Objective:To investigate the safety and prognosis of partial nephrectomy (PN) in the treatment of highly malignant non-clear renal cell carcinoma (nccRCC).Methods:Clinical data of 47 patients with cT 1N 0M 0 high malignant nccRCC treated in Changhai Hospital from March 2016 to March 2022 were retrospectively analyzed. All patients received PN. There were 34(72.3%) males and 13(27.7%) females. The mean age was (53.5±15.0) years, and average BMI, was(23.7±3.4)kg/m 2.The maximum tumor diameter was (29.8±12.6) mm, and R. E.N.A.L. score was 7(5-9), with 37(78.7%) cases of T 1a and 10(21.3%) cases of T 1b. The mean estimated glomerular filtration rate (eGFR) before surgery was (96.3±25.5) ml/ (min·1.73m 2). All patients underwent PN, including 1 patient (2.1%) undergoing open surgery, 29 patients (61.7%) undergoing laparoscopic surgery, and 17 patients (36.2%) undergoing robotic surgery. There were a total of 22(46.8%) cases of papillary cell carcinoma(pRCC)type Ⅱ, 4(8.5%) cases of collecting duct carcinoma (cdRCC), 9(19.1%) cases of MiT family translocated renal cell carcinoma (tRCC), 5(10.6%) cases of mucoid tubular and spindle cell carcinoma (mtSCC)and 7(14.9%) cases of unclassified renal cell carcinoma (uRCC). The surgical conversion rate, positive margin rate, operative time, intraoperative blood loss, complications, and postoperative hospital stay were analyzed. Preoperative and postoperative eGFR were analyzed, and overall survival (OS) and cancer specific survival (CSS) were calculated. Results:All the operations were successfully completed. No radical operation or open operation was performed, with operation time of(100±60) min and intraoperative blood loss of(100±59) ml. There were no intraoperative complication and 1 case (2.1%) suffered from postoperative complication. Postoperative hospital stay were 5 (4-6) days. The mean eGFR after surgery was (86.5±27.1) ml/(min·1.73m 2), and the difference was statistically significant ( P=0.041). In this study, the mean follow-up time was (45.7±20.9)months, and no adjuvant therapy was used after surgery. During the follow-up period, 2 patients died, who all of them were kidney cancer-related death, and both OS and CSS were 95.7% (45/47). Conclusions:PN is safe, feasible and has a good prognosis in the treatment of high malignant T 1 nccRCC. For tumors with clear imaging boundaries and complete envelope, complete tumor resection is more likely, postoperative follow-up should be strict, and no remedial radical or systemic treatment was required.

目的 探索经后腹腔单孔机器人肾肿瘤肾部分切除术和肾上腺肿瘤切除术的安全性和有效性.方法 2021年11月至2022年2月,海军军医大学(第二军医大学)第一附属医院和南京医科大学第二附属医院采用国产单孔蛇形臂机器人手术系统完成经后腹腔肾肿瘤肾部分切除术和肾上腺肿瘤切除术7例,其中肾上腺肿瘤切除术4例,肾肿瘤肾部分切除术3例.记录所有患者肿瘤最大直径、手术入路、手术时间、术中出血量、切口数量、切口大小、围手术期并发症、病理诊断等资料.记录肾肿瘤肾部分切除术患者术前和出院前血肌酐、热缺血时间和切缘情况.结果 所有手术均采用经后腹腔途径.4例患者接受肾上腺肿瘤切除术,3例肿瘤位于右侧、1例位于左侧,肿瘤最大直径1.2～3.3 cm;4例均为纯单孔手术,切口直径3.0～4.5 cm;手术操作时间50～96 min,术中出血量10～50 mL,围手术期无明显并发症.3例患者接受肾肿瘤肾部分切除术,术前血肌酐分别为77、43、108μmol/L;3例肿瘤均位于右侧,最大直径1.9～2.7 cm,R.E.N.A.L.评分分别为5P、4X、4P;2例采用纯单孔术式,切口分别为4.5、4.0 cm,1例增加一个12 mm辅助通道;手术操作时间52～150 min,术中出血量10～50 mL,热缺血时间22～30 min;术后病理诊断为肾透明细胞癌2例、切缘均为阴性,血管平滑肌脂肪瘤1例,围手术期未出现出血、漏尿、发热等并发症,出院前血肌酐分别为99、50、93μmol/L.结论 采用国产单孔蛇形臂机器人手术系统可安全、有效地开展经后腹腔肾肿瘤肾部分切除术和肾上腺肿瘤切除术.

