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Objective To explore the effect of different doses remifentanil on hyperalgesia and the analgesic effect of gynecological laparoscopic operation.Methods Ninety gynecologic laparoscopic operation patients were divided into A group,B group and C group by random digits table method with 30 cases each.The anesthesia induction in A group and B group was intravenous injection remifentanil 1.5 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg,and in C group was intravenous injection fentanyl 3 μ g/kg,propofol 2 mg/kg,cisatracurium 0.2 mg/kg.The maintenance of anesthesia in A group was infusion of remifentanil 0.3 μ g/ (kg· min),in B group was infusion of remifentanil 0.2 μ g/ (kg· min),and in C group was infusion of fentanyl 2 μ g/kg.The operation time,anesthesia time,time to extubation,intraoperative doses of propofol and remifentanil (A group and B group) were recorded.The visual analogue score (VAS) before operation and 15,30,60,120,240 min after extubation were recorded.The analgesia time,number of analgesia and adverse reaction after extubation were observed.Results There were no statistical differences in operation time and anesthesia time among 3 groups (P ＞ 0.05).The extubation time in A group and B group was significantly shorter than that in C group:(5.9 ± 2.7) and (6.1 ± 2.3) min vs.(9.6 ± 3.3) min,the dose of propofol in A group was significantly lower than that in B group and C group:(461.3 ± 69.7) mg vs.(543.4 ± 101.9) and (552.5 ± 93.8) ng,the dose of remifentanil in A group was significantly higher than that in B group:(1.12 ± 0.33) mg vs.(0.71 ± 0.1 l) mg,there were statistical differences (P＜ 0.05).The VAS 15,30,60,120,240 min after extubation in 3 groups were significantly higher than those before operation,A group:(7.3 ± 1.2),(7.4 ± 1.3),(6.5 ± 0.8),(4.5 ± 0.6),(4.1 ± 0.3) scores vs.(1.2 ± 0.3) scores,B group:(6.4 ± 1.5),(6.6 ± 1.1),(5.3 ± 0.4),(4.6 ± 0.3),(4.0 ± 0.4) scores vs.(1.5 ± 0.4) scores,C group:(3.4 ± 0.5),(4.2 ± 0.8),(4.1 ± 0.6),(3.8 ± 0.7),(3.8 ± 0.6) scores vs.(1.4 ± 0.2) scores,there were statistical differences (P ＜ 0.05).The VAS 15,30,60 min after extubation in A group were significantly higher than those in B group,and the VAS 15,30,60,120 min after extubation in A group and B group were significantly higher than those in C group,there were statistical differences (P ＜ 0.05).There was no statistical difference in VAS 240 min after extubation among 3 groups (P ＞ 0.05).The number of analgesia in A group,B group and C group were 28,29 and 3 cases,and the analgesia time were (16.1 ± 4.6),(17.9 ± 5.8) and (68.5 ± 10.l) min,there were statistical differences (P＜ 0.05),there were no statistical differences between A group and B group (P＞ 0.05),and there were statistical difference between A group,B group and C group (P ＜ 0.05).There was no statistical difference in adverse reaction among 3 groups (P ＞ 0.05),and there was no respiratory depression in 3 groups.Conclusion The degree of hyperalgesia is related to the dose of remifentanil during gynecologic laparoscopic operation.
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Objective To summarize the experience of diagnosis and surgical treatment of long distance ureteral stenosis after kidney transplantation. Methods Eleven cases of ureteral stenosis following renal transplantation were analyzed. Ureteral stenosis happened between 2-6 months after transplantation. The clinical manifestations were as follows: serum creatinine and weight elevated,urine decreased, graft area swelling. All cases were diagnosed using ultrasound, MRU or CTU. The ureteral obstruction length was 3-7 cm. In 5 patients a Boari flap technique was used, and the native ureter for pyelo-ureterostomy was used in 2 patients. Four patients were subjected to surgical operation using the native ureter for uretero-ureterostomy. Results All of the surgical treatments were successful and no operation-related complications occurred. The operation time was 2. 5 to 4 h.After reconstruction of ureter-bladder anastomosis, the urine was increased, the serum creatinine decreased to 75-156μmol/L, and uronephrosis disappeared or alleviated. The follow-up lasting 8 to 62 months showed no recurrence in all the cases. Conclusion For such cases, ultrasound should be routinely used for the possibility of stenosis. CTU or MRU is important to know the obstruction length and position. For the patients with long distance ureteral stenosis after kidney transplantation,surgical correction is the first choice.
