To evaluate the feasibility and safety of suprapubic three-arm robot-assisted laparoscopic radical prostatectomy (STA-RLRP). Fifteen patients with prostatic cancer underwent STA-RLRP. All the 15 procedures were completed successfully, without the need for ancillary trocars or additional instruments. No patient required conversion to standard laparoscopy or open surgery. STA-RLRP is feasible and safe with good short-term tumor control, satisfactory recovery of urinary control function and good cosmetic outcome, which is worthy of clinical application.

目的:探讨硕通镜治疗输尿管石街的临床疗效.方法:回顾性分析2018年3月-2020年3月在我院采用硕通镜下钬激光碎石术治疗输尿管石街患者的临床资料.患者共12例,男8例,女4例;年龄25～62岁,中位年龄44岁;输尿管石街长5.2～10.8 cm,平均7.4cm.观察一期手术成功率、手术时间、结石清除率、术中及术后并发症发生情况.结果:12例患者均一期顺利完成手术,手术时间40～100 min,平均60 min,术中未发生肾盂输尿管黏膜穿孔、撕脱、断裂以及大出血、感染性休克等严重并发症.术后住院时间1～3 d,平均1.5d,1例术后出现发热,对症治疗后痊愈,无其他术后并发症发生.术后第1天和术后1个月的清石率分别为83％和92％.术后1个月均顺利拔除双J管,复查彩超肾积水较术前减轻,未见肾周积液及血肿形成.复查肾功能较术前改善.结论:硕通镜治疗输尿管石街安全、有效.

目的:观察诺氟沙星联合雌三醇治疗绝经期女性泌尿生殖系统感染的疗效及其对患者阴道pH值的影响.方法:选择2017年2月至2019年2月于我院门诊就诊的绝经期女性泌尿生殖系统感染患者80例,按照门诊号随机分为对照组(n=40)和观察组(n=40),对照组给予诺氟沙星治疗,观察组给予诺氟沙星+雌三醇治疗,比较两组临床疗效、阴道pH值、雌二醇(E2)、子宫内膜厚度及感染复发率.结果:治疗后,观察组总有效率(92.50％)高于对照组(75.00％)、pH值(5.12±0.70)低于对照组(7.79±1.80)、E2(61.71±10.33)pmol·L-1高于对照组(53.90±7.34)pmol·L-1、复发率(10.0％)低于对照组(35.0％),差异均有统计学意义(P均<0.05);两组子宫内膜厚度差异无统计学意义(P>0.05).结论:诺氟沙星联合雌三醇治疗绝经期女性泌尿生殖系统感染疗效好,能降低患者阴道pH值和感染复发率.

目的 评价超选择性髂内动脉栓塞术治疗晚期前列腺癌合并难治性出血的安全性及疗效.方法 应用弹簧钢圈及聚乙烯醇颗粒,对2例晚期前列腺癌合并难治性出血患者进行超选择性髂内动脉栓塞术,观察其临床疗效.结果 本组2例超选择性髂内动脉栓塞术均获成功,术后出血症状明显改善,持续监测血红蛋白、红细胞压积保持平稳,分别随访44、4个月,无再发严重出血.结论 超选择性髂内动脉栓塞术治疗晚期前列腺癌难治性出血安全、有效,值得临床选用.

