Nomogram for predicting early complications after distal gastrectomy

BACKGROUND Reducing or preventing postoperative morbidity in patients with gastric cancer(GC)is particularly important in perioperative treatment plans.AIM To identify risk factors for early postoperative complications of GC post-distal gastrectomy and to establish a nomogram prediction model.METHODS This retrospective study included 131 patients with GC who underwent distal gastrectomy at the Second Hospital of Shandong University between January 2019 and February 2023.The factors influencing the development of complications after distal gastrectomy in these patients were evaluated using univariate and multivariate logistic regression analysis.Based on the results obtained,a predictive nomogram was established.The nomogram was validated using internal and external(n=45)datasets.Its sensitivity and specificity were established by receiver operating characteristic curve analysis.Decision curve(DCA)analysis was used to determine its clinical benefit and ten-fold overfitting was used to establish its accuracy and stability.RESULTS Multivariate logistic regression analysis showed that hypertension,diabetes,history of abdominal surgery,and perioperative blood transfusion were independent predictors of postoperative complications of distal gastrectomy.The modeling and validation sets showed that the area under the curve was 0.843[95%confidence interval(CI):0.746-0.940]and 0.877(95%CI:0.719-1.000),the sensitivity was 0.762 and 0.778,respectively,and the specificity was 0.809 and 0.944,respectively,indicating that the model had good sensitivity and specificity.The C-indexes of the modeling and validation datasets were 0.843(95%CI:0.746-0.940)and 0.877(95%CI:0.719-1.000),respectively.The calibration curve(Hosmer Lemeshow test:χ^(2)=7.33)showed that the model had good consistency.The results of the DCA analysis indicated that this model offered good clinical benefits.The accuracy of 10-fold cross-validation was 0.878,indicating that the model had good accuracy and stability.CONCLUSION The nomogram prediction model based on independent risk factors related to postoperative complications of distal gastrectomy can facilitate perioperative intervention for high-risk populations and reduce the incidence of postoperative complications.

Acquired haemophilia as a complicating factor in treatment of nonmuscle invasive bladder cancer:A case report

BACKGROUND Acquired haemophilia(AH)is a serious autoimmune haematological disease caused by the production of auto-antibodies against coagulation factor VIII.In some patients,AH is associated with a concomitant malignancy.In case of surgical intervention,AH poses a high risk of life-threatening bleeding.CASE SUMMARY A 60-year-old female patient with multiple recurrences of non-muscle invasive bladder cancer underwent transurethral tumour resection.A severe haematuria developed postoperatively warranting two endoscopic revisions;however,no clear source of bleeding was identified in the bladder.Subsequent haematological examination established a diagnosis of AH.Treatment with factor VIII inhibitor bypass activity and immunosuppressive therapy was initiated immediately.The patient responded well to the therapy and was discharged from the hospital 21 d after the primary surgery.At the 38-mo follow-up,both AH and bladder cancer remained in complete remission.CONCLUSION AH is a rare,life-threatening haematological disease.AH should be considered in patients with persistent severe haematuria or other bleeding symptoms,especially if combined with isolated activated partial thromboplastin time prolongation.

Neobladder as content in inguinal herniationd-A rare late complication

Dear editor,Secondary inguinal herniation of intraperitoneal content represents a late complication following radical cystectomy.We presenta case of an inguinoscrotal hernia withStuder ileal neobladder as a content following post radical cystectomy for bladder cancer 10 years ago.Exploration revealed herniation of Studer ileal neobladder along with few ileal loops.Neo-bladder in hernial sac was reduced and reinforcement with prolene meshwas done.To our knowledge this is the first case report on neobladder herniation into the scrotum.

