摘要
Objective:To evaluate the safety and efficacy of bipolar plasmakinetic endoscopic enucleation of the prostate (BEEP) in the treatment of benign prostatic hyperplasia (BPH) in a day surgery mode.Methods:The clinical data of 162 BPH patients admitted to the First Affiliated Hospital of Anhui Medical University from January 2021 to June 2022 were analyzed retrospectively. The patients were divided into day group(80 cases) and conventional group(82 cases) according to hospitalization mode. In the day group, preoperative screening and anesthesia evaluation was completed during the pre-hospitalization period, and the patient was discharged within 24 hours. The two groups were treated with BEEP, the urethral mucosa was cut at a " Ω" 5 mm proximal to the external sphincter ring in front of the verumontanum. Following the standard of anatomical enucleation of the prostate, the gland tissue was cut out after enucleation. There were no significant differences in age [(63.6±8.9) years vs. (67.5±7.1) years], body mass index [(24.3 ±2.6) kg/m 2vs. (23.0±3.2) kg/m 2], prostate volume [(55.8±16.9) ml vs. (53.7±20.7) ml], preoperative prostate-specific antigen [3.8(1.2, 5.3)ng/ml vs. 3.5(2.1, 5.6)ng/ml], the international prostate symptom score (IPSS) [(25.9±5.2) vs. (26.3±5.9)], the quality of life score (QOL) [(5.0±0.7) vs.(5.0±0.6)], the maximum urine flow rate (Q max) [(8.2±4.5) ml/s vs. (7.9±4.1) ml/s] and residual urine volume (PVR) [49(0, 131) ml vs. 45(11, 106) ml] between the two groups ( P>0.05). The waiting time before admission was [(2.6±1.2) d vs. (5.3±1.5) d], and the difference between the two groups was statistically significant ( P<0.05). The perioperative efficacy indicators, total hospitalization expenses and short-term postoperative complications were compared between the two groups. Results:In this study, all patients successfully completed the operation. There were no statistical significances in the perioperative indicators between the day group and the conventional group including the operation time [(38.4±15.2) min vs. (40.4±13.9) min], enucleated tissue weight [(34.6±9.6) g vs. (35.4±10.8) g], the decrease value of hemoglobin [(13.0±2.5) g/L vs. (12.0±3.7) g/L] and the decrease value of blood sodium [(2.2±0.9) mmol/L vs. (2.4±1.3) mmol/L]( P>0.05). The significant differences were observed in bladder irrigation time [(16.9±2.1)h vs. (22.7±12.1)h], catheterization time [(18.8±5.1) h vs.(65.6±13.0)h], postoperative hospital stay [(16.8±2.4)h vs. (64.8±6.3)h] and the total hospitalization expenses [(13 282.2±2 236.3) yuan vs. (15 969.3±2 420.6) yuan] between the day group and the conventional group ( P < 0.01). In the day group, 1 case was transferred to the general ward for observation for 1 day. There were no significant differences in the incidence of complications as urinary retention [6.3% (5/80) vs. 3.7% (3/82)], temporary incontinence [2.5% (2/80) vs. 2.4%(2/82)], urethra stricture [7.5% (6/80) vs. 6.1% (5/82)], and hematuria for intervention [1.3% (1/80) vs. 1.2% (1/82)]between the day group and the conventional group ( P > 0.05). After 6 months of follow-up, there were no significant differences in IPSS[(6.7±2.8) vs. (6.1±2.5)], QOL[(1.8±0.9) vs. (2.0±0.8)], Q max [(26.4±5.5)ml/s vs. (25.8±4.6)ml/s] and PVR [7(2, 11)ml vs. 5(4, 8)ml] between the two groups at 6 months after operation ( P > 0.05), but there were significant improvements when compared with those items of preoperation ( P < 0.01). Conclusions:The treatment of BPH with BEEP in the day surgery mode is as safe and effective as that in the conventional surgery mode, with little bleeding, high resection efficiency, definite therapeutic effect and low incidence of complications. BEEP can shorten the length of hospital stay and reduce medical expenses in the day surgery mode, and can be carried out in hospitals with conditions.