总结耻骨上机器人辅助经脐双通道腹腔镜巨大嗜铬细胞瘤/副神经节瘤(pheochromocytoma and paraganglioma,PPGL)切除术的经验与体会,探讨其安全性和可行性.回顾性分析2019年8月-2020年3月我院施行的5例耻骨上机器人辅助经脐双通道腹腔镜巨大PPGL切除术的临床资料.男4例,女1例,中位年龄45.5(26～57)岁,中位BMI 23.4(20.4～24.8) kg/m2.中位收缩压142(115～220) mmHg,中位舒张压106(78～140) mmHg,中位心率98(72～114)次/min.伴有高血压病史3例,其中1例曾有脑梗死病史;其余2例无特异性症状,为体检时发现.肿瘤位于右肾上腺区3例,左肾上腺区1例,左肾门部1例;中位肿瘤最大径6.5(6.0～8.3) cm.术前中位24 h尿多巴胺896.4(650.7～1 236.3) μg/24 h,中位24 h尿去甲肾上腺素450.7(114.6～775.8) μg/24 h,中位24 h尿肾上腺素66.5(45.6～114.8) μg/24 h,均升高.记录手术时间、出血量及住院时间等指标.本组5例手术均顺利完成,无中转开放或普通腹腔镜手术.中位手术时间115(75～165) min,中位术中估计失血量90(50～180) mL.术中、术后均未发生严重并发症,均未输血.所有患者术后恢复顺利.术后24 h中位视觉模拟疼痛评分(VAS)2(1～3)分,术后第1～2天下床活动,术后第2～3 d拔除腹腔引流管.中位术后住院时间4(3～6)d.术后病理诊断:嗜铬细胞瘤3例,副神经节瘤2例.所有患者均获随访,中位随访时间5(2～9)个月.切口愈合良好,脐部瘢痕因被脐部皱褶遮蔽而不明显,耻骨上切口被阴毛遮蔽而不易察觉;无肿瘤复发;24 h尿儿茶酚胺均恢复正常;术前3例血压升高者,术后血压均恢复正常2例,1例仍需口服降压药治疗,但药量减少且血压控制良好.耻骨上机器人辅助经脐双通道腹腔镜巨大PPGL切除手术安全、可行,且美容优势显著,值得临床应用.

目的:总结腹腔镜辅助小切口“零缺血”巨大肾血管平滑肌脂肪瘤(renal angiomyolipoma,RAML)切除术的经验与体会,探讨其安全性和可行性.方法:回顾性分析2015年7月～2019年10月我院施行的9例腹腔镜辅助小切口“零缺血”巨大RAML切除术患者的临床资料.男4例,女5例;中位年龄43.7(36～78)岁;中位BMI 24.6(19.5～32.9) kg/m2;右肾3例,左肾6例;中位肿瘤最大径10.5(8.5～15.0) cm.其中1例合并胃间质瘤(直径2.0 cm).全麻.健侧70.卧位,于患侧脐缘置入一trocar,插入腹腔镜,于患侧肋缘下沿腹直肌旁分别置入2个trocar,间距约10 cm,插入操作器械.先在腹腔镜下游离肾脏及肾蒂,肿瘤周围暂不作游离.再取患侧腹直肌旁两trocar间小切口,必要时适当延长.直视下游离肾脏与肿瘤交界处,并用手指挤压正常肾实质,不阻断肾动脉,切除肿瘤并缝合创面,再将肿瘤周围游离后完整取出.合并胃间质瘤者,同期腹腔镜下一并处理.结果:本组9例手术均顺利完成.中位手术时间150(120～210) min,术中中位失血量220(150～350) mL,中位体表切口长径11.2(10.0～13.5) cm.均未输血,术中、术后均未发生严重并发症.所有患者术后恢复顺利,切口愈合良好.术后复查肾功能与术前无显著变化.术后中位视觉模拟疼痛评分(VAS)2(1～3)分,术后第1～2天即下床活动,术后第2～3天拔除腹腔引流管,术后第8天拆除切口缝线,中位术后住院时间8(6～9)d.术后病理均为肾血管平滑肌脂肪瘤.所有患者术后均获随访,中位随访时间26(2～53)个月,无肿瘤复发.结论:腹腔镜辅助小切口“零缺血”巨大RAML切除术安全、可行.该术式充分结合了腹腔镜和开放手术的优势,既最大程度保护了肾功能,又减少了手术创伤,值得临床应用.