Endoscopic submucosal dissection for superficial esophageal neoplasms

Endoscopic submucosal dissection(ESD) is currently accepted as the major treatment modality for superficial neoplasms in the gastrointestinal tract including the esophagus.An important advantage of ESD is its effectiveness in resecting lesions regardless of their size and severity of fibrosis.Based on excellent outcomes for esophageal neoplasms with a small likelihood of lymph node metastasis,the number of ESD candidates has increased.On the other hand,ESD still requires highly skilled endoscopists due to technical difficulties.To avoid unnecessary complications including perforation and postoperative stricture,the indications for ESD require careful consideration and a full understanding of this modality.This article,in the highlight topic series,provides detailed information on the indication,procedure,outcome,complications and their prevention in ESD of superficial esophageal neoplasms.

Prognostic value of postoperative complication for early recurrence after curative resection of hepatocellular carcinoma

Background: Postoperative complications may adversely affect oncological outcomes. The aim of this study was to evaluate the impact of postoperative complications on early-phase recurrence after curative resection for hepatocellular carcinoma(HCC).Methods: We included 145 HCC patients who underwent initial and curative resection between January2004 and December 2013. Postoperative complications of grade III or higher based on Clavien–Dindo classification were defined as clinically relevant postoperative complications. Recurrence within two years after hepatectomy was defined as early-phase recurrence.Results: Thirty-eight patients(26%) developed postoperative complications. The only predictive factor for postoperative complication was longer operative duration(P = 0.037). The disease-specific survival rate of patients with complication was lower than that of patients without complications(P = 0.015). Earlyphase recurrence was observed in 20/38(53%) patients who suffered postoperative complications and36/107(34%) patients with no complications, which was statistically significant(P = 0.039). Multivariate analysis identified four factors contributing to early-phase recurrence: high serum AFP level(P = 0.042),multiple tumors(P < 0.001), poor differentiation(P = 0.036) and presence of postoperative complication(P = 0.039).Conclusions: Postoperative complication is an independent prognostic factor for early-phase recurrence after curative resection of HCC. Close observation of patients with postoperative complications may be a necessary treatment strategy for HCC.

Neurological complications of hematopoietic cell transplantation in children and adults

Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.

Treatment efficacy of radiof requency ablation of 338 patients with hepatic malignant tumor and the relevant complications

AIM: To investigate the treatment efficacy of radiofrequency ablation (RFA) of hepatic malignant tumor and the relevant complications.METHODS: A total of 338 patients with 763 hepatic tumors underwent ultrasound-guided RFA (565 procedures).There were 204 cases of hepatic cellular carcinoma (HCC)with 430 tumors, the mean largest diameter was 4.0 cm.Of them, 48 patients (23.5％) were in stages Ⅰ-Ⅱ (UICC Systems) and 156 (76.5％) in stages Ⅲ-Ⅳ There were 134 cases of metastatic liver carcinoma (MLC), with 333metastases in the liver, the mean diameter was 4.1 cm,the liver metastases of 96 patients (71.6％) came from gastrointestinal tract. Ninety-three percent of the 338patients were treated using the relatively standard protocol. Crucial attention must be paid to monitor the abnormal changes in ultrasound images as well as the vital signs of the patients to find the possible hemorrhage and peripheral structures injury in time. The tumors were considered as ablated completely, if no viability was found on enhanced CT within 24 h or at 1 mo after RFA. These patients were followed up for 3-57 mo.RESULTS: The ablation success rate was 93.3％ (401/430tumors) for HCC and was 96.7％ (322/333 tumors) for MLC. The local recurrence rate for HCC and MLC was 7.9％ (34/430 tumors) and 10.5％ (35/333 tumors),respectively. A total of 137 patients (40.5％) underwent 2-11times of repeated ablations because of tumor recurrence or metastasis. The 1st, 2nd, and 3rd year survival rate was84.6％, 66.6％, and 63.1％, respectively;the survival rate from 48 patients of Ⅰ-Ⅱ stage HCC was 93.7％, 80.4％,and 80.4％, respectively. The major complication rate in this study was 2.5％ (14 of 565 procedures), which consisted of 5 hemorrhages, 1 colon perforation, 5 injuries of adjacent structures, 2 bile leakages, and 1 skin burn.CONCLUSION: RFA, as a minimally invasive local treatment,has become an effective and relatively safe alternative for the patients of hepatic malignant tumor, even of advanced liver tumor, tumor recurrence, and liver metastases. Knowledge about possible complications and their control may increase the treatment efficacy and help to promote the use of RFA technique.

