Home    中文  
 
  • Search
  • lucene Search
  • Citation
  • Fig/Tab
  • Adv Search
Just Accepted  |  Current Issue  |  Archive  |  Featured Articles  |  Most Read  |  Most Download  |  Most Cited

Most Viewed

  • Published in last 1 year
  • In last 2 years
  • In last 3 years
  • All
Please wait a minute...
  • 1.
    Free
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 120-120. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.025
    Abstract (704) HTML (2) PDF (1268 KB) (7)

    本视频采用前列腺尖部尿道黏膜预离断技术,改善BPH患者经尿道前列腺激光解剖性剜除术后早期控尿。其操作手术要点为:

    1.在前列腺尖部尿道黏膜及黏膜下组织(包括前列腺尖顶部分的前列腺腺体及尿道平滑肌),向两侧叶前列腺组织,拓展尖部平面,再环形离断增生腺体远端与尿道外括约肌之间的连接。这样可以避免在剜除增生腺体时,反复牵拉和撕裂尿道外括约肌,减少术后早期暂时性尿失禁的发生。

    2.前列腺尖部预离断后,从左侧或右侧尖部轻轻推挤腺体,可以更容易找到外科包膜平面,标志是可见清晰的血管平面。再向两侧拓展,递进分离至预离断的尖顶部层面。

    3.在剜除术中,分离平面使用镜鞘尖端的背侧及斜面形成的三角形楔入缝隙,推挤内侧腺体用以分离拓展外科包膜平面,尽量避免用镜鞘大幅度撬动腺体来分离增生腺体与外科包膜平面。这样也能减少对外括约肌的撬动挤压。当遇到前进阻力较大时,主动伸出光纤切段纤维连接,就能轻轻分离开平面,避免用力撬开。

    4.对于>80 g的腺体,分叶剜除可避免剜除时空间不足,导致对外科包膜和外括约肌的过度撬动。当一侧叶或中叶完全剜出后先推入膀胱,让另外一部分剜除有较大的空间。

    5.顶部的前列腺不会增生引起梗阻,为纤维基质部分。利用激光的精准切割,可以适当保留部分组织,具体方法详见视频。

    6.保留膀胱颈部内括约肌。剜除中叶时避免因为推挤导致膀胱颈6点处分离裂开。从外科包膜平面的侧面进入膀胱颈,再向上下拓展外科包膜平面,可以较好保护膀胱颈部内括约肌。

    术后我们根据情况留置尿管2~5 d,3个月内都能获得良好控尿。部分压力性尿失禁患者采用盆底肌训练可以完全康复。偶尔尿道滴尿,与老年患者合并基础疾病,括约肌本身功能不全,神经因素等有关。少部分患者术后LUTS持续1个月以上,可能与激光的炭化层较厚有关,坏死组织脱落排出,此时尿中白细胞增高不一定为炎症。

  • 2.
    The application skills and summary of the "eight methods of operating the ureteroscope" in ureteroscopy
    Sicheng Wang, Bin Jia, Tiwu Fan
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (02): 168-171. DOI: 10.3877/cma.j.issn.1674-3253.2024.02.009
    Abstract (623) HTML (128) PDF (1642 KB) (95)

    输尿管镜碎石术在泌尿外科的应用越来越普遍。初学者最大的愿望是短期内掌握好输尿管镜的操作技巧,从而尽可能减少并发症的发生。输尿管硬镜技术在诊治输尿管中下段结石方面处于首要地位,具有创伤小、恢复快、效果确切和经济等优点[123]。随着腔内泌尿外科设备和技术在国内逐渐普及,越来越多的泌尿外科医师在学习和开展输尿管镜碎石手术[4]

  • 3.
    Free
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 119-119. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.024
    Abstract (473) HTML (3) PDF (1295 KB) (3)

    上尿路移形细胞癌(upper urinary tract urothelial carcinoma,UTUC)的标准术式为患侧肾输尿管全切加同侧膀胱袖状切除术,传统的手术方法为开放手术和腹腔镜微创手术。研究表明腹腔镜肾输尿管全切术治疗UTUC的疗效和改善患者生存率与开放手术相当。因开放手术需要在腹部作两处切口或一个长切口,创伤大、术后恢复慢,因此逐渐被腹腔镜微创手术替代。腹腔镜肾输尿管全切术的关键步骤是输尿管膀胱壁间段处理,常用方法是先经尿道电切镜处理患侧输尿管开口周围膀胱黏膜,分离出壁内段输尿管,电灼封闭输尿管开口后再将分离段输尿管推向膀胱外,该方法的缺点是术中尿液和肿瘤细胞外溢可能导致肿瘤种植转移。其他方法有:先游离输尿管下段和部分膀胱壁,用Hem-o-lok夹闭部分膀胱或采用直线切割闭合器切除膀胱壁段,该方式不能分辨切缘肿瘤情况,可能导致患侧输尿管末端残留和增加术后切缘阳性率。我们采用达芬奇机器人手术系统可以单次锚定一体位行肾输尿管根治性全切除+膀胱袖状切除+扩大盆腔淋巴结清扫,术中无需重新定位机器人手术系统和调整手术床,大大缩短了手术时间,同时具有在保证瘤控的情况下有效减少创伤、加快术后恢复等特点,值得临床推广。