目的:观察经皮肾镜取石术(percutaneous nepholithotomy,PCNL)并发感染性休克血中性粒细胞变化特点,探讨血中性粒细胞监测在早期诊断感染性休克的价值,为临床诊断提供预警指标.方法:对我院2013年6月至2015年12月6例行PCNL术后并发感染性休克的临床资料进行研究,分析术后2h、术后6h,术后24 h,术后第3d和术后第7d血中性粒细胞计数和降钙素原值,观察血中性粒细胞计数和降钙素原值变化,运用多次重复测量方差分析.结果:PCNL并发感染性休克的患者术后血中性粒细胞呈现出先急剧下降后上升最后恢复正常的特点.6例患者2h内血中性粒细胞较术前急剧下降.6h血中性粒细胞较术前上升,术后24 h术前相比明显升高,术后第3d较下降,第7d基本正常;血降钙素原呈现出迅速上升最后恢复正常的特点.术后6h上升为严重感染指示(≥10 ng·mL-1),上升到术后第3d后开始下降.外周血白细胞计数与降钙素组间时间差异均有统计学意义(P＜0.05).相对降钙原的变化,血中性粒细胞变化更早出现,敏感性更高.结论:PCNL患者术后并发感染性休克时血中性粒细胞2h内急剧下降,可作为临床并发感染性休克的预警提示.

Objective:To analyze the complications of urologic suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS),and to explore effective measures for its prevention and management.Method:From July 2010 to April 2015,a total of 573 cases underwent SA-LESS in our center.Of them 356 were men and 217 were women.The median age was 45.4 (range,6-78) years old,and the median body mass index was 23.6 (range,15.3-32.8) kg/m2.The various SA-LESS procedures included nephrectomy (n=214;simple 150,radical 64),partial nephrectomy (n=16),heminephroureterectomy for duplex kidney (n=15),nephroureterectomy (n=29),adrenalectomy (n=43),renal cyst excision (n=34),pyelolithotomy or ureterolithotomy (n=183),pyeloplasty (n=15) and ureterovesical reimplantation (n =24).Intraoperative and postoperative complications were graded according to Satava and Clavien-Dindo grade classifications,respectively.The severe complications and their treatments were mainly analyzed.Result:Among the 573 SA-LESS procedures,there were 65 (11.34％) complications occurred,including 21 (3.66 ％) severe complications.The intraoperative severe complications included inferior vena cava injury (n=3),renal vascular injury (n=3),iliac vein injury (n=1),pleural injury (n=1),duodenal injury (n=1),ileum injury (n=1),spleen injury (n=1) and femoral nerve injury (n=1).The postoperative severe complications included secondary hemorrhage (n=5),urinary leakage (n =3) and ureteropelvic junction stenosis after pyeloplasty (n=1).No intraoperative or postoperative death occurred.Conclusion:SA-LESS is safe and feasible in urology,but there are some severe complications for consideration.

Objective To investigate the role of osteopontin (OPN) in the formation of idiopathic calcium oxalate stone (ICS) by detecting OPN transcription and translation level in the renal tissue and the urine concentration of OPN in ICS patients.Methods From January 2013 to January 2014,34 cases of no-function kidneys were collected after the nephrectomy as the case group,38 cases of normal renal tissuesfar away from the tumor as the control group after the radical nephrectomy,and 19 healthy persons as the normal group in our hospital.The expression of OPN mRNA and protein in the tissues of kidney were detected by real-time quantitative polymerase chain reaction (Real-time PCR),Western blotting and immunohistochemistry,respectively.The concentration of OPN in the urine of the groups was measured by enzyme-linked immunosorbent assay.Results The levels of OPN mRNA and protein in the renal tissues of the case group (2.040 ± 1.200,0.776 ± 0.071) were higher than that of control group (2.590 ± 0.910,0.449 ±0.085,P ＜0.05).The concentration of OPN in the urine of the patients in the case group [(1.052 ±0.229) mg/L] was lower than that of control group [(1.579 ± 0.256) mg/L] and normal group [(1.498 ± 0.155) mg/L,P ＜ 0.05].Conclusion The over-expression of OPN in the renal tissue and the low concentration of OPN in the urine may play an important role in the formation of ICS.