Postoperative complications after robotic resection of colorectal cancer:An analysis based on 5-year experience at a large-scale center

BACKGROUND As a common gastrointestinal malignancy,colorectal cancer(CRC)poses a serious health threat globally.Robotic surgery is one of the future trends in surgical treatment of CRC.Robotic surgery has several technical advantages over laparoscopic surgery,including 3D visualization,elimination of the fulcrum effect,and better ergonomic positioning,which together lead to better surgical outcomes and faster recovery.However,analysis of independent factors of postoperative complications after robotic surgery is still insufficient.AIM To analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.METHODS In total,1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively.Postoperative complications were categorized according to the Clavien-Dindo(C-D)classification,and possible risk factors were evaluated.RESULTS Among 1040 patients who had undergone robotic surgery for CRC,the overall,severe,local,and systemic complication rates were 12.2%,2.4%,8.8%,and 3.5%,respectively.Multivariate analysis revealed that multiple organ resection(P<0.001)and level III American Society of Anesthesiologists(ASA)score(P=0.006)were independent risk factors for overall complications.Multivariate analysis identified multiple organ resection(P<0.001)and comorbidities(P=0.029)as independent risk factors for severe complications(C-D grade III or higher).Regarding local complications,multiple organ resection(P=0.002)and multiple bowel resection(P=0.027)were independent risk factors.Multiple organ resection(P<0.001)and level III ASA score(P=0.007)were independent risk factors for systemic complications.Additionally,sigmoid colectomy had a lower incidence of overall complications(6.4%;P=0.006)and local complications(4.7%;P=0.028)than other types of colorectal surgery.CONCLUSION Multiple organ resection,level III ASA score,comorbidities,and multiple bowel resection were risk factors for postoperative complications,with multiple organ resection being the most likely.

Does testosterone prevent early postoperative complications after gastrointestinal surgery?

AIM:To investigate the role of sex hormones in the early postoperative complications of gastrointestinal diseases. METHODS:A total of 65 patients who underwent operations for gastric and colorectal diseases(mainly malignant diseases)were included in the study. Peripheral venous blood samples were collected at different times for analysis of estradiol,testosterone and progesterone.The only study endpoint was analysis of postoperative complications. RESULTS:Patients of both sexes were uniform but postoperative complication rate was significantly higher in female patients(P=0.027).There was no significant association of estradiol and progesterone with postoperative complications.Testosterone levels in complicated patients were significantly lower than in uncomplicated patients(P<0.05).Area under the receiver operating characteristic curve showed that a lower value of testosterone was a predictor for higher complication rate(P<0.05),and a lower value oftestosterone at later times after surgery was a better predictor of complications. CONCLUSION:Patients with low testosterone level were prone to higher postoperative complications,which was evident in both sexes.However,further studies are necessary to support this result.

Urethral complications after tension-free vaginal tape procedures:A surgical management case series