  • 4.
    How to perform a successful hypospadias surgery
    Xincheng Jiang, Weijing Ye
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (04): 415-415. DOI: 10.3877/cma.j.issn.1674-3253.2024.04.020
    Abstract (427) HTML (0) PDF (1292 KB) (1)

    尿道下裂作为一种常见的泌尿系统先天畸形,其诊疗过程复杂,需要一套系统化、模式化的诊疗理念来提高手术治疗效果和患者的生活质量。本视频通过介绍一种全新的尿道下裂治疗理念,为临床医师讲解如何做好一台尿道下裂手术,并提供科学、规范的治疗指导。

    本视频重点介绍尿道下裂系统化诊疗模式:(1)尿道下裂的术前评估和治疗,包括门诊评估检查,尿道下裂的分型,与性发育异常的鉴别诊断,术前激素治疗方案等,旨在术前帮助医师准确判断尿道下裂严重程度和制定手术计划;(2)尿道下裂手术方式的选择,包括尿道板纵切卷管尿道成形术、Inlay术以及蒙太奇术的应用和适应证等,分析和评价既往术式的利弊,旨在术中帮助医师在阴茎弯曲矫正方法、尿道重建方式选择等细节处理上提供新的思路和参考;(3)尿道下裂手术中游离移植物的应用技巧,"策略造瘘"的应用,阴茎皮肤覆盖的"四大法宝",旨在介绍如何根据个体化差异,制定个性化的治疗方案,以满足不同患者的需求;(4)术后并发症的处理方法和再手术或手术失败后的尿道下裂补救治疗方案,同时提出了一种蒙太奇术的衍生术式—利用游离口腔粘膜和带蒂包皮瓣耦合方式重建尿道治疗失败的尿道下裂;(5)手术细节管理,包括系带重建,新尿道的组织覆盖,皮瓣改型和阴茎外观再造,以及术后引流和包扎方式等。

    系统化诊疗模式是笔者通过总结多年临床经验形成一套相对标准化的治疗模式,可复制、推广,使临床医师在面对不同严重程度的尿道下裂患者时都能够迅速作出相应反应,确定治疗方案,提高手术治疗效率和质量。

  • 5.
    Preliminary experience of single-port gasless retroperitoneal laparoscopic adrenalectomy
    Nan Ma, Zhenyu Yang, Xuman Lin, Zhenhua Liu, Xianda Chen, Shengjie Guo, Hui Han, Fangjian Zhou, Zhuowei Liu, Kai Yao
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 25-30. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.005
    Abstract (419) HTML (33) PDF (2453 KB) (35)
    Objective

    To explore the safety and feasibility of single-port gasless retroperitoneal laparoscopic adrenalectomy (SGRLA) for adrenal tumors.

    Methods

    The clinical data of 65 patients undergoing single-port posterior laparoscopic adrenal tumor resection by the same operator from October 2020 to March 2022 in Sun Yet-Sen University Cancer Center were retrospectively collected and analyzed, including 23 cases of SGRLA and 42 cases of conventional single-port laparoscopy.

    Results

    All the surgical procedures were successfully completed without intermediate opening or conversion to multi-port operation. Baseline characteristcs were balanced between the two groups. There were no significant difference between the SGRLA group and the conventional single-port laparoscopy group in terms of operative time, intraoperative bleeding, postoperative hospital stay, postoperative pain medication duration, and drainage tube retention time (P>0.05); the mean cost of hospitalization was lower in the SGRLA than in the traditional group [(32 072 ±2 667) vs (34 972 ± 2 783 yuan), P<0.001].

    Conclusion

    Single-port gasless retroperitoneal laparoscopic adrenalectomy is safe and feasible, which can avoid the complications of pneumoperitoneum, reduce hospitalization costs of patients, and is a minimally invasive cosmetic and economic procedure.

  • 6.
    The preliminary application of transurethral thulium laser en-bloc resection for the treatment of non-muscle invasive bladder cancer by laser controller
    Hao Wang, Zhuo Wang, Qi Wang, Jinli Gao, Xintao Tian, Wenyuan Zhang, Wenhui Jiang, Jiasun Lu, Guosheng Yang, Jiling Wen
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 31-35. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.006
    Abstract (390) HTML (13) PDF (1370 KB) (17)
    Objective

    To evaluate the technique and preliminary experiences of thulium laser en bloc resection in the treatment of non-muscle invasive bladder cancer by laser controller.