Objective:To investigate the feasibility and safety of a novel single-port robotic surgical system with flexible 3D endoscope and deformable surgical instruments in zero ischemic partial nephrectomy.Methods:From May 2021 to October 2021, a prospective study on patients with renal tumor who plan to receive zero ischemic partial nephrectomy was conducted. Inclusion criteria included over 18 years old, body index between 18.5 to 30.0 kg/m2, American Society of Anesthesiologists Score ranged from 1 to 3 points, cooperation with the follow-up and related examinations, voluntary in participating the clinical trial and signing the informed consent. Exclusion criteria included patients with other co-existed malignant tumors or a medical history of other malignant tumors, the patients who have received the same urological surgery in the past, the patients who underwent or plan to undergo other major operations 3 months before or after the surgery, the patients with active pulmonary tuberculosis or severe systemic diseases, the patients to be considered not suitable to enroll in by the researchers. A novel single-port robotic surgical system was used to perform the surgery. The system consiststed of a remote control console, a surgical equipment cart, a four-arm operation cart and deformable robotic instruments which were reusable. The two-section deformable robotic instruments were able to bend in four directions and carried different surgical instruments such as unipolar scissors, bipolar grasping forceps and needle holders. The deformable robotic instruments entered the body through a special trocar with single hole and multi-channel, and then unfolded in a triangle. By bending instruments, surgeons could perform single-port robotic surgery without the trouble of "chopstick effect" or "reverse direction" . Four cases of single-port partial nephrectomy were carried out. Under general anesthesia, the patients were taken the lateral recumbent position, with elevated waist and lowered head and feet. A 3-4 cm incision was taken layer by layer along the lateral edge of the rectus abdominis at the umbilicus level. A special 2.5 cm robotic trocar was set into the cavity, and a high-definition 3D laparoscopic lens and a snake shaped mechanical arm were then put into the abdominal cavity through the trocar. All operations were performed by transperitoneal approach with an auxiliary port through the same or a different skin incision if necessary. Tumor resection and renal reconstruction were performed by the way of zero ischemia. The perioperative parameters such as tumor size, operation time, intraoperative bleeding and postoperative complications were analyzed.Results:Four patients were involved, including 2 males and 2 females, with 2 of them having a history of hypertension. The ECOG scores were all 0, and KPS score was 100 in 3 cases and 90 in 1 case. Preoperative mean serum creatinine was (76.8±18.8)μmol/L (range 70-104 μmol/L). The tumors were located on the left in 3 cases and on the right in 1 case. The diameter of the tumor ranged from 1.1 to 2.8 cm, with the TNM classification of T 1a. The R. E.N.A.L. scores were 4a, 7p, 6p and 4P respectively. The first operation was performed by pure single-port surgery, and the other 3 cases were performed with the help of an auxiliary port to ensure the safety .The operation time ranged from 155 min to 210 min, and the intraoperative bleeding ranged from 20 ml to 170 ml. Postoperative pathology showed 2 cases of renal clear cell carcinoma with negative margin and 2 cases of angiomyolipoma. No severe complications, such as bleeding or urinary leakage, were observed during the perioperative period, and the change of serum creatinine was insignificant before discharge and before operation( P=0.24). Conclusions:A robotic single-port partial nephrectomy can be successfully carried out by using this novel single-port robotic surgical system with flexible 3D endoscope and deformable surgical instruments.