AIM:To analyze the clinical features,diagnostic modalities,and the surgical management of urethral complications after tension-free vaginal tape procedures.METHODS:This study encompasses a retrospective review of nine patients presented with urethral complications after midurethral sling procedures.The patients underwent the procedures during a period from 1999 to 2012 in three different regional hospitals in the southwest part of Sweden.The time from sling placement to diagnosis,the risk factors,clinical features,diagnosis,surgical management,and functional outcome are presented.The presenting symptoms were described as either early onset(< 12 mo) or late onset(> 12 mo) according to when they were first reported.RESul TS:Eight cases of urethral erosion and one case of bladder-neck erosion were detected.The mean interval for diagnoses of the erosions ranged from 3 mo to 11 years.The most common presenting symptoms included de novo urgency with or without incontinence(7/9 patients),urinary retention/voiding dysfunction(4/9 patients),urethritis(4/9 patients),relapse of stress-incontinence(3/9 patients),recurrent urinary tract infections(5/9 patients),and hematuria(1/9 patient).In most cases,voiding dysfunction and urethritis occurred early after the operation.The surgical management applied in most cases was transurethral resection of the intraurethral part of the mesh.The removal of the intraurethral mesh resulted in improvement or complete cure of urgency symptomsin 5/7 patients with urgency.Four patients were reoperated with a new stress-incontinence surgery,one with laparoscopic Burch,and three with retropubic tension-free vaginal tape procedures.COn Clu SIOn:Urethral complications should be suspected in the case of de novo urgency and relapse of stressincontinence.Transurethral excision of the intraurethral mesh is the recommended treatment.

Reconstructive Surgery in the Lower Urinary Tract in Children: Can the Complication Rate Be Reduced?

Objective: Reconstructive surgery of the lower urinary tract in children is reported with a high complication rate. The aim was to evaluate the complication rate at our institution. Material and methods: Between 2000 and 2010, 41 boys and 19 girls were consecutively operated on with augmentation with ileum (45), alternative CIC-channel (57) and bladder neck plasty (42) in isolation or as combined procedures in individuals with neurogenic bladder dysfunction NBD (42), bladder exstrophy-epispadias complex BEEC (13), isolated epispadias IE (2) and posterior urethral valves, PUV (3). Median age at surgery was 11 years (range 1.3 -21) and median follow-up time 7 years (1 -10). Complications were consecutively observed at follow-up according to a structured protocol. As first line care, specially trained nurses followed the patients and daily bladder irrigation was included in the CIC follow-up regimen. Results: In individuals with augmentation with ileum, of which all but one performed CIC through an alternative channel, there were stones reported in 3/45 (7%), perforation in 2/45 (4%), reoperation of CIC channel in 5/57 (9%), bowel obstruction in 3/56 (5%) and rupture of BNP in 3/39 (8%). Re-augmentation was not needed and malignancy not found. No significant difference was seen between patients with NBD and BEEC/IE. Conclusion: Complication rates were among the lowest reported for stones, perforation and reoperations of CIC channels and were average for bowel obstruction. Bladder stones and perforation were seen in individuals with bad compliance to recommended CIC-and irrigation regimens.

经尿道钬激光整块切除术治疗高危非肌层浸润性膀胱癌47例疗效及术后并发症与复发风险的观察

目的 探讨经尿道钬激光整块切除术治疗高危非肌层浸润性膀胱癌(NMIBC)的效果。方法 选取2019年1月至2021年5月承德医学院附属医院94例高危NMIBC病人进行前瞻性研究,按随机数字表法分组,各47例。对照组行经尿道膀胱肿瘤等离子电切术,观察组行经尿道钬激光整块切除术。比较两组手术相关指标、临床疗效、手术前后外周血循环肿瘤细胞(CTCs)计数、肿瘤标志物[癌胚抗原(CEA)、膀胱肿瘤抗原(BTA)、糖链抗原19-9(CA19-9)]、并发症及预后情况。结果 观察组术中出血量、膀胱冲洗、尿管留置及术后住院时间分别为(25.10±4.12)mL、(18.65±6.74)min、(19.57±3.48)h、(8.01±1.69)d,均优于对照组的(43.25±6.78)mL、(24.78±8.12)min、(35.24±5.12)h、(15.32±2.89)d(P<0.05);观察组总有效率87.23%高于对照组68.09%(P<0.05);术后72 h观察组外周血CTCs计数为5.47±2.00,低于对照组的8.96±3.12(P<0.05);术后3、6、12个月观察组血清BTA、CEA、CA19-9水平低于对照组(P<0.05);观察组并发症发生率6.38%(3例)低于对照组23.40%(11例)(P<0.05);术后随访1年,观察组病人1年无复发生存率97.83%(45/46)与对照组90.91%(40/44)比较,差异无统计学意义(P>0.05)。结论 经尿道钬激光整块切除术可提高高危NMIBC病人临床疗效,减少并发症,加速术后康复进程,并可减少外周血循环肿瘤细胞,降低肿瘤标志物水平。