    Methods

    The data of 57 patients with NMIBC admitted to Shanghai East Hospital from October 2021 to June 2022 were retrospectively analyzed, including 51 males and 6 females. The median tumor diameter was 2 cm (0.4~6 cm), 27 patients had single tumor and 30 patients had multiple tumors. The muscle of the base of the tumor was pushed directly at the muscle fiber level by the laser controller. In case of bleeding or muscle fibers could not be pushed away, the fiber was extended to coagulate or cut off, and the tumor was eventually en-bloc resected.

    Results

    All 57 operations were successfully completed. There was no conversion to traditional TURBT. The median operation time was 30 min (range: 15 min to 90 min). No obturator nerve reflex and obvious bladder perforation occurred during the operation. In 57 patients with 89 tumor specimens, detrusor muscle could not be detected in 3 specimens, and the proportion of detrusor muscle retrieval was 96.6%(86/89). The pathological diagnosis was affected by cauterization of the resection margin in 1 case specimen, and the pathological evaluation was not affected by cauterization of the remaining 88 specimens.

    Conclusion

    Bloc resection in the treatment of non-muscle invasive bladder cancer by laser controller is a feasible technique with low complication rate, high safety, high proportion of specimens with detrusor muscle, and low incidence of specimen cauterization, which will affect pathological evaluation.

  • 7.
    Hot research and interpretation of surgical therapy for stone disease in the annual meeting of American Urology Association in 2024
    Boxing Su, Bo Xiao, Jianxing Li
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (04): 303-308. DOI: 10.3877/cma.j.issn.1674-3253.2024.04.001
    Abstract (381) HTML (38) PDF (1538 KB) (139)

    This article mainly summarizes the research hotspots on surgical treatment of urinary tract stones at the Annual meeting of American Urological Association. The basic research related to surgical therapy, multi-center randomized controlled trials comparing different surgical methods, surgical complications related research, research on new instruments and equipment, and the application of robot-assisted and artificial intelligence in stone surgery were shared and interpreted.

  • 8.
    2024 Annual Meeting of European Association of Urology: frontier exploration and future trends in prostate cancer research
    Hai Huang, Bisheng Cheng, Jian Huang
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (03): 202-207. DOI: 10.3877/cma.j.issn.1674-3253.2024.03.001
    Abstract (366) HTML (32) PDF (1381 KB) (123)

    This article summarizes the important advances and future trends in prostate cancer research presented at the 2024 European Urological Association (EAU) Annual Meeting. Studies have indicated that molecular imaging techniques such as prostate-specific membrane antigen positron emission tomography (PSMA-PET) demonstrate high sensitivity and specificity in the diagnosis and staging of prostate cancer, despite existing technical limitations and the need for standardization. The role of biomarkers in early diagnosis and treatment decision-making is becoming increasingly important, with liquid biopsy methods showing high sensitivity and specificity. There is an ongoing debate regarding the treatment strategy for PSMA-positive M1a patients, with a need for further research to clarify best practices. Focal therapy, as a method to reduce side effects and improve quality of life, is suitable for specific patients. Nutritional support is crucial for the overall health and treatment response of patients. Technological innovations, including remote monitoring, artificial intelligence (AI), and electronic patient-reported outcome measures (ePROMs), are changing the diagnostic and treatment paradigms for prostate cancer. Future research will focus on optimizing treatment plans, innovating focal therapy techniques, evaluating the long-term effects of nutritional interventions, and further applying technological innovations to improve treatment outcomes and patient satisfaction.

  • 9.
    Free
    Chinese Journal of Endourology(Electronic Edition) 2023, 17 (06): 659-660. DOI: 10.3877/cma.j.issn.1674-3253.2023.06.023
    Abstract (298) HTML (0) PDF (1692 KB) (1)

    【视频简介】近年来随着临床证据不断增多,手术技巧不断提高,根治性前列腺切除术在前列腺癌的治疗中占据越来越重要的位置。特别是对于高危和局部进展期前列腺癌,该手术已经作为综合治疗的一部分。根据手术的病理结果和随访情况,后续可以选择联合内分泌治疗和放疗,实现良好的肿瘤控制[1]。但根治性前列腺手术的目标不仅是良好的肿瘤控制,还包括良好的功能恢复。高危或者局部进展期患者大多需要联合放疗和内分泌治疗,因此对于这些患者更应该追求肿瘤控制和控尿功能的二连胜。