Objective:To evaluate the safety and efficacy of Toumai ? endoscopic robotic system in radical prostatectomy. Methods:This study was a single-center phase Ⅲ randomized controlled study. From June 2020 to January 2021, patients with prostate cancer who met the inclusion criteria in Changhai Hospital Affiliated to Naval Military Medical University were divided into the experimental group and the control group by random table method. Inclusion criteria included aged 18 to 80 years, pathologically diagnosed as prostate cancer, clinical stage ≤T 2N 0M 0. Exclusion criteria included patients requiring emergency surgery, having serious cardiovascular diseases and cannot tolerate surgery, having participated in other investigational drug or device clinical trials within the last 3 months. The experimental group used Toumai ? laparoscopic robotic system, and the continence group used the Da Vinci robotic system. The patients in both groups underwent radical prostatectomy via a transabdominal approach, which was performed by two surgeons. The clinical characteristics between the two groups were compared, related adverse events were recorded, and PSA and urinary continence were followed up one month after the operation. Results:A total of 44 patients were enrolled in this study, including 22 cases in the experimental group and 22 cases in the control group. The mean age of patients in the trial group and the control group was (67.7±7.5) years and (66.4±6.3) years, respectively. The median PSA at diagnosis was 10.5 (7.7, 23.7) ng/ ml and 13.5 (8.9, 24.7) ng/ ml, respectively. Biopsy Gleason score of 6, 7, 8 and 9 in experimental group were 13.6% (3/22), 68.2% (15/22), 4.5% (1/22) and 13.6% (3/22), respectively, and in the control group were 4.5% (1/22), 59.1% (13/22), 22.7% (5/22) and 13.6% (3/22) respectively. The middle risk and high risk group in the experimental group was 50.0% (11/22), 50.0% (11/22), and the control group was 36.4% (8/22), 63.6% (14/22). There was no statistical difference between the two groups.The operations in both groups were successfully performed. There were no conversions to open or laparoscopic surgeries, and no Clavien-Dindo grade Ⅲcomplications. There was no significant difference in the estimated blood loss during the operation [(109.1±51.6)ml vs.(94.5±51.6)ml] and the blood transfusion rate [9.1%(2/22)vs. 4.5%(1/22)] in both groups. The operation time was significantly higher in the experimental group than that in the control group [164.5(130.5, 214.3) min vs. 88.0(65.3, 110.5)min, P<0.001]. The positive rate of surgical margin was 13.6% (3/22) in the experimental group and 36.4% (8/22) in the control group, respectively, showing no significant difference. The pathologic stages of pT 2, pT 3a and pT 3bin experimental group were 63.6% (14/22), 13.6% (3/22) and 22.7% (5/22), respectively, while those in control group were 36.3% (8/22), 40.9% (9/22) and 22.7% (5/22), respectively, showing no significant difference. The recovery rates of urine control in the experimental group and the control group were 22.7% (5/22) and 22.7% (5/22), respectively. The median PSA in the experimental group and the control group were 0.055 (0.021, 0.103) ng/ ml and 0.032 (0.010, 0.089) ng/ ml, respectively, with no statistical difference. Conclusions:The Toumai ? endoscopic robotic system can successfully perform radical prostatectomy, based on insignificant difference from Da Vinci robotic system in safety and efficacy. The short-term follow-up showed that tumor control and urinary continence have recovered well in the test group. The long-term effect of the new system on tumor control and functional recovery after radical prostatectomy needs further multi-center studies.

Renal cell carcinoma is one common type of urologic cancers. It has tendencies to invade into the inferior vena cava (IVC) and usually requires an open surgery procedure. High rates of operative complications and mortality are usually associated with an open surgery procedure. The recently emerged robot-assisted laparoscopic radical nephrectomy (RAL-RN) and IVC tumor thrombectomy have shown to reduce operative related complications in patients with renal cell carcinoma. This case series study aimed to summarize technical utilization, perioperative outcomes, and efficacies of RAL-RN and IVC tumor thrombectomy in our hospital. A retrospective analysis was performed on clinical data from 20 patients who underwent RAL-RN and IVC tumor thrombectomy from January 2017 to December 2019 in our department. Patients had a median age of 59 years (interquartile range [IQR], 46-68). Four patients had renal neoplasm on left side and 16 on right side. Nineteen patients underwent RAL-RN (level 0: n = 2) or RAL-RN with IVC thrombectomy (n = 17) (level I: n = 3; level II: n = 12; and level III: n = 3) and 1 patient was converted into an open surgery. The median operative time was 328 minutes (IQR, 221-453). The estimated median blood loss was 500 mL (IQR, 200-1200). The median size of removed renal carcinoma was 67 cm(2) (IQR, 40-91); the length of IVC tumor thrombus was 5 cm (IQR, 3-7). The postsurgery hospital length of stay was 6 days (IQR, 5-7). The complications included intestinal obstruction (n = 1), lymphatic fistula (n = 1), heart failure (n = 1), and low hemoglobin level (n = 1). The outcomes for patients after 16 months (IQR, 11-21) follow-up were tumor-free (n = 10), tumor progression (n = 4), loss of contact (n = 1), and death (n = 5). We concluded that RAL-RN and IVC thrombectomy renders good safety profiles including minimal invasiveness, low estimated median blood loss, short hospitalization, low morbidity, and quick renal function recovery. The long-term efficacy needs a further investigation.