非肌层浸润性膀胱癌患者二次经尿道膀胱肿瘤钬激光切除术的临床意义

目的探讨非肌层浸润性膀胱癌(NMIBC)患者二次经尿道膀胱肿瘤钬激光切除术治疗的临床效果。方法选取82例NMIBC患者,按随机数字表法分为2组,各41例。对照组予以经尿道膀胱肿瘤电切术(TURBT)治疗,观察组予以经尿道膀胱肿瘤钬激光切除术治疗。比较2组手术情况、炎症因子水平、氧化应激因子、病理诊断准确率及并发症。结果观察组肉眼血尿时间[(1.29±0.23)d]、尿管留置时间[(2.35±0.27)d]、术后膀胱冲洗时间[(1.42±0.25)d]较对照组短,有统计学差异(P<0.05)。观察组治疗后白介素-6(IL-6)[(67.25±6.19)pg/mL]、C反应蛋白(CRP)[(17.25±2.19)mg/L]及肿瘤坏死因子-α(TNF-α)[(40.39±4.28)pg/mL]水平较对照组低,有统计学差异(P<0.05)。观察组治疗后丙二醛(MDA)[(5.74±1.05)mmol/L]水平低于对照组,超氧化物岐化酶(SOD)[(105.96±9.58)μmol/L]及谷胱甘肽过氧化物酶(GSH-Px)[(70.14±6.23)pg/mL]水平较对照组高,有统计学差异(P<0.05)。观察组病理诊断准确率[90.24%(37/41)]高于对照组,并发症发生率[4.88%(2/41)]低于对照组,有统计学差异(P<0.05)。结论二次经尿道膀胱肿瘤钬激光切除术治疗NMIBC较TURBT效果更佳,能够减轻手术创伤,缩短肉眼血尿、尿管留置时间,减轻炎症反应及氧化应激反应,且切除标本更符合病理分期要求,安全可靠。

尿路造口病人生活质量现状及影响因素分析

目的:了解尿路造口病人的生活质量现状,并分析其影响因素,为制定个性化病人健康教育方案提供依据。方法:选取2018年1月至2023年4月安徽省某三甲医院收治的196例行全膀胱切除+尿路造口病人为研究对象,采用膀胱肿瘤病人生活质量量表进行横断面调查,并进行影响因素的单因素分析和多元线性回归分析。结果:尿路造口病人生活质量总分(59.85±5.16)分,其中生理状况得分(15.07±2.53)分,社会/家庭状况得分(9.02±2.97)分,情感状况得分(6.48±2.24)分,功能状况得分(9.64±2.46)分,特异性模块得分(19.65±2.14)分。单因素分析显示,不同年龄、文化程度、月收入、照顾者及造口类型病人的生活质量得分差异有统计学意义(P<0.01)。多元线性回归分析显示,年龄、文化程度及造口类型均为安徽地区尿路造口病人生活质量的独立影响因素(P<0.01)。结论:尿路造口病人总体生活质量水平不高,在临床工作中需根据病人具体情况进行内容灵活、形式多变的健康宣教。