    对于高危或者局部进展期患者,应尽可能保证肿瘤的完整切除。由于辅助放疗会对控尿功能的恢复造成不良影响,因此应尽早地实现控尿功能的恢复。在手术中,扩大淋巴结清扫是高危患者手术治疗的重要组成部分,包括髂外动静脉组、闭孔神经组、髂内动脉组淋巴结[2]。但应注意髂内动脉内侧淋巴结清扫可能损伤盆腔内自主神经丛,不利于术后尿控、性功能的恢复[3]。近年来内窥镜的手术进展使我们可以更清晰地辨认盆底组织结构,随着对盆底功能解剖认识的加深,我们在手术过程中可以采用多种方法以改善术后控尿功能。首先应该减少组织损伤,尤其是减少对控尿相关神经和肌肉结构的破坏。减少损伤要求我们在切除过程中精准定位和精细分离,保留神经血管束、保留膀胱颈、尿道尖部冷刀精细分离、保留膀胱前间隙等技术都对改善术后控尿功能有积极的影响。但是这些术式对术者技巧要求更高,而且紧贴前列腺进行分离具有更高的切缘阳性和肿瘤残留的风险[4-10]。尽管目前有一些量表可以通过患者年龄、临床分期、PSA、穿刺阳性部位及评分等评估肿瘤外侵的风险。但是目前指南不推荐局部晚期的患者进行保留神经的手术[2]。改善术后控尿功能的另一个要点是注意控尿相关结构的重建。目前对控尿结构的重建技术主要包括Rocco等[11]提出的后重建技术以及Patel等[12]提出的前悬吊技术。这些技术机制的可能与控尿的吊床理论有关,通过重建技术恢复尿道周围的解剖结构减少尿外渗对组织纤维化的影响,可能促进控尿功能的恢复[12-14]。多项研究显示,这些重建技术可以显著改善患者术后控尿恢复时间,特别是术后短期控尿的恢复,而且不增加手术切缘阳性率[14]。笔者所在单位通过回顾性分析,发现采用联合重建技术的患者术后短期至9个月控尿明显改善。重建技术为不适合精细保留控尿结构的患者改善尿控提供了新的方案。

    腹腔镜和机器人设备为根治性前列腺切除术带来了更精细的视野和工具。但是术后尿失禁依然是影响患者术后生活质量的重要因素。根治性前列腺切除术中对组织结构的精准切除和充分重建都有助于术后控尿功能恢复。但是精细切除可能会增加切缘阳性的风险,因此对于高危患者,保留控尿功能的术式选择应慎重,为这些患者选择合适的综合治疗方式,达到瘤控-尿控的最佳平衡,是未来研究的方向。

  • 10.
    Surgial techniques of laparoscopic resection of giant right adrenal cortical carcinoma
    Xingjian Cai, Qi Yang, Yuquan Ju
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (03): 302-302. DOI: 10.3877/cma.j.issn.1674-3253.2024.03.021
    Abstract (298) HTML (0) PDF (1281 KB) (1)

    本例患者男性,67岁。术前诊断:(1)右肾上腺占位性病变(髓髓样脂肪瘤?嗜铬细胞瘤?恶性肿瘤?)大小约8.6 cm×7.3 cm×7.2 cm;(2)心律失常室性早搏;(3)2型糖尿病。术前严格控制血糖,监测血压及心率正常,予以口服酒石酸美托洛尔12.5 mg一日两次,治疗室性早搏。手术方法为"上浮式"经腹腹腔镜下右肾上腺巨大肿瘤切除术。注意事项:(1)肿瘤巨大,中心牵引法无法实施,逐步处理肿瘤周围,底部牵引组织血管,轻轻上托,扩大游离间隙,直至完全切除肿瘤。(2)肿瘤血供特点呈现"三角形"分布,下腔静脉外侧后方,是肿瘤血管系膜所在,分束结扎,近心端结扎夹夹闭,远心端超声刀慢档凝闭或双极电凝止血。(3)肿瘤游离分"三区一线"展开,即"肾区、膈区、肝区及下腔静脉",严格按照层面解剖分区交替游离肿瘤。(4)肿瘤与周围脏器关系密切,防止十二指肠及下腔静脉损伤,应充分显露出中央静脉时夹闭剪断,近心端保留充分,防止脱夹。

    术后病理结果为肾上腺皮质癌。

  • 11.
    Efficacy of laparoscopic bladder muscle flap ureteroplasty for the treatment of ureterovaginal fistula
    Huadong Xie, Siping Zeng, Shiyu Zhang, Qiyue Zhao, Yanxiang Xiong, Gangyun Guan, Yongyan Meng, Yi Zhan
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 46-51. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.009
    Abstract (290) HTML (14) PDF (2103 KB) (35)
    Objective

    To explore the effectiveness of laparoscopic bladder muscle flap ureteroplasty for the treatment of ureterovaginal fistula.