Background: The feasibility of hybrid transvaginal NOTES (natural orifice transluminal endoscopic surgery) nephrectomy (HTNN) has already been demonstrated. However, pure transvaginal NOTES nephrectomy (PTNN) has been limited to animal experiments with only one report of its use in humans. Objective: To describe our initial experience with HTNN and a stepwise transition towards PTNN. Design, setting, and participants: Between May 2010 and September 2011, 63 patients underwent nephrectomy (60 HTNNs and 3 PTNNs) in our institution, including 45 patients with benign renal disease and 18 patients with malignant renal disease. Surgical procedure: Of the HTNNs, 33 were performed using two umbilical trocars and one transvaginal trocar, and 27 were performed using one umbilical trocar and a transvaginal multi-instrument access port; 3 PTNNs were performed using a self-developed, three-channel ZOU-port without any transumbilical assistance. Outcome measurements and statistical analysis: All data referring to patient demographics, surgery, pathology, and perioperative outcomes were recorded. Sexual function was assessed with the Female Sexual Function Index (FSFI) questionnaire before and after surgery. The cosmetic result was investigated by administering the Patient Scar Assessment Questionnaire and Scoring System(PSAQ). Results and limitations: A total of 59 HTNNs and 3 PTNNs were successfully performed. One patient was converted to open surgery because of injury to the inferior vena cava. The mean operative time was 130 min (range: 100-260 min) for HTNN and 193 min (range: 180-210 min) for PTNN. The mean estimated blood loss was 150 ml. The mean postoperative hospital stay was 7.4 d. Forty-eight patients completed the FSFI questionnaire, and analysis did not show differences in FSFI scores before and after surgery. The better cosmetic results were confirmed by the PSAQ score. Conclusions: HTNN is feasible and safe in appropriate patients. Existing instruments are adequate for HTNN, but significant improvement is still needed. PTNN is technically challenging, but is feasible and may be performed safely. Further improvement of instruments is necessary for PTNN. Clinical investigation in comparison to the established techniques should take place to evaluate the outcome of technique. Patient summary: Pure transvaginal natural orifice transluminal endoscopic nephrectomy (PTNN) is technically challenging but feasible and may be performed safely. Further improvements in instruments are necessary for PTNN. (C) 2015 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Objective To investigate the expression of cancerous inhibitor of protein phosphatase 2A(CIP2A) in bladder urothelial carcinoma tissues and its relationship with clinical pathologic characteristics,and to discuss the feasibility of CIP2A as prognostic markers.Methods RT-PCR and Western blot were used to evaluate the mRNA and protein expression of CIP2A in cancer tissues and corresponding paracancerous tissues from 25 bladder urothelial carcinoma patients.A tissue microarray(TMA) containing specimens from 117 bladder urothelial cell carcinoma tissues and 30 paracancerous tissues was constructed and then immunohistochemistry was used to examine the protein expression of CIP2A.The correlations between CIP2A and clinicopathological characteristics and prognosis were also analyzed.Results CIP2A mRNA and protein were undetectable or very low in paracancerous tissues,but were dramatically elevated in cancer samples in 25 patients.The positive expression rate of CIP2A protein in bladder urothelial cell carcinoma tissues [76.9%(90/117)] was significantly higher than that in paracancerous tissues [6.7%(2/30)].Such difference had statistic significance(P<0.001).CIP2A expression correlated with histological grade(P<0.001),tumor stage(P<0.001),tumor diameter(P=0.002) and lymph nodes metastasis(P=0.046);while it was not related with age,gender,tumor number and tumor recurrence(P>0.05).Kaplan-Meier univariate analysis showed that the overall and recurrence-free survival rates were significantly higher in the group with low expression of CIP2A than in the group with high expression of CIP2A(P<0.001).Cox proportional hazards model revealed that tumor stage,histological grade,and CIP2A expression were independent predictors of an unfavorable prognosis for overall survival rate(P<0.001,P=0.001 and P=0.035,respectively) and recurrence-free survival rates(P<0.001,P<0.001 and P=0.003,respectively).Conclusion The expression of CIP2A protein is significantly increased in bladder urothelial cell carcinoma tissues,which may be involved in the progress of bladder urothelial cell carcinoma.CIP2A may be a valuable biomarker for assessing the prognosis of bladder urothelial cell carcinoma.