目的 为自救互救技术教学提供新的教学思路与方法,缓解目前自救互救教学过程中存在的学员参与度不高、技术掌握不牢、考核易流于形式等问题.方法 在传统教学法的基础上引入视频、PPT等现代教学媒体,多角度分层解析自救互救操作步骤,进而采用实战模拟训练与循环迭代有机结合的方式加深学员印象、巩固教学成果,最后收集学员实践反馈信息与国外自救互救与创伤急救指南用以指导下次教学内容设计.结果 学员参与度高、实践操作力强,自救互救技术理论掌握准确、操作规范,全员通过考核.结论 在自救互救技术教学过程中引入多媒体,采用实战模拟训练与循环迭代相结合的方式,其教学效果与教学质量优于传统教学,对提高学员参与度、提升学员自救互救能力可望发挥积极作用.

目的 针对机器人辅助腹腔镜肾部分切除术(RAPN),建立一种基于虚拟现实技术和分段操作理念的渐进式分段培训体系.方法 选择1名近期取得达芬奇(da Vinci)机器人手术资格的泌尿外科医师,采用虚拟现实技术进行基础操作培训和缝合强化培训.随后将RAPN分为6个步骤,受训医师参与实际手术操作,每次手术完成其中的1个步骤,在减少对患者影响的前提下获得实践操作经验.最后受训医师独立开展RAPN.结果 受训医师顺利完成虚拟现实培训.在分段操作阶段共参与手术18例,与同期上级医师独自开展的手术相比,手术时间由(134±41)min延长至(161±51)min,但差异无统计学意义(P=0.087).术中出血量、并发症发生率和术后住院时间等围手术期指标与同期上级医师独自开展的手术相比差异均无统计学意义(P均>0.05).通过培训后,受训医师能够独立开展RAPN.结论 通过虚拟培训、分段操作的方式,可以在较好地保证手术安全性和效果的前提下培养受训医师的操作技能,使其高效、高质量地完成RAPN.

Objective To explore the feasibility and safety of robot‐assisted laparoscopic infe‐rior vena cava tumor thrombectomy· Methods We retrospectively analysed the clinical and follow‐up data of 10 patients with robot‐assisted laparoscopic inferior vena cava tumor thrombectomy· Results Ten patients were diagnosed by B ultrasound CT or M RI .T he 3 cases had left renal cancer with vena cava tumor thrombus ,then left renal artery embolism was performed preoperatively .T he 7 cases were right renal cancer with vena cava tumor thrombus ,and one of the patients was found in‐ferior vena cava occlusion by preoperative inferior vena cava angiography· T he 10 patients underwent robot‐assisted laparoscopic inferior vena cava tumor thrombectomy ,and the operations were all suc‐cessful .T he postoperative pathological results confirmed the diagnosis of renal cancer with inferior vena cava tumor thrombus· Conclusions Radical nephrectomy and inferior vena cava thrombecto‐my can effectively prolong the survival rate of patients .After adequate preoperative preparation and evaluation ,robot‐assisted laparoscopic inferior vena cava tumor thrombectomy is safe and feasible .

目的 探讨体外修剪输尿管断端及置入双J管在腹腔镜下输尿管膀胱再植术中的可行性和有效性.方法 回顾性分析2014年3月至2016年3月行腹腔镜输尿管膀胱再植术治疗的21例输尿管出口梗阻患者的资料.其中12例行常规腹腔镜输尿管膀胱再植术(对照组),9例行腹腔镜配合体外操作输尿管膀胱再植术(改良组).改良组患者均于腹腔镜下游离患侧输尿管,离断狭窄段输尿管,将近端输尿管沿12mmTrocar孔拉出体外;直视下修剪输尿管断端并向输尿管内置入双J管,用4-0可吸收线将双J管固定在输尿管黏膜上,然后将其送人腹腔;在腹腔镜下游离膀胱,吻合膀胱和输尿管.结果 21例患者均顺利完成手术,无一例中转开放手术,术后均未发生漏尿.改良组患者手术时间短于对照组[(77±17) minvs (104±20) min,P＜0.05].21例患者术后随访半年,超声及静脉肾盂造影检查均提示无输尿管吻合口狭窄,肾积水不同程度减轻;膀胱造影提示有2例存在输尿管反流(对照组及改良组各1例).结论 在腹腔镜输尿管膀胱再植术中,应用体外修剪输尿管断端及置人双J管可在保证微创的前提下缩短手术时间、降低手术难度.