    Methods

    A retrospective analysis was conducted on the clinical data of 13 patients with ureterovaginal fistula treated in the Fourth Affiliated Hospital of Guangxi Medical University from July 2018 to January 2023. The patients' ages ranged from 36 to 66 years, with an average of (51±8) years, The time of involuntary vaginal leakage was found to be 2-20 days after gynecological surgery, with an average time of (11±5) days. All patients underwent laparoscopic bladder muscle flap ureteroplasty. The operation time, length of hospital stay, intraoperative blood loss and postoperative clinical outcomes of the 13 patients were analyzed.

    Results

    All 13 patients in this group successfully underwent laparoscopic bladder muscle flap ureteroplasty. The operation time ranged from 85 to 180 min, with an average of (109±23) min. The hospital stay ranged from 8 to 15 days, with an average of (10±2) days. The intraoperative blood loss ranged from 20 to 300 ml. The preoperative creatinine was (65±15) μmol/L, and the postoperative creatinine was (53±9) μmol/L, with a statistically significant difference (P<0.05). After the surgery, all 13 patients did not have any vaginal leakage of urine. Among them, two patients showed mild to moderate renal hydronephrosis on CT examination one month after removing the double-J stent, but the creatinine indexes were within the normal range (preoperative 52 μmol/L and 70 μmol/L, and postoperative 48 μmol/L and 60 μmol/L, respectively). The patient had mild hydronephrosis that did not continue to worsen until 3 months after removal of the double-J stent, the hydronephrosis of the other patient as reduced by follow-up CT examination until 3 months after removal of the stent. One patient had recurrent urinary tract infection after surgery. All patients had no wound fat liquefaction after the surgery. All patients were followed up for 3 to 9 months.

    Conclusion

    Laparoscopic bladder muscle flap ureteroplasty for the treatment of ureterovaginal fistula is a reliable and effective surgical procedure. It provides the advantages of less trauma, fast recovery, precise efficacy, and fewer complications.

  • 12.
    A case report of fistula tube ectopia into the inferior vena cava caused by renal vein injury during percutaneous nephroscopy
    Yi Zhang, Chengren Gou, Zhenyu Guo
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 90-92. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.016
    Abstract (288) HTML (19) PDF (1489 KB) (50)

    经皮肾镜碎石取石术(PCNL)是治疗2 cm以上肾结石的主要手段。目前越来越多的泌尿外科医师开始采用超声定位引导进行PCNL。但血管损伤导致的术中大出血仍为其最严重的并发症[1]。2019年1月至2022年6月务川自治县人民医院泌尿外科共行150例B超定位下PCNL,发生术中肾静脉损伤并导致造瘘管异位至下腔静脉内1例,现就其诊治经过报道如下。

  • 13.
    Direct view pressure controlled synchronous stone removal technology through natural channels: ShuoTong ureteroscopy technique
    Zhichao Wang, Junhong Zhou, Songtao Xiang
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (02): 201-201. DOI: 10.3877/cma.j.issn.1674-3253.2024.02.019
    Abstract (268) HTML (0) PDF (1222 KB) (2)

    经自然通道全程直视控压同步碎石清石技术——硕通镜技术是一项具有独立知识产权、国内首创的民族品牌技术。目前国内、国际应用研究显示:Ⅰ期置鞘成功率90%,Ⅰ期清石率83.4%~86.5%,并发症发生率9.8%~23.3%,具有简单、便捷、经济、安全、高效的优势,值得临床推广。本视频演示硕通镜治疗输尿管结石、肾盂肾上盏结石,及同期联合输尿管软镜处理肾中下盏结石的手术步骤及技巧。手术步骤:(1)采用硕通标准镜联合硕通镜鞘进行输尿管镜检查,并将硕通镜鞘留置于结石停留处;(2)解锁退出标准镜,连接负压收集装置,置入碎石镜及200 μm(或365 μm)的钬激光;(3)根据结石硬度,设置低能高频的钬激光能量进行粉末化碎石;(4)术中实时调控内窥镜冲洗吸引器压力档位,同时左手控制负压收集装置上的负压微调阀,精准控制输尿管或肾盂的充盈程度,将结石粉末负压吸出。手术操作技巧:(1)对于输尿管结石,可采用头高脚低倾斜15°体位,预防输尿管碎石上移,对于肾盂输尿管口结石,可采用头低15°,健侧倾斜体位,以避免碎石向肾下盏移位;(2)对于输尿管结石,建议负压维持在输尿管黏膜轻微向镜头方向隆起,可有效防止结石移位,同时不损伤黏膜,对于肾盂口或肾内结石,建议维持轻微肾盂扩张,可增加回流,加快碎石清除;(3)激光粉碎以粉末化为主,尽量减少碎块化结石;(4)对于肾中下盏的结石,如果视野内可见结石,可采用外鞘或者激光光纤撬拨结石的方法,将结石移至肾盂或上盏粉碎;(5)肾下盏结石或移位下盏碎石可以同期直接切换软镜碎石清石。