Objective:To compare surgical outcomes of retroperitoneal laparoscopic pyelolithotomy/uret- erolithotomy(RPL),transumbilical laparoendoscopic single-site surgery(U-LESS)and suprapubic-assisted lapa- roendoscopic single-site surgery(SA-LESS)for upper urinary tract stones in patients with solitary kidney.Meth- od:There were 32patients with upper urinary tract stones and solitary kidney in the study.They were divided into three groups(RPL,n=12;U-LESS,n=10;SA-LESS,n=10)according to the experience of the surgeons and the patients' wishes.The indices including operative time,intraoperative estimated blood loss,Visual Analog Pain Scale(VAPS),postoperative intestinal function recovery time,postoperative drainage time,the incidence of com- plications,hospital stay,Patient Scar Assessment Questionnaire(PSAQ)were used to compare among three groups.Result:All the 32procedures were successfully completed without serious complications.The operative time of SA-LESS and RPL group was shorter than U-LESS group(P<0.05).The scores PSAQ for SA-LESS and U-LESS were less than RPL group(P<0.01).There was no statistically significant differences in intraoper- ative estimated blood loss,postoperative drainage time,postoperative intestinal function recovery time,hospital stay,VAPS,and the incidence of complications among three groups(P>0.05).Degree of hydronephrosis and re- nal function improved and no stones recurrence and ureter stenosis were shown in all cases after follow-up period of seven to forty months.Conclusion:Three procedures of RPL,U-LESS and SA-LESS are all safe,feasible and ef- fective for upper urinary tract stones in patients with solitary kidney.They may be the firs-line treatment for pel- vic and upper-middle ureter calculi in patients with solitary kidney.SA-LESS can be the first choice because of good cosmetic and easy-to-operate results.

Objective:To describe the initial clinical experience of suprapubic-assisted laparoendoscopic single-site surgery nephrectomy(SA-LESS-N)in Urology,and evaluate its safety,feasibility and efficacy.Methods:Ninety consecutive patients including 72males and 18females,with a mean age of 51.7years(range 20to 78),were subjected to SA-LESS-N in our center.There were 69non-functioning kidneys,19renal carcinomas,and 2tuberculosis kidneys in our study.Under general anesthesia,the patients were positioned in lateral decubitus with affected side elevated 70°.One 5-and 10-mm(or two 5-mm)trocars were inserted into the umbilical edge.A 10-or 5-mm trocar was inserted into abdominal cavity below the pubic hairline,through which a 10-mm 30°or 5-mm 0°laparoscope was placed.The operation was same as that of standard laparoscopy.The specimens were removed after the incisions below the pubic hairline were enlarged or they were crashed.Results:SA-LESS-N was successfully completed in 84patients.Five patients required conversion to standard laparoscopy because of intraoperative bleeding(n=4),and failure to progress(n=1).One patient underwent open conversion because of gradual bleeding during the dissection of dense adhesive renal pedicle due to infection and fibrosis.The mean operative time for simple nephrectomy 110(range from 95to 175)mins,radical nephrectomy 90(range from 75to 160)mins.The mean blood loss was 155(range from 55to 300)ml.Hospitalization duration was between 5and 8days with a mean postoperative stay of 7.2days.The mean follow-up of 16.2(range from 2to 35)months showed hidden umbilicus scar.The suprapubic scar was not detectable because of the pubic hairs.Conclusions:SA-LESS-N appears to be feasible,safe and effective.It would not only lead to improved cosmetic results,but lead to little postoperative pain.

Ureter avulsion is one of the rare and severe complications of ureteroscopy. This case developed to ureteropelvic avulsion and proximal ureteral avulsion completely with a blood vessel connected to middle ureter, which was treated by open surgery. This kind of ureter avulsion has not been reported yet.