目的 探讨68Ga-PSMA-617 PET/CT在初诊前列腺癌远处转移灶检测中的应用时机.方法 回顾性分析空军军医大学第一附属医院2017年05月至2018年05月接诊的68例初诊前列腺癌患者的临床资料,按有无发生远处病灶转移及转移类型分为无远处转移组、仅伴区域外淋巴结转移组、仅伴骨转移组、同时伴区域外淋巴结和骨转移组及伴内脏转移组5组,分析68Ga-PSMA-617PET/CT检查不同的远处转移灶结果与患者发病年龄、前列腺特异性抗原(PSA)水平、Gleason评分、T分期、N分期间的关系.结果 68例初诊前列腺癌患者中,68Ga-PSMA-617 PET/CT检查结果显示,无远处转移患者38例(55.9％)、远处转移性患者30例(44.1％).远处转移患者较无远处转移患者具有更高的PSA水平、Gleason评分、T分期及N分期,两者差异有统计学意义(P＜0.000 1),但发病年龄无明显差异(P=0.675).无远处转移组、仅伴区域外淋巴结转移组、仅伴骨转移组、同时伴区域外淋巴结和骨转移组及伴内脏转移组的PSA水平与转移程度存在正相关(r=0.602,P＜0.000 1),并提示当PSA≥37 ng/mL时,即可能发生远处转移.结论 推荐Gleason评分为8-10分、T分期为3-4、N分期为1的初诊前列腺癌患者,特别是当PSA≥37 ng/mL时,行68Ga-PSMA-617 PET/CT检查,尽早发现患者远处转移灶及精准分期,有利于对患者制订更合理的个体化治疗方案.

地震救援争分夺秒,要求药材品种和数量既能科学地满足救治的需要,又可快速筹集获得.为了科学地缩短救援药材的响应时间,作者立足地震灾害类别及特点,利用既往救援数据和医学模型,分别制定较为精确的标准化救援药材品量目录; 对已纳入的救援品种,建立地区的采购/调集渠道库,详细纳入药材企业、供应商、疾控中心、大型医院等药材品种、数量、物流储备等信息,并定期维护,待灾害来临时可迅速启动调集.地震医疗救援药材应急响应信息系统,可望将药材筹措时间缩短至0.5~3 h,且品量更为精确,不仅为地震医疗救援赢取宝贵的时间、减少运行负担、提高救治效率,也可为救援的总体决策提供科学的参考依据.

Objective To investigate the validity, security, feasibility and superiority of the clinical application of central venous catheter instead of traditional thoracic drainage tube in uniportal video-assisted thoracoscopic surgery(UVATS) based on the concept of enhanced recovery after surgery(ERAS).Methods The clinical data of 194 patients who underwent spontaneous pneumothorax in the Tianjin First Central Hospital from June 2013 to November 2016 were included in this study. Patients were divided into central venous catheter group(CVC group) and 28 F polyvinylchlorid chest tube group(28 F group), 97 cases in each group. Clinical effects, chest drainage volume and related complications were compared between the two groups.Results The hospital stay[(3.4±1.1) d vs.(5.9±1.7) d], leave-bed time after operation[(4.7±0.7)h vs.(11.5±2.5) h]and remove drainage tube time[(34.9±5.4) h vs.(72.3±9.8) h]were significantly less in CVC group than those of 28 F group(P<0.05). The pain score(3.1±1.4 vs. 7.0±2.5) and incidence of poor wound healing of drainage(100% vs. 93.8%) were also less in CVC group than those of 28 F group(P<0.05). There were no significant differences in the complication of lung infection(1.0% vs. 3.1%), subcutaneous emphysema(4.1% vs. 2.1%) and persistent leakage(1.0% vs.3.1%) between the two groups.Conclusion The application of the central venous catheter technology in uniportal video-assisted thoracoscopic bullectomy is superior to the traditional thoracic drainage, and which is worthy of clinical promotion.