  • 14.
    Free
    Chinese Journal of Endourology(Electronic Edition) 2023, 17 (06): 657-658. DOI: 10.3877/cma.j.issn.1674-3253.2023.06.022
    Abstract (263) HTML (0) PDF (1746 KB) (1)

    【视频简介】复杂性肾结石主要指多发性肾结石和鹿角形肾结石等外科治疗棘手的病例。EAU及CUA指南明确指出经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)是复杂性肾结石首选外科治疗方案,但其结石清除率较低及围手术期并发症发生率较高[1-4]。随着科技的进步,逆行肾内手术(retrograde intrarenal stone surgery,RIRS)相关技术、设备快速发展,RIRS以创伤小、低风险等优势逐渐成为上尿路结石内镜手术的主要趋势。但RIRS在指南中仅被推荐为复杂性肾结石的二线治疗方案[4]。如何及时清除结石碎片、维持肾内低压、保持术中视野清晰、提高清石效率等问题是RIRS挑战复杂性肾结石必须逾越的障碍。近年来国内外学者开展了诸多研究探索。

    一次性电子软镜的直径比传统软镜小,术中视野更清晰,术者操作更灵活,术中联合应用负压吸引设备可降低软镜手术的风险,提高手术的舒适度,这使得该技术快速得到推广应用。随着脉宽可调钬激光、摩西激光、超脉冲光纤铥激光等新型碎石设备的出现,其碎石效率得到进一步提升[5-6]。这些内窥镜及碎石工具的革新使得我们有勇气去探索:如何通过逆行的途径处理更大、更复杂的结石。

    本视频分析了现阶段逆行入路治疗复杂肾结石存在的困境,介绍了一种用于治疗复杂肾结石的新型双镜联合手术,结合了负压吸引技术的逆行硬镜联合软镜取石术[7-8]。通过回顾分析多中心的347例患者数据,发现其一期结石清除率达到81.3%,其中多发肾结石的一期清石率可以达到83.8%,围术期仅1例患者发生了Ⅲ级并发症,证实了逆行入路硬镜联合软镜处理复杂性肾结石是安全有效的[9]。视频中还介绍了激光碎石的原理,结合文献及手术视频汇报了国产超脉冲光纤铥激光(sTFL)碎石的一期临床研究数据,结果显示,sTFL产生的结石碎屑直径更小,碎石过程中结石位移少,碎石时误触黏膜不渗血,这些特点使得其效率大大提升[5]。在压力反馈型灌注平台、负压吸引技术以及新型高效碎石设备的助力下,复杂性肾结石的外科治疗或将迎来新的变革。

  • 15.
    Free
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 118-118. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.023
    Abstract (262) HTML (1) PDF (1366 KB) (2)

    机器人辅助腹腔镜下肾部分切除术(Robot-assisted laparoscopic partial nephrectomy,RAPN)已被广泛接受为T1a期肾癌微创的保肾策略。常规经腹腔入路的肾部分切除术术中需要打开同侧的结肠旁沟,较大范围地游离结肠或小肠系膜,显露肾静脉并在其后方分离出肾动脉。此种情况下,腹腔内创伤依然较大,尤其对既往有肾手术史者,分离难度和血管损伤的风险显著增加。因此,对于非复杂的肾肿瘤,如何微创切除,甚至将手术微创进一步由皮肤推进到腹腔层面,是围绕肾部分切除术探讨的热点问题。

    血管介入技术已经广泛应用数十年,其中,球囊封堵术已在大量研究中得到证实,其对于阻断远端血供具有良好的安全性和有效性。华中科技大学同济医学院附属同济医院泌尿外科团队曾尝试在数字减影血管造影(digital subtraction angiography,DSA)的引导下使用球囊封堵进行肾部分切除术。然而,此技术依赖具备专业DSA设备的杂交手术室,同时术者需要装备厚重的铅衣以减少电离辐射。更重要的是,在杂交手术室中体积庞大的DSA相关设备很难与达芬奇手术机器人配合使用。因此我们创造性地提出用腹腔镜超声(laparoscopic ultrasonography,LUS)引导球囊实现肾部分切除术中肾动脉的阻断。在LUS协助下,无需专门的杂交手术室,省略了转移患者至机器人手术间的步骤,降低了球囊脱位的风险。

    本视频对实现肾部分切"三连胜"的同时减小腹腔内创伤的新技术做了简要描述。与常规RAPN相比,"超微创"机器人杂交肾部分切除术的特点在于不必广泛游离结肠旁沟、肠系膜、升降结肠、下腔静脉等腹腔器官和组织,特别是不用打开肾门并解剖分离肾动静脉,因而降低了手术难度和手术风险。其优势在于:(1)适合部分追求更大限度微创的患者;(2)适合既往肾部分切除术、肾盂输尿管成形术、肾盂切开取石术后患者;(3)无需使用含碘造影剂,适合对含碘造影剂过敏、肾功能不全或甲状腺功能亢进的患者。