摘要
OBJECTIVES@#To evaluate the feasibility and safety of bipolar-plasmakinetic transurethral enucleation and resection of the prostate (B-TUERP) in day surgery.@*METHODS@#From January 2021 to August 2022, 34 patients with benign prostatic hyperplasia (BPH) underwent B-TUERP in day surgery in the First Affiliated Hospital of Anhui Medical University. Patients completed the screening and anesthesia evaluation before admission and received the standard surgery which implements "anatomical enucleation of the prostate" and "absolute bleeding control" on the same day of admission, and by the same doctor. Bladder irrigation was stopped, catheter was removed and the discharge evaluation was performed on the first day after operation. The baseline data, perioperative conditions, time of recovery, treatment outcomes, hospitalization costs, and postoperative complications were analyzed.@*RESULTS@#All operations were successfully conducted. The average age of the patients was (62.2±7.8) years, average prostate volume was (50.2±29.3) mL. The average operation time was (36.5±19.1) min, the average hemoglobin and blood sodium were decreased by (16.2±7.1) g/L and (2.2±2.0) mmol/L, respectively. The average postoperative length of hospital stay, and total length of hospital stay were (17.7±2.2) and (20.8±2.1) h, respectively, and the average hospitalization cost was (13 558±2320) CNY. All patients were discharged on the day after surgery except for one patient who was transferred to a general ward. Three patients received indwelling catheterization after catheter removal. The 3-month follow-up results showed a substantial improvement in the International Prostate Symptom Score, quality of life score and maximum urinary flow rate (all P<0.01). Three patients experienced temporary urinary incontinence, 1 patient experienced urinary tract infection, 4 patients were diagnosed with urethral stricture and 2 patients experienced bladder neck contracture. No complications above Clavien grade Ⅱ occurred.@*CONCLUSIONS@#The preliminary results showed that B-TUERP ambulatory surgery is a safe, feasible, economical and effective treatment for appropriately selected patients with BPH.
Subject(s)
Male , Humans , Middle Aged , Aged , Prostate/surgery , Prostatic Hyperplasia/surgery , Ambulatory Surgical Procedures , Quality of Life , Feasibility Studies , Retrospective Studies , Treatment Outcome摘要
Objective To investigate the roles of tumor necrosisfactor-α(TNF-α) and nuclear factor-κB (NF-κB) in cerebral ischemia-reperfusion injury in rats w ith diabetes mel itus. Methods Thirty-six healthy male Sprague-Daw ley rats w ere divided into a euglycemic sham operation group, a euglycemic isc hemia-reperfusion group, and a diabetes ischemia-reperfusion group (n=12 in each group) according to a random number table. A diabetes model w as induced by intraperitoneal injection of streptozotocin, and then a focal cerebral ischemia-reperfusion model w as induced by the suture method. The neurological deficit score was performed at 24 h after reperfusion. 2,3,5 triphenyl tetrazolium staining was used to measure the cerebral infarction area. Western blotting w as used to detect the expression levels of NF-κB and TNF-αon the ischemic sides. Results The neurological function scores w ere 0.00 ±0.00, 2.50 ±1.08, and 3.20 ± 1.03, respectively in the euglycemic sham operation, euglycemic cerebral ischemia-reperfusion and diabetes cerebral ischemia-reperfusion groups, and there w ere significant differences (F=38.015, P<0.001). The neurological deficit scores of the diabetes cerebral ischemia-reperfusion group w ere significantly aggravated compared with the euglycemic cerebral ischemia-reperfusion group (P<0.05). The infarct areas of the euglycemic sham operation, euglycemic cerebral ischemia-reperfusion and diabetes cerebral ischemia-reperfusion groups w ere 0.00% ±0.00%, 33.09% ±5.17%, and 55.45% ±9.29%, respectively, and there w ere significant differences among the groups (F=206.614, P<0.001), in w hich the infarct area in the diabetes cerebral ischemia-reperfusion group w as enlarged significantly compared w ith the euglycemic cerebral ischemia-reperfusion group ( P< 0.05 ). At 24 h after reperfusion, there w ere no significant differences in the expression levels of the cortical NF-κB (F=29.993, P<0.001) and TNF-α(F=28.722, P<0.001) on the ischemic sides in each group, in w hich the expression levels of NF-κB and TNF-αin the diabetes cerebral ischemia-reperfusion group w ere increased significantly compared w ith the euglycemic cerebral ischemia-reperfusion group (al P<0.05). Conclusions Diabetes may aggravate cerebral ischemia reperfusion injury. The upregulated expression of TNF-αand NF-κB may be one of the mechanisms of diabetes aggravating cerebral ischemia-reperfusion injury.