Objective To provide more knowledge that is theoretical and reduce postoperative complications by finding the useful pelvic landmarks, on the characteristics of laparoscopic radical prostatectomy basis. Methods Seven adult male pelvic specimens were anatomised. The bladder neck, both the lateral sides of prostate and the surrounding tissues of prostatic apex were observed, measured and positioned. Results There were two muscularly longitudinal fibers at the junction of the bladder neck and the prostate, with a transverse diameter of (4.42±1.38) mm and a distance of (1.78±0.32) mm from the center of the bladder. There was a constantly claw-shaped prostatic arterial trunk, which was (16.34±5.76) mm away from bladder-prostate groove. Pelvic plexus were located on both sides of the rectum, the upper part contributed to rectal plexus, and the lower part formed nerve vessel bundle (NVB) in the posterolateral aspect of prostate, which was approximately 5.40 mm wide. NVB contained the cavernous nerve entering the apex of prostate at 5 o'clock and 7 o'clock, with the distance of (2.84±0.56) mm. Penis dorsal nerve issued small branches into the urethral sphincter at 5 o'clock and 7 o'clock when it was (2.78±1.04) mm away from the apex. Sphincter was also innervated by the small fibers issued by NVB, distributing from 3 to 5 o'clock and 7 to 9 o'clock. Conclusion Bladder neck can be cut down according to the muscularly longitudinal fiber. The ligation of the artery can be performed at the level of 25 mm or more above the lateral aspect of groove. To avoid making damage to the cavernous nerve by recognizing small blood vessels in NVB. When separating the prostatic apex, cutting down urethra, even performing anastomosis of the bladder neck and urethra, do not damage the nerves around 5 o'clock and 7 o'clock. To find the above landmarks, the incidence of complications may be lowed. Key words: Clinical anatomy; Laparoscopic; Radical prostatectomy; Pelvic landmarks; Prostate cancer; Anatomical features

Objective:To evaluate the efficacy of preoperative neoadjuvant targeted therapy combined with robotic laparoscopic surgery for metastatic renal cell carcinoma.Method:We retrospectively analysed 18 metastatic renal cell carcinoma patients treated with preoperative neoadjuvant targeted therapy combined with robotic surgery from December 2013 to December 2017 in our center.The effect and adverse events of neoadjuvant targeted therapy,and the efficacy of robot-assisted laparoscopic surgery were evaluated.Result:The diameter of the primary lesion in the sunitinib group was(5.21±0.71)cm before neoadjuvant targeted therapy and(4.36±0.82)cm after therapy,P=0.024.In the sorafenib group,the diameter of the primary lesion was(5.14±1.13)cm before neoadjuvant targeted therapy and(4.6±1.4)cm after therapy,P=0.442.In one patient treated with axitinib,the diameter of the primary lesion decreased from 5.2 cm to 4.5 cm and the diameter of the primary lesion in all patients decreased from(5.18±0.85)cm to(4.46±1.03)cm,P=0.029.All patients receiving neoadjuvant targeted therapy experienced grade 1-2 adverse events.All patients underwent robot-assisted laparoscopic surgery,including 17 nephron sparing surgery(NSS)and 1 radical nephrectomy(RN).The intraoperative renal arterial blockade time in patients receiving NSS was(12.64±1.69)min.There was no difference in glomerular filtration rate between preoperative and postoperative data.Conclusion:Preoperative neoadjuvant targeted therapy can reduce the diameter of primary tumors in metastatic renal cancer and provide patients with an opportunity to retain NSS.Robot-assisted laparoscopic surgery has advantages of short warm ischemia time and less trauma.It can maximize the protection of renal function.This conclusion still needs a large number of multicenter randomized controlled trials to confirm.

目的 探讨虚拟现实培训在机器人辅助腹腔镜前列腺癌根治术膀胱尿道吻合中的应用价值.方法 采用机器人模拟培训系统,对3名受训医师进行基础操作训练的吻合模拟训练,评价培训前后总体评分、吻合时间、运动距离、器械碰撞次数、器械离开视野次数和脱离目标次数等关键指标的变化.随后3名受训医师利用机器人系统对9例患者施行机器人辅助腹腔镜前列腺癌根治术中的膀胱尿道吻合,评价吻合的可靠性.结果 训练后3名受训医师总体评分由训练前的(65.0±10.8)分提高至(92.7±3.5)分,平均吻合时间由(279.0±48.0)s缩短至(119.3±12.5)s,运动距离由(459.0±59.2)cm缩短至(239.3±33.9)cm,差异均有统计学意义(P均<0.05);器械离开视野次数和脱离目标次数在训练前后无明显变化.3名受训医师均顺利完成9例患者机器人辅助腹腔镜前列腺癌根治术中的膀胱尿道吻合,平均吻合时间为(23.4±8.6)min.患者术后引流液肌酐水平未见明显升高,未见漏尿.术后第7天膀胱造影均未见造影剂外漏,术后第8天顺利拔除导尿管.结论 对泌尿外科医师进行机器人模拟系统培训可使医师迅速熟悉操作,提高术中膀胱尿道吻合的操作水平,从而高效、高质量地完成手术.