  • 16.
    Controversy and application of neoadjuvant therapy for local high-risk prostate cancer
    Xiang Li
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (03): 300-300. DOI: 10.3877/cma.j.issn.1674-3253.2024.03.019
    Abstract (258) HTML (0) PDF (1252 KB) (1)

    对于局部高危前列腺癌,根治手术前是否需要行新辅助治疗,目前尚存在一定争议。

    既往研究发现,局部高危前列腺癌出现微小转移的风险增加,并且伴有微小转移的患者往往更容易出现疾病进展。为了更好地改善患者的生存,在根治性局部治疗如前列腺癌手术之后,需要进行以内分泌治疗为主的全身性辅助治疗,部分患者还可补充区域性辅助放疗。以往针对局部高危前列腺癌的新辅助治疗的主要策略,是以雄激素剥夺治疗为基础,遗憾的是,目前已报道的大型研究结果均未观察到新辅助内分泌治疗在总生存和无进展生存方面的获益,但术前新辅助内分泌治疗已被证实能够缩小前列腺体积并降低肿瘤负荷、降低肿瘤分期和分级,进而降低局部复发风险。从理论上分析,新辅助内分泌治疗能控制微小转移病灶的发展,进而可能为根治性局部治疗之后的系统化治疗提供更好的基础。近年来,随着新型内分泌治疗药物包括各种更强效的雄激素受体抑制剂、雄激素合成抑制剂进入临床,在传统内分泌治疗的基础上显著改善了晚期转移性前列腺癌及去势抵抗性前列腺癌的预后。与这些药物相关的新辅助研究也在开展,但从目前已报道的结果来看,以雄激素及雄激素通路为治疗策略的新型内分泌治疗,同样只发现了组织和病理学方面肿瘤学指标的改善,仍未取得患者在生存方面的获益。而一项新辅助内分泌治疗联合化疗的研究观察到了可能的生存获益,这可能是由于使用了细胞毒性的化疗药物,可以有效控制微小转移。此外,内分泌治疗联合聚二磷酚腺苷核糖聚合酶抑制剂、免疫治疗和靶向治疗等新辅助临床研究也正在开展。

    尽管新辅助内分泌治疗在生存获益方面存在争议,但因其在缩小肿瘤和前列腺体积、降低肿瘤负荷、减少手术切缘阳性等方面有已被确证的效果,仍有相应的临床应用价值。对于局部晚期(T3b-T4/cN+)、膀胱颈条件差(腺体/瘤体突入膀胱、三角区/输尿管口受侵),大体积前列腺(狭小骨盆)、前列腺尖部条件差或伴有其它高危因素的患者,经过术前的新辅助内分泌治疗可以为根治性手术或放疗提供更好的局部治疗效果。

  • 17.
    Interpretation of the diagnosis and treatment guidelines for adrenal occasional tumors by the European Endocrine Society and the Canadian Urological Association in 2023
    Shengjie Lai, Xin Fang, Youqiang Fang
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (04): 309-312. DOI: 10.3877/cma.j.issn.1674-3253.2024.04.002
    Abstract (234) HTML (24) PDF (1564 KB) (86)

    In recent years, incidental adrenal masses have been increasingly discovered during health check-ups or in the course of investigations unrelated to the adrenal glands. The decision on whether or not to intervene with these masses poses a dilemma for patients, and currently, there is no unified consensus among urologists in China regarding the management of incidental adrenal tumors. Therefore, we aim to provide an interpretation of the latest international guidelines on the diagnosis and treatment of incidental adrenal tumors, offering some guidance for urologists in China.

  • 18.
    A preliminary study on the treatment of severe bleeding after ureteroscopy
    Zijie Mai, Xueqing Zeng, Qiansheng Zhang, Yongda Liu
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (04): 366-371. DOI: 10.3877/cma.j.issn.1674-3253.2024.04.011
    Abstract (225) HTML (16) PDF (1461 KB) (101)
    Objective

    To explore the causes of severe bleeding after retrograde intrarenal surgery and explore the feasibility of related treatment methods and strategies.

    Methods

    The general data and preoperative and postoperative clinical data of patients with severe bleeding after retrograde intrarenal surgery in the First Affiliated Hospital of Guangzhou Medical University from 2022 to 2023 were retrospectively collected and analyzed, and the causes of bleeding and the feasibility of treatment strategies were analyzed.