Objective:To investigate the effects of gene silencing of CD147 by adenovirus-mediated small interfering RNA(siRNA) interference on the proliferation,migration and invasion of bladder cancer T-24 cells in vitro.Methods:The recombinant adenoviral vector encoding CD147 siRNA was constructed,and then the T-24 cells were infected with this recombinant adenoviral vector.The blank control(Mock),negative control(Ad-siControl) and siRNA interference(Ad-CD147 siRNA) groups were designed in this study.The expression levels of CD147 and vascular endothelial growth factor(VEGF) mRNAs were detected by RT-PCR,and the expression level of CD147 protein was detected by Western blotting.The cell proliferation was detected by MTT method.The invasion and migration capabilities were evaluated by using Transwell chamber migration assay and scratch wound healing assay,respectively.The secretion levels of matrix metalloproteinase(MMP)-2 and MMP-9 were detected by gelatin zymography.The secretion level of VEGF protein was examined by ELISA.Results:The recombinant adenoviral vector Ad-CD147 siRNA was successfully constructed and infected into T-24 cells.The expression levels of CD147 mRNA and protein in T-24 cells were decreased by more than 90%(P0.01),and the proliferative rate was decreased by more than 40%(P0.01).The invasion and migration capabilities were both decreased significantly(P0.01).The secretion levels of MMP-2 and MMP-9 were reduced by 68.5% and 37.1%,respectively(P0.01).The VEGF mRNA and protein levels were reduced by 57.2%(P0.01) and 56.5%(P0.01),respectively.Conclusion:Ad-CD147 siRNA can efficiently inhibit the expressions of CD147 protein and mRNA,which results in decreased capacities of proliferation,migration and invasion of T24 cells.CD147 maybe become a new potential target in the treatment of bladder cancer.

Objective:To research the cause of complicating hydrothorax of MPCNL.Methods:A total of 285 cases with upper urinary tract calculi underwent MPCNLs.They included 174 males and 111 females,aged from 11 years to 72 years(median,32 years).91 cases were ureteral calculi,167 were renal calculi,and 27 were renal calculi with upper ureteral calculi.The size of the calculi ranged from 1.2 to 4.5 cm(median,2.3 cm).In all operations, the 12th rib subcostal punctures were guided by ultrasound to avoid injuring pleura between midaxillary line and scapular line.Physiological saline with Chinese ink was used as irrigation fluid.Hydrothorax identified postoperatively by Chest X-ray,B ultrasound or CT scan was tested under microscope to find carbon granule.At last,the influencing factors were analyzed.Results:All the procedures were successful.Hydrothoraxes were occurred in 16 cases identified by B ultrasound,while the other 5 cases complicating hydrothorax were identified by CT scan.Hydrothoraxes were acquired in 13 cases by thoracentesis and carbon granules were found in hydrothorax under microscope in all 13 cases,while it can not be found in peripheral blood.After comparing the data of cases complicating hydrothorax with the clinical data of cases without hydrothorax,we find that the stone size,stone multiplicity,operative perfusion time,the perfusion pressure and the perfusion volume of irrigation fluid in cases with this complication were significantly higher than those without complication(P<0.05),meanwhile operative perfusion time,the perfusion pressure and the perfusion volume of irrigation fluid were independent factors(P< 0.05).Conclusions:Hydrothoraxes were occurred after MPCNLs without injury of pleura.We conjecture that the long operative perfusion time,the high perfusion pressure and the large perfusion volume of irrigation fluid promote irrigation fluid extravasation to retroperitoneal space and abdominal cavity,and then it can enter into the pleural cavity and cause hydrothorax.