目的:探讨混合现实技术联合达芬奇机器人系统对于完全内生型肾肿瘤行肾部分切除术的临床效果及优势.方法:回顾性分析2017年4月 ～2018年3月应用机器人辅助腹腔镜肾部分切除术治疗完全内生型肾肿瘤15例患者临床资料.其中右肾肿瘤6例,左肾肿瘤9例.术前利用三维影像工作站建立3D数字模型,规划手术方案,术中将全息虚拟模型与机器人手术影像实时融合辅助导航.结果:15例患者均顺利完成手术,无中转开放及大血管损伤病例.平均手术用时122 min(67～211 min),其中经后腹腔途径10例,经腹腔途径5例,术中行肾盂修补6例.肾动脉平均阻断时间21 min(15～42 min),术中平均出血量78 ml(48～480 ml).病理回报:透明细胞癌13例,乳头状肾癌1例,囊性肾细胞肿瘤1例.术后无漏尿及切缘阳性病例.平均随访9个月(3～14个月),无局部复发及转移病例.结论:应用混合现实技术联合机器人手术系统治疗完全内生型肾肿瘤,在肿瘤定位及手术安全性方面优势明显,可以明显降低手术难度.

Objective To investigate the clinic efficacy of "two section and three leaves approach" on laparoscopic radical cystectomy (LRC) or robot assisted radical cystectomy (RARC).Methods A retrospective statistical analysis collected a total of 103 cases with bladder cancer undergoing LRC or RARC,from Jan 2013 to Dec 2015 in our center.Those patients were divided into two groups,including "two section and three leaves approach" group (46 cases) and conventional group (57 cases).The two section,which means that to cut lateral prostate gland and lateral vesical gland respectively,the three leaves include lateral lobe of lateral vesical gland (superior vesical arteries and veins),medial lobe of lateral vesical gland and lateral prostate gland.In two groups,whose age ranged from 35 to 84 years,the median age were (63.3 ± 9.8) years and (63.7 ± 9.1) years,respectively.The median BMI values were (23.2 ± 2.9) kg/m2 and (23.0 ± 2.2) kg/m2,respectively.The occurrence of history of abdominal surgery were 4 (8.7％) cases and 9(15.8％) cases,respectively.In two section and three leaves approach,the ASA scores of 1,2,3 were found in 5,35,6 cases,respectively.In conventional group,the ASA scores of 1,2,3 were found in 12,38,7 cases,respectively.The difference between two groups in age distribution,BMI value,ASA score,history of abdominal surgery,urinary diversion,surgical methods,pathological staging and grading had no statistical significance (P ＞ 0.05).Then,the operation time,the blood loss and the time to remove drainage tube,et al of the above two groups were compared.Patients with BMI≥24 kg/m2 in the two groups were 24 cases and 20 cases,respectively,following the strategy based on BMI ≥24 kg/m2 and BMI ＜ 24 kg/m2 to compare the difference of subgroups in the operation time and the bleeding amount,for the purpose of corroborating the applied effectiveness of "two section and three leaves approach" compared with the conventional measure on LRC or RARC for patients with BMI ≥ 24 kg/m2.Results All endoscopic operations were completed successfully.No conversion was recorded.In two groups,the median operation time were (255.1 ± 99.3) min and (284.2 ± 171.3) min,respectively,the difference was statistically significant (P =0.011).The blood loss was (233.1 ± 196.9)ml and (272.0 ±268.8) ml,respectively(P =0.009).The time to remove drainage tube were (10.6 ± 5.0) d and (9.9 ± 4.4) d,respectively (P =0.880).In addition,the difference in the intraoperative blood transfusion rate(10.9％ vs.21.1％),occurrence of lymph fistula (13.0％ vs.17.5％),gastric extubation time [(4.3 ± 1.9) d vs.(4.0 ± 1.9) d],time for flatus recovery [(3.9 ±1.2) d vs.(3.7 ± 1.7) d],the incidence of perioperative complications (26.1％ vs.36.8％) and postoperative hospital stay [(13.3 ± 5.5) d vs.(13.5 ± 4.8) d] were no statistical significance (P ＞0.05).The results of comparisons for patients with BMI ≥ 24 kg/m2 between subgroups included the operation time were (264.3 ± 68.1) min and (298.5 ± 80.2) min,respectively.The blood loss were (247.8 ± 199.4) ml and (295.3 ± 204.5) ml,respectively,both of them were statistical significance (P ＜0.05).The "two section and three leaves approach" was significantly better than those patients operated by conventional method.Conclusions Compared with conventional method undergoing LRC or RARC,"two section and three leaves approach" could shorten operative time and reduce the blood loss markedly,especially for patients with BMI≥24 kg/m2.