不同尿流改道方式在膀胱癌患者行机器人辅助腹腔镜下全膀胱切除术后的效果观察

目的探析不同尿流改道方式应用于膀胱癌患者机器人辅助腹腔镜(以下简称腹腔镜)下全膀胱切除术后的效果。方法采用前瞻性研究法,选取2018年5月~2022年5月南京大学医学院附属鼓楼医院收治的行腹腔镜下全膀胱切除术的膀胱癌患者102例,采用随机数表法分为对照组和试验组两组,各51例。对照组行输尿管皮肤造口术,试验组行原位回肠新膀胱重建术。比较两组患者围术期指标、生活质量变化,并统计并发症发生率情况。结果试验组手术时间及住院时间分别为(372.07±45.48)min、(24.83±4.16)d较对照组(339.47±52.07)min、(21.05±4.72)d长,术中出血量为(857.06±125.39)ml较对照组的(749.14±140.06)ml多,差异有统计学意义(t=3.367、4.291、4.100,P<0.001)。试验组治疗后生理功能、心理健康及总体健康评分分别为(64.08±7.25)分、(63.93±7.02)分和(61.17±6.93)分,较对照组的(60.13±6.59)分、(59.97±6.84)分和(57.08±7.11)分高,差异有统计学意义(t=2.879、2.885、2.942,P<0.05);试验组术后尿路感染发生率为1.96%(151),低于对照组的15.69%(851),差异有统计学意义(χ^(2)=4.387,P=0.036)。结论原位回肠新膀胱重建术应用于膀胱癌患者腹腔镜下全膀胱切除术后虽手术时间长,术中出血量多,但可提高生活质量,且术后尿路感染发生率低,安全性更高。

SCAMP2和SCAMP3在膀胱癌中的表达及意义

目的探讨分泌载体相关膜蛋白2和3(SCAMP2和SCAMP3)在膀胱癌(BC)中的表达及其意义。方法应用免疫组织化学法检测181例BC及相应癌旁组织中SCAMP2和SCAMP3的表达水平。结果与相应癌旁组织相比较,SCAMP2和SCAMP3在BC组织中的表达水平显著升高(χ^(2)=41.242、110.576,P<0.001)。SCAMP2高表达与饮酒史和癌症家族史有关(χ^(2)=4.784、3.904,P<0.05)。SCAMP3高表达与浸润性BC和癌症家族史有关(χ^(2)=6.893、7.411,P<0.05)。预后分析显示,SCAMP2和SCAMP3表达与BC病人预后没有相关性。结论SCAMP2和SCAMP3在BC组织中的高表达可能与BC的发生和进展密切相关,可能可以作为BC治疗的潜在靶点。

非肌层浸润性膀胱癌激光整块切除研究进展

非肌层浸润性膀胱癌的标准治疗方式为经尿道膀胱肿瘤电切术(TURBT)辅以膀胱腔内化疗或免疫治疗。TURBT具有创伤小、恢复快、可反复切割等优点,但在安全性与病理精确评估方面存在一定的缺陷。而激光用于膀胱肿瘤时既不会产生闭孔神经反射,又可减少手术出血,目前开展的激光手术多以膀胱肿瘤整块切除术为主,激光因其汽化切割避免了组织炭化的可能,因此剜除的膀胱肿瘤基底部肌层组织得以完整保留,对病理的分级及临床分期有独到的优势。本文综述了激光膀胱肿瘤整块切除术的技术优势、现状与进展。