    Results

    Among the 5 patients, 3 cases did not experience any further bleeding after renal artery embolization treatment. One patient who underwent renal artery embolization three times and then underwent nephrostomy successfully stopped bleeding. Another patient continued to experience bleeding after two rounds of renal artery embolization, and underwent another embolization procedure after nephrostomy. No further bleeding occurred thereafter. During the hemostasis period, a combination of fluid replacement, blood transfusion, anti infection, continuous bladder irrigation, and other treatments were used, and ultimately all patients improved and were discharged.

    Conclusion

    The bleeding after retrograde intrarenal surgery is characterized by multiple blood vessel injuries. The cause of bleeding is not completely clear at present, and may be related to elevated renal pelvis pressure, false aneurysm formation and other reasons. Nephrostomy alleviates the intrarenal pressure and subsequent embolization of renal artery is effective in the treatment of bleeding.

  • 19.
    The role of cytoreductive nephrectomy in metastatic renal cell carcinoma in the targeted therapy and immunotherapy era
    Xing Huang, Lei Wang, Dan Xia
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (03): 208-213. DOI: 10.3877/cma.j.issn.1674-3253.2024.03.002
    Abstract (219) HTML (22) PDF (1401 KB) (52)

    Renal cell carcinoma (RCC) is one of the most common malignant tumors in the urinary systems, and the incidence of RCC has gradually increased. Metastatic RCC (mRCC) accounts for 13% of primary RCC, however, the prognosis of mRCC is extremely poor. Cytoreductive nephrectomy (CN) is the removal of primary tumor in patients with mRCC, and it has been the standard for patients receiving systemic cytokine therapy. With the development of targeted therapies and immunotherapies, the treatment outcome of mRCC has been significantly improved, and targeted therapies and immunotherapies have become frontline treatments for mRCC. Therefore, the role of CN in the management of patients with mRCC came into question in the targeted therapy and immunotherapy era. This article will try to describe the development process of CN in the treatment paradigm of mRCC, especially the latest progress in the targeted-immunotherapy era, as well as patient selection and timing of CN.

  • 20.
    The application of self-made "forceps lifting" auxiliary device for en-bloc resection of bladder tumor through urethra in the treatment of non-muscular invasive bladder cancer
    Weifeng Wang, Jun Zhang, Jiansheng Wan, Siming Liu, Yuan Zou, Shaoqiu Zheng, Jidong Hao, Guoqiang Liao, Hua Gong, Lei OuYang
    Chinese Journal of Endourology(Electronic Edition) 2024, 18 (01): 36-40. DOI: 10.3877/cma.j.issn.1674-3253.2024.01.007
    Abstract (204) HTML (10) PDF (1456 KB) (46)
    Objective

    To explore the clinical effect of self-made "forceps lifting" auxiliary device for transurethral bladder tumor en-bloc resection in the treatment of non-muscle invasive bladder cancer.

    Methods

    The clinical data of 64 cases of non-muscle invasive bladder cancer in Shanghai University of Medicine&Health Sciences Affiliated Zhoupu Hospital from March 2021 to January 2023 were retrospectively analyzed. They were divided into general group and improved group, 32 cases in each group. For enucleation, the improved group used a self-made "forceps lifting" auxiliary device for transurethral en-bloc enucleation of bladder tumors with holmium laser, the general group underwent traditional transurethral holmium laser en-bloc enucleation of bladder tumors. The operation time, intraoperative hemoglobin decrease, surgical complications and tumor recurrence were compared between the two groups.

    Results

    The operations of all patients went smoothly. The hemoglobin in the improved group decreased by (5±3) g/L, the probability of bladder perforation was 0%(0/32), the tumor recurrence rate in situ was 3.13%(1/32), and the hemoglobin in the general group decreased (6±3) g/L, the probability of bladder perforation was 9.38%(3/32), and the tumor recurrence rate in situ was 12.5%(4/32), there was no significant difference between the two groups (P>0.05). The operation time of the improved group was (19±7) min, shorter than the general group [(25±8) min](P=0.004); the number of people with muscular layer tissue in the tumor base of the improved group accounted for 93.75%, which was significantly more than that of the general group, which was 40.63% (P<0.001).

    Conclusions

    The holmium laser enuclear enucleation of transurethral bladder tumors treated with self-made "forceps lifting" auxiliary device has the same fewer surgical complications as general en bloc holmium laser enucleation of transurethral bladder tumors, and is safe. Because it can clearly and stably expose the tumor base, the operation time is shorter, and more muscle tissue at the base of the tumor can be obtained, which is conducive to tumor pathological detection. The technology is self-made with existing equipment, easy to operate, and worthy of clinical promotion.

京ICP 备07035254号-20
Copyright © Chinese Journal of Endourology(Electronic Edition), All Rights Reserved.
Tel: 020-85252990 E-mail: chinendourology@126.com
Powered by Beijing Magtech Co. Ltd