Objective To investigate the safety and effectiveness of open radical prostatectomy (ORP) for locally advanced prostate cancer (LAPC).Methods From January 2012 to April 2017,132 cases underwent ORP were included.The mean age was 65.1 years old (ranged 41 to 83 years old),median PSA was 28.9 ng/ml (ranged 1.2 to 319.7 ng/ml) and mean Glcason score was 8.0(ranged 6.0 to 10.0).The number of clinical stage T3aN0,T3bN0,T4N0 and T1 ～4N1 were 92 cases(69.7％),20 cases (15.2％),8 cases (6.1％) and 12 cases (9.0％),respectively.Results The median length of hospital day,mean operative time and median blood loss were 9 d,180 min and 350 ml respectively.The intraoperative complication rate was 3.0％ (4/132),including 2 rectum injury and 2 iliac vessel injury.Pathological tumor stage revealed that ≤ pT2 N0 7 cases (5.3％),pT3a N0 61 cases (46.2％),pT3b N0 38 cases (28.8％),pT4N0 12 cases (9.1％) and pT1～4N1 14 cases (10.6％).The mean Gleason score was 8.0 (ranged 6 tol0).The numbers of patients with perineural invasion,seminal vesicle invasion and positive surgical margin were 81 cases (61.4％),49 cases (37.1％) and 41 cases (31.1％) respectively.The median follow-up duration was 24.1 (ranged 1.8 to 62.2) months.The rate of postoperative complications was 3.0％ (4/132) including 1 urethral stricture,1 wound infection,1 intestinal fistula and 1 lymphatic fistula.The rates of patients with urinary continence 1,3,6 and 12 months after surgery were 30.4％ (38/125)、63.9％ (76/119)、72.6％ (82/112)、89.1％ (90/101).The rates of adjuvant hormonal therapy and radiotherapy were 34.1％ (45/132) and 38.6％ (51/132).One patient (0.8％) died of lung cancer.The rate of biochemical recurrence(BCR) was 25.8％ (34/132).The 5-year BCRfree survival rate was 57.2％ (95％ CI 41.9％ ～ 70.6％).Conclusion The oncological control and functional recovery outcomes of ORP for locally advanced prostate cancer were reliable.

Objective To explore the diagnosis and prognosis of mixed renal carcinoma with clear cell carcinoma and papillary cell carcinoma. Methods A retrospective analysis of 26 cases of mixed renal carcinoma with clear cell carcinoma and papillary cell carcinoma from 2007 to 2017 of our department was done. Results All 26 patients were diagnosed by B ultrasonic and CT examination clearly.Eighteen of them underwent open radical nephrectomy,seven patients underwent laparoscopic radical nephrectomy,and the rest one patient underwent robot assisted laparoscopic partial nephrectomy.The operations were all successful,and the postoperative pathology confirmed the diagnosis of mixed renal carcinoma with clear cell carcinoma and papillary cell carcinoma.The treatment and follow-up were given according to the individual situation.Their median follow-up period was63 months.Their mean survival was 59.93 months,and three-year survival rate and five-year survival rate were 83%and 73%respectively. Conclusions It is rare for patients with mixed renal carcinoma with clear cell carcinoma and papillary cell carcinoma.The patients should be treated with radical nephrectomy,and postoperative treatment should be individualized.The prognosis of patients was mainly affected by clinical and pathological stages,and the postoperative individual treatment and follow-up were also important.

Laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy have become the preferred treatments for patients with small renal masses.Clamping the renal brunch artery has become a promising technique to decrease warm ischemia injury.In order to decrease the difficulty of this technique,the authors present the "leapfrog" laparoscopic partial nephrectomy (L-F LPN).Compared with traditional technique of clamping the selective artery,L-F LPN is safer and simpler,and easier to be widely spread.