经尿道钬激光膀胱肿瘤切除术对表浅层膀胱癌患者血清相关指标及炎症因子的影响

目的 探讨经尿道钬激光膀胱肿瘤切除术(HoLRBT)治疗表浅层膀胱癌的临床效果及安全性。方法 选取70例表浅层膀胱癌患者,按随机数字表法分为2组,各35例。对照组行经尿道膀胱肿瘤电切术(TURBT)治疗,观察组行HoLRBT治疗。比较2组手术情况、血清相关指标、炎症因子水平及并发症。结果 观察组膀胱冲洗、尿管留置及住院时间分别为(19.58±2.14)min、(20.34±3.35)d、(8.96±1.15)d,均短于对照组的(32.54±3.49)min、(35.41±4.12)d、(13.75±2.14)d;术中出血量为(26.58±2.35)ml,少于对照组的(40.18±4.27)ml,差异有统计学意义(P<0.05)。观察组术后恶性肿瘤特异生长因子(TSGF)、肝细胞生长因子(HGF)水平分别为(65.36±6.15)U/ml、(2.21±0.32)μmol/L,低于对照组的(80.41±8.36)U/ml、(3.42±0.45)μmol/L,有统计学差异(P<0.05);观察组术后白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平分别为(57.25±5.19)pg/ml、(39.39±4.28)pg/ml、(12.25±2.19)mg/L,低于对照组的(64.31±6.28)pg/ml、(45.41±4.38)pg/ml、(15.41±2.23)mg/L,有统计学差异(P<0.05)。观察组并发症较对照组少,有统计学差异(P<0.05)。结论 HoLRBT治疗表浅层膀胱癌效果更佳,可缩短膀胱冲洗、尿管留置时间,减轻手术创伤,降低TSGF、HGF水平,且并发症少。

前列腺癌多参数MRI诊断及误诊原因分析

目的 探讨前列腺癌临床特点、多参数MRI表现,总结其误诊原因及防范措施。方法 对2020年4月—2022年2月收治的多参数MRI检查后误诊为膀胱癌、前列腺增生的前列腺癌10例的临床资料进行回顾性分析。结果 10例年龄54~73岁。6例因尿急、尿频、尿潴留、排尿困难就诊,直肠指诊示前列腺肥大,查血清前列腺特异性抗原升高,多参数MRI及前列腺穿刺活组织病理检查未发现前列腺肿瘤证据,误诊为前列腺增生,后经术后病理检查确诊T1期前列腺癌。4例以尿痛、血尿、排尿困难就诊,经多参数MRI检查误诊为膀胱癌,查血清前列腺特异性抗原升高,直肠指诊发现前列腺肥大,再次行多参数MRI和前列腺组织穿刺活组织病理检查证实为前列腺癌累及膀胱。误诊时间4~10 d。误诊为前列腺增生6例接受根治性手术,误诊为膀胱癌4例予内分泌和放射治疗,随访至今病情控制尚可。结论 临床接诊以尿急、尿频、尿潴留、排尿困难等症状就诊的中老年男性患者时应考虑到前列腺癌可能。加强对前列腺癌影像学特征认识,行多参数MRI检查时重点观察前列腺结构、包膜完整与否、膀胱壁连续性等重要特征,必要时可行前列腺穿刺活组织病理检查,以提高该病术前诊断正确率。

新型等离子针状电极在膀胱癌整块切除手术中的应用效果及安全性分析

目的 观察新型等离子针状电极在膀胱癌整块切除手术中的应用效果及安全性。方法 本研究为前瞻性研究,选择洛阳市东方人民医院2020年5月~2022年6月期间收治的90例膀胱癌患者为研究对象,以计算机随机分组法将其分为常规组和试验组,各45例。常规组实施经尿道膀胱肿瘤切除术(TURBT)治疗,试验组实施新型等离子针状电极精准切除术(ATUNER)治疗,所有患者术后开展为期1年随访,比较两组患者的手术情况、术后并发症发生情况、术后泌尿功能恢复情况及短期生存情况。结果 联合组的CRP、IL-6、IL-8,术后2周、4周的伤椎后凸角、Cobb角、ODI评分均低于手术组,JOA评分均高于手术组;联合组的住院时间、卧床时间、骨折愈合时间,术后并发症发生率均低于手术组(P<0.05)。结论 ATUNER能加快膀胱癌患者的术后康复进程,对降低术后并发症发生风险、促进膀胱功能恢复,并改善术后短期预后均有积极意义。