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Objective To discuss the feasibility,safety and efficacy of robot-assisted laparoscopic buccal mucosal ureteroplasty in the treatment of long segment upper ureteral stricture.Methods Five patients with complex ureteral strictures were treated with robot-assisted laparoscopic buccal mucosa ureteroplasty (5 males;right side,2 cases;left side,3 cases) in our hospital from March to July of 2017.The patients aged 25-40 years with median of 35 years old.The median body mass index was 23.5 kg/m2 (19-29 kg/m2).Data of surgical conditions,postoperative complications,and follow-up were collected.Results All patients were treated with robot-assisted laparoscopic buccal mucosa ureteroplasty and the operations were uneventful.The median length of stricture of upper ureter were 3 cm (2-6 cm).The median operation time was 360 min (200-400 min),median blood loss was 100 ml (50-200 ml),drainage tube retained time was 5 d(2-9 d),post-operative hospital stay was 11 d(7-12 d),and the median creatinine value was 85 μmol/L (76-98 μmol/L).No urine leakage,infection,buccal mucosa necrosis or other serious complications occurred after surgery.Five patients' CT examnation showed improved hydronephrosis 3 weeks post-operatively.DJ stent was removed 3 months after surgery in 2 patients,and 1 patient presented with no hydronephrosis,another one with mild hydronephrosis.DJ stent was removed 6 months after surgery in the other 3 patients with improved hydronephrosis.Conclusions Robot-assisted laparoscopic buccal mucosal ureteroplasty for the treatment of long segment upper ureteral stricture is a safe and feasible procedure,with a good short-term effectiveness and without severe complications.
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Objective To investigate whether initial intervention based on WBC measured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL.Methods From May,2015 to July 2015,24 female New Zealand rabbits,weighing 2.0-2.5 kg,born 2-3 months,used as uroseptic shock model.Their ureters were ligated and followed by injection of Escherichia coli solution into the renal pelvis.Then,those animals were randomly assigned into control group(the first group)and experimental groups (the second group,the third group).Each group had 8 rabbits initially.The first group did not receive sensitive antibiotic or fluid resuscitation.The second group received imipenem and cilastatin sodium 15mg/kg and normal saline 5 ml/kg 2 hours postoperatively.The third group received sensitive antibiotic and fluid resuscitation the same dosage as the second group 6 hours postoperatively.Mean arterial pressure(MAP) was recorded for 10 hours and survival rate of all groups for 72h postoperatively was recorded..The clinical data of 46 patients whose WBC count less than 2.85 × 109/L within two hours after UUTEL were analyzed retrospectively.These patients were divided into two groups based on the time of intervention.Group A including 19 patients received routine antibiotic,fluid therapy,low-dose corticosteroids when there was symptom of shock.Group B including 27 patients immediately received resuscitation bundle protocol when there was a drastic decrease in WBC.The incidence of septic shock,the rate of intubation,length of stay in ICU,length of stay in hospital postoperatively,hospitalization cost and survival rate of these two groups were compared.Results All 8 rabbits of the first group died within 72 h,postoperatively and the median time of survival was 11 h.None of the second group rabbits developed shock and all rabbits survived 72 h after operation.6/8 rabbits of the third group survived 72 h after operation.15 patients in Group A and 3 patients in Group B experienced acute uroseptic shock (P ＜ 0.05).11 patients in Group A and one patients in Group B underwent tracheal intubation (P ＜ 0.05).18 patients in Group A and 6 patients in Group B were transferred to ICU(P ＜ 0.05),and their length of stay in ICU was (10.8 ± 5.4) d and (7.5 ± 2.8) d,respectively(P ＞ 0.05).The length of stay in hospital and hospitalization cost of Group A and B were (19 ± 9.8)d vs.(7 ±4.7)d(P ＜0.05),(94 583 ±51 623) RMB vs.(35 389 ± 16 342) RMB respectively (P ＜ 0.05).One patient in Group A died due to acute uroseptic shock and none of Group B died.Conclusions Our animal model and clinical cohort study showed that initial intervention based on WBC mneasured within 2 hours postoperatively can reverse the uroseptic shock induced by UUTEL and improve the prognosis.
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Objective To investigate the clinical effect of laparoscope microwave ablation therapy for liver cancer.Methods Twenty-four special sites (at least 1 lesion close to diaphragmatic muscle,gallbladder,stomach,colon and big lacuna exterior and interior of liver) of primary liver cancer patients (32 nodes) were selected,and the patients were treated with laparoscope microwave ablation therapy.The rate of complete remission after treatment,the level of alpha-fetoprotein (AFP) before and after treatment,postoperative complication and follow-up condition were observed.Results All the patients successfully completed the operation.The rate of complete remission after treatment was 87.50％ (28/32).Six patients had fever,8 patients had pain,and 2 patients had pleural effusion,and no patient had serious complication such as postoperative bleeding,biliary fistula or gastrointestinal perforation,etc.Five patients showed recurrence at 2,3,3,7 and 9 months after treatment,1 patient was treated with radio frequency ablation,1 patient was treated with microwave ablation again,2 patients were treated with γ knife,1 patient was treated with conservative method and then died of liver failure.The patients without recurrence were disease-free survival.Conclusions Laparoscope microwave ablation therapy has the advantages of laparoscope and microwave ablation.It is safe and feasible,with few trauma and outstanding curative effect,especially for the liver cancer in special site.
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Objective To study the medicine dynamics, distribution in tissue and abdominal cavity fluid concentration of 5-FU after giving intraperitoneal by using a gelatin carrier to be made 5-FU slowing-release microballoons. Methods 5-FU slowing-release microballoons medicine release speed, tissue distributing and the concentration in abdominal cavity fluid were measured by high performance liquid chromatography. Results 5-FU wrapped by gelatin were slowly released. The concentration in abdominal cavity fluid was obviously higher than that in tissue or in blood. Using established standard curve line, it was proved that in body area under curve (AUC) of 5-FU slowing-release microballoons group was obviously higher than that of simple 5-FU injection group, analyzed by 3p97 pharmacokinetic software management. Conclusion 5-FU enwrapped by gelatin can retain an effective anticancer activity concentration in abdominal cavity 7 days after giving intraperitoneal and it is distributed mostly in abdominal cavity.
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Objective To compare the expression difference of heat shock protein 70 (HSP70)!in blood of acute cholecystitis (AC) patients before and after laparoscopic cholecystectomy, and to explore the relationship between HSP70 and AC at molecular and proteinic level.Methods Subjects in the study included 85 in-hospital AC patients who received laparoscopic cholectectomy. Blood before and after laproscopic operation were obtained. Ezyme linked immunosorbent assay (ELISA) was used to determine the quantity of HSP70. Four subjects were randomly selected and the total RNA and protein in blood were extracted. RT-PCR and Western-blotting were applied to determine the expression of HSP70. The data on the figure was analysed with the software Quantity one of Bio-rad Company.Results The expression level of HSP70 of acute cholecystitis patients before laparoscopic cholecystectomy (181.42?13.58) was significantly higher than that of those patients after laparoscopic cholecystectomy (63.74?9.03) (P