Objective:To describe the initial clinical experience of pure transvaginal NOTES for unroofing of renal cyst,and evaluate its feasibility.Methods:In December 2010,one 61 year-old female patient with right renal cyst,underwent pure transvaginal NOTES.After induction of general anesthesia,the patients was positioned in lithotomy with right lumbar at 30°angle to the operating table.The patients was in a Trendelenburg's position.A 3 mm incision was made at the posterior vaginal fornix,and a 5 mm Trocar was introduced into the pelvic cavity guided by a 5 mm forceps.A 5 mm 0°flexible laparoscope was inserted into the pelvic cavity to confirm no rectum injury.Then a Triport was introduced at the posterior vaginal fornix.The patients head end was uppered by 25°with right lumbar at 60°angle to the horizontal plane.The right renal cyst was found after wrapped tissues dissection. Part of renal cyst wall was cut by an ultracision harmonic scalpel and removed.Drainage tube was placed in the pelvic cavity through vagina.The vaginal incision was closed under direct vision using a 2/0 absorbable suture. Results:The procedure was successfully finished.The operative time was 75 min.The estimated blood loss was 20 ml.There was no intraoperative or postoperative complications.The pelvic drainage was removed on postoperative day 1 and the patient resumed ambulation.The patient resumed nutrition 2 days after surgery,and discharged on postoperative day 4.Conclusions:Pure transvaginal NOTES for unroofing of renal cyst is feasible.This novel technique seeks to provide cosmetic and minimally invasive result.This procedure could also provide experience for exploration for other transvaginal pure NOTES.

Objective:To describe the initial clinical experience of pure transvaginal natural orifice transluminal endoscopic surgery(NOTES) for nephrectomy,and evaluate its feasibility and efficacy.Methods:A 55-year-old female patient with nonfunctional right kidney,and a 44-year-old female patient with nonfunctional left kidney,underwent pure transvaginal NOTES nephrectomy.After induction of general anesthesia,the patients were positioned in lithotomy.A Triport was introduced at the posterior vaginal fornix.The patients head end was elevated by 25°with right lumbar at 60°angle to the floor.The ipsilateral kidney was dissected,and renal artery and vein were clipped with Hem-OTock clips according to the method of a standard laparoscopic nephrectomy.The specimen was placed inside a homemade bag and removed under direct vision through an extended incision at posterior vaginal fornix,after the kidney was completely excised.The pelvic cavity was drained by one tube brought out through vagina.The vaginal wound was closed under direct vision using a 2/0 absorbable suture.Results:Both procedures were successfully finished.The operative time was 330 and 300 min,respectively.The estimated blood loss was 300 and 250 ml,respectively.There was no intraoperative or postoperative complication.The patients resumed ambulation on postoperation day 2 and 1,respectively.The patients resumed oral diet on postoperative day 3 and 2,respectively.Both patients were discharged on postoperative day 6.Conclusions:Pure transvaginal NOTES for nephrectomy is feasible and effective.This novel technique seeks to provide cosmetic result even when compared to today's minimally invasive procedures.However,special instruments need developing.

心肺复苏（CPR）是急诊常用技术。徒手操作胸外心脏按压，操作者的熟练程度，按压的位置、深度、频率等都直接影响着CPR成功与否。胸外心脏按压的最佳频率为120～140次/min，而徒手操作较难以做到。为此，我们应用冲压式心肺复苏机（Thumper CPR）对9例急诊心脏停搏患者进行抢救，其疗效较好。报告如下。 1　病例与方法 1.1　病例：1998年10月～1999年2月本院急诊科收治呼吸心脏停搏患者9例，其中男5例，女4例；年龄35～78岁，平均(53.0±15.9)岁。9例患者均在我科急诊监护病房（EICU）抢救，临床资料见表1。

患者,男性,56岁,因高血压右侧基底节出血入院.行颅内血肿清除术,24小时后患者神志转清.因呼吸道分泌物较多于病程第9天行气管切开术.术后除吸出较多粘稠分泌物外,尚有少量血性分泌物,探查切口未见有明显出血部位,后因出现气促、氧分压逐渐下降及意识模糊而转我院ICU.查体:轻度意识障碍,左侧鼻唇沟略浅,瞳孔等大等圆,直径0.3cm,对光存在.颈稍有抵抗,气管置入为8号气管套管,切口部外观无渗出.