摘要
Objective To investigate the protective effect of lipoxin A4 on diabetic rats with focal cerebral ischemia-reperfusion and its mechanisms.Methods Thirty-six adult male Sprague-Dawley rats were randomly divided into a sham operation group,a cerebral ischemia-reperfusion group,and a lipoxin A4 group (n=12 in each group).Diabetes was induced by repeated intraperitoneal injection of low-dose streptozotocin.A model of middle cerebral artery occlusion and reperfusion was induced by the intraluminal suture method.Five minutes after cerebral ischemia,lipoxin A4 0.03 nmol/5 μ1 was injected via intracerebroventricular in the lipoxin A4 group.The other groups were injected equal volume of saline.Two hours after ischemia,the suture was pulled out and reperfusion was achieved.Neurological deficit scores were performed at 24 hours.Then the rats were decapitated and their brains were taken out.2,3,5-triphenyl tetrazolium chloride (TTC) staining was used to detect infarct size.Western blotting was used to detect the expression of cortical tumor necrosis factor-α (TNF-α) and nuclear factor-κB (NF-κB).Results The neurological deficit score showed that no neurological deficit was observed in the sham operation group (score 0).The neurological deficit score in the lipoxin A4 group was significantly lower than that in the cerebral ischemia-reperfusion group (2.20 ± 1.03 vs.3.20 ± 1.03; P ＜0.05).TTC staining showed that no infarct was observed in the sham operation group.The infarct size in the lipoxin A4 group was significantly lower than that in the cerebral ischemia-reperfusion group (27.52％ ± 5.71％ vs.55.45％ ± 9.29％ ; P ＜0.05).Western blotting showed that the expression levels of TNF-α in the sham operation,cerebral ischemiareperfusion,and lipoxin A4 groups were 0.64 ± 0.16,1.85 ± 0.52,and 1.40 ± 0.34,respectively.There were significant differences among the 3 groups (F =18.868,P ＜0.001).The expression level of TNF-α in the lipoxin A4 group was significantly lower than that in the cerebral ischemia-reperfusion group (P ＜0.05).The expression levels of NF-κB in the sham operation,cerebral ischemia-reperfusion and lipoxin A4 groups were 0.79 ±0.24,2.09 ± 0.47,and 1.27 ± 0.35,respectively.There were significant differences among the 3 groups (F =16.736,P ＜ 0.001).The expression level of NF-κB in the lipoxin A4 group was significantly lower than that in the cerebral ischemia-reperfusion group (P ＜0.05).Conclusions Lipoxin A4 has certain protective effect on focal cerebral ischemia-reperfusion injury in diabetic rats,its mechanism may be associated with the inhibition of the expression of TNF-α and NF-κB.
摘要
Lipoxin A4 is an arachidonic acid metabolite,it is an important endogenous anti-inflammatory mediators in the body,which is known as an inflammatory braking signal. Inflammatory response is an important factor for causing cerebral ischemia-reperfusion injury.Lipoxin A4 can exert neuroprotective effects by inhibiting inflammatory response.In addition,lipoxin A4 can also reduce blood-brain barrier permeability,reduce cerebral edema,and promote recovery of neurological function.This article reviews the neuroprotective roles and mechanisms of lipoxin A4 in cerebral ischemia-reperfusion.
摘要
Objective To summarize the clinical experience of successful intervention in single chronic coronary actery total ocdusion (CTO) lesions by the transradial.Methods A retrospective analysis was conducted in 103 patients with single CTO lesions who got intervention treatment by the radial artery.Results ( 1 ) Of the 103 cases,57 cases had unstable angina,12 cases had stable angina,and 34 cases chronic myocardial infarction.Lesions' block time was ≤ 6 months in 83 cases,and ＞ 6 months in 20 cases.(2)The path vessels of the 103 patients have no severe tortuosity and anatomical structure variation.Fifty-one cases occurred left anterior descending occlusion,25 cases occurred left circumflex branches occlusion,and 27 cases occurred right coronary artery occlusion.Furthermore,24 cases had chronic complete occlusion,and 79 cases had chronic functional block.The side branches did not block in 91 cases,no lesions(bridge) collateral formation occurred in 87 cases,lesions length was less than 15 mm in 67 cases,and tapered lesions was observed in 81 cases.( 3 ) Final intervention rate via Judkins,XB,EBU guide catheter was 37.86％,30.10％ and 29.13％ respectively.(4)the PILOT successfully through the lesions for the series wire guided was 64.08％.(5) 1.25 mm diameter series with a balloon through the first lesions and successful expanding was observed in 57 cases (55.34％),and 1.5 mm diameter series with a balloon occurred in 38 cases(36.89％ ).Conclusion Intervention treatment by the radial of single CTO lesions is feasible for experienced performers.The successful intervention depends on path vessels unimpeded,target vessels with characteristic pathological features and reasonable choice of instruments.