival analysis, we evaluated the prognostic valueof the ERCC1, MSH2, PARP1 and the related clinicopathological factors. COX regression analysis was used todetermine whether ERCC1, MSH2 and PARP1 were independent prognostic factors. Results: In the enrolled111 non-small cell lung cancer patients, the positive expression rate of ERCC1, MSH2 and RARP1 was 33.3%,36.9% and 55.9%, respectively. ERCC1 (P<0.001) and PARP1 (P=0.033) were found to be correlated with thesurvival time while there was no correlation for MSH2 (P=0.298). Patients with both ERCC1 and PARP1 negativecancer had significantly longer survival time than those with ERCC1 (P=0.042) or PARP1 (P=0.027) positivealone. Similalry, the survival time of patients with both ERCC1 and PARP1 positive cancer was shorter thanthose with ERCC1 (P=0.048) or PARP1 (P=0.01) positive alone. Conclusion: Patients with ERCC1 or PARP1negative non-small cell lung cancer appear to benefit from platinum-based postoperative adjuvant chemotherapy.     

Beyond the Learning Curve of the Retzius-sparing Approach for Robot-assisted Laparoscopic Radical Prostatectomy: Oncologic and Functional Results of the First 200 Patients with ≥1 Year of Follow-up

Background

Robot-assisted laparoscopic radical prostatectomy (RARP) has become the main surgical option for localized prostate cancer. We recently developed a new approach for RARP, passing through the pouch of Douglas and avoiding all the Retzius structures involved in continence and potency preservation.

Objective

To report the functional and oncologic results of our first 200 patients operated on using this new approach.

Design, setting, and participants

This was a prospective, noncontrolled case series including the first 200 consecutive patients undergoing this kind of surgery (January the 1st, 2010 to December the 31st, 2011).

Surgical procedure

Retzius-sparing RARP.

Outcome measurements and statistical analysis

All perioperative, oncologic, and functional data were prospectively recorded. Potency was defined as an International Index of Erectile Function-5 questionnaire score >17; continence was defined as use of no pad or of one safety liner. Oncologic results were reported as positive surgical margins (PSM) and 1-yr biochemical disease-free survival (1y-bDFS). Recurrence was defined as a repeated prostate-specific antigen >0.2 ng/ml. Complications were graded according to the Clavien-Dindo system. The first 100 patients (group 1) were compared with the second 100 (group 2) to evaluate the learning curve effects.

Results and limitations

The median patient age was 65 yr. Comparing the two groups, transfusions were needed in 8% versus 4% of cases in groups 1 and 2, respectively (p = 0.02). There was one Clavien-Dindo grade 3b in group 1 versus one grade 3a complication in group 2. In patients with pT2 disease, PSMs were recorded in 22.4% of those in group 1 versus 10.1% in group 2 (p = 0.045). 1y-bDFS was 89% in group 1 versus 92% in group 2. For groups 1 and 2, respectively, immediate continence was reached in 92% versus 90% of patients, and the 1-yr continence rate was 96% versus 96%. Considering the 77 potent patients aged <65 yr who underwent bilateral intrafascial nerve-sparing surgery, 40.4% of those in group 1 versus 40% of those in group 2 reached their first intercourse within 1 mo; at 1 yr of follow-up, these figures had increased to 81% versus 71%, respectively (p = 0.162). The main limitation of this study is its noncontrolled nature.

Conclusions

We demonstrated Retzius-sparing RARP to be oncologically safe and to result in high early continence and potency rates. Long-term, prospective, comparative, and possibly randomized studies are needed.