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Objective To evaluate early diagnosis and preemptive therapy of human cytomegalovirus infection in renal transplant recipients. Methods We selected 165 renal transplant recipients who underwent transplantation from January 2007 to January 2009 and adhered to follow-up as research subjects. The samples of blood and urine were collected before transplantation, every 1 week from 2 to 8 weeks and every 2 weeks from 9 to 24 weeks after transplantation. The viral load of blood and urine was detected by fluorescence quantitative polymerase chain reaction (FQ-PCR). Once HCMV DNA load was more than 103 copies/ml, preemptive therapy was done immediately by ganciclovir. Results All the samples of blood and urine were negative before operation. HCMV DNA load could be detected in the concentrated urine at the second week and the peak of HCMV DNA loadoccurred from the sixth to eighth week after operation. At the same detection time, the number ofpositive recipients in the concentrated urine was more than in blood. In 30 cases HCMV DNA load was detected in the blood and the positive rate was 18.18%. In 64 cases HCMV DNA load was detected in the concentrated urine and the positive rate was 38.79%. The positive rate of the concentrated urine was significantly higher than in blood (P＜0.05). In 30 cases positive for HCMV DNA in the blood and urine, ganciclovir was given and the viral load was decreased gradually. But 8 recipients developed into CMV pneumonia and were cured through the comprehensive treatment. The clearance time of HCMV DNA in the concentrated urine was 10.2 ± 3.4 days. Thirty-four cases that were only positive for HCMV DNA in the urine were also treated by ganciclovir and no case developed into CMV pneumonia. The clearance time of HCMV DNA was 5.5 ± 2.1 days, and the clearance time was shortened as compared with that in those positive for HCMV DNA in the blood and urine (P＜0.05). Conclusion FQ-PCR can detect HCMV DNA in the concentrated urine in advance and increase the positive rate. Once the sample of the concentrated urine is positive, preemptive therapy has a good effect.
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Objective To assess the urinary continence at a follow-up of 1 year after radical retro-pubic prostatectomy. Methods By using subjective (questionnaire) and objective (pad-test) methods, 165 consecutive prostate cancer patients were followed up at least 1 year. With the purpose to improve post-operative continence, surgical techniques such as preservation of external striated sphincter, preservation of bladder neck and pre-prostate sphincter (PPS), and nerve-sparing technique have been carried out.Analyses were also made in comparison by age. Results A post-operative incontinence rate of 0.7% was found in the sphincter preserving group and 5.3% in the sphincter repairing group. Patients aged 50～60 revealed a continence rate of 60% when the urethral catheter was removed, whereas 82% in the 60～70 group.After 3 months of follow-up, the continence rate of both age groups tended to be similar. Conclusions Surgical improvement and patients' age are important factors in post-operative continence after radical retro-pubic prostatectomy. The preservation of external urethral sphincter helps improve continence rate. Younger patients tend to regain to continence in a shorter period while the elders longer.
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Objective To study the diagnosis and treatment of renal cell carcinoma. Methods 369 cases of renal cell carcinoma were reviewed for their incidence,diagnosis,treatment and prognosis. Results 281 cases(76.2%) were clear cell carcinoma ,39 cases (10.6%) of granular cell carcinoma,42 cases(11.4%) being a combination of the above two varieties and 7 cases being of other cell types. Radical nephrectomy was performed for 301 cases (81.6%) and other procedures for 45 cases. 297 cases have been followed up:three-year,five-year and ten-year survival rates were 74.6%、56.2% and 28.2% respectively. Conclusions B type ultrasonography and computerized tomography (CT) are important means in the diagnosis of renal cell carcinoma.The most effective treatment is radical nephrectomy at early stage,wherea sbiological treatment works in certain degree.
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Objective To evaluate a kind of operative management in the treatment of chronic non bacterial prostatitis. Methods From 1992 to 1999,cross incision of the prostatic capsule and bladder neck plasty were performed for 102 cases of chronic non bacterial prostatitis. Results The effective rate is 85.3% (87/102).It was 92.6% for the prostatitis of obstructive type (63/68) and 70.6% for patients complained of pain (24/34).43 cases have been followed up for an average of 4.5 years of which the outcome has been satisfactory in 36 and noneffective in 7. Conclusions The operative management for chronic non bacterial prostatitis is effective,safe,with less damage and less complication.