BackgroundThis retrospective cohort study and meta-analysis aims to explore the association between microvascular invasion (MVI) and clinicopathologiccal features, as well as survival outcomes of patients with renal cell carcinoma (RCC).Material and methodsThe retrospective cohort study included 30 RCC patients with positive MVI and another 75 patients with negative MVI as controls. Clinicopathological features and follow-up data were compiled. The meta-analysis conducted searches on PubMed, Cochrane Library, Web of Science, Embase, and WanFang Data from the beginning to 30 September 2023, for comparative studies relevant to MVI patients. The Newcastle-Ottawa Scale and Egger Test were used to assess the risk of biases and certainty of evidence in the included studies.ResultsThe cohort study showed that MVI was associated with advanced primary tumor stage, high pathological grades, high tumor size, high clinical symptoms and lymph node invasion (P <0.05). Kaplan-Meier analyses demonstrated MVI was associated with worse CSS rates when compared to MVI negative group (P <0.05). However, in the multivariate analysis it was not presented as an independent predictor of cancer survival mortality (P >0.05). The meta-analysis part included 11 cohort studies. The results confirmed that patients with MVI positive had worse 12 and 60 mo CSS rates (HR12mo = 0.86, 95%CI 0.80–0.92; HR60mo = 0.63, 95% CI 0.55–0.72; P < 0.00001). Moreover, the meta-analysis also confirmed that MVI group was associated with higher rate of advanced tumor stage, pathological grades, tumor size diameter, higher rate of clinical symptoms and lymph node invasion (P <0.05).ConclusionsThe presence of MVI in renal cell carcinoma patients is linked to poorer survival outcomes and worse clinicopathological features. In spite of this, it does not seem to be an independent predictor for cancer survival mortality in renal cell carcinoma.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023470640, identifier CRD42023470640.

Objective:To explore the technical essentials of robot-assisted radical prostatectomy via posterior and completely intrafascial for organ-confined prostate cancer, and to evaluate the oncological and functional outcomes.Methods:Fifteen prostate cancer patients with T1-2bN0M0 were scheduled for robot-assisted radical prostatectomy via posterior and completely intrafascial approach, and their international index of erectile function (IIEF) were performed before operation. All patient was placed in a supine position and the robotic system was established. Firstly, expose the Douglas fossa, free bilateral vas deferens and seminal vesicles, blunt dissection of the Denonvillier fascia, severed lateral ligament and visceral pelvic fascia, then exposed and disconnected urethra, continuous suture bladder neck urethra. Perioperative complications and functional outcome data were recorded. All patients were regularly followed up for tPSA testing, daily urine pads and IIEF-5 scores.Results:All of the 15 patients were successfully completed the operations. The median (range) operation time was 86(65-116) min, and estimated blood loss was 20 (10-60) ml, and no serious complications occurred. Postoperative pathology was 18.Conclusions:Robot-assisted radical prostatectomy via posterior and completely intrafascial approach is technically feasible for patients with low-risk localized prostate cancer and demonstrates promising functional outcomes regarding continence and potency.

目的 比较经逆行置管引流和经皮肾穿刺造瘘引流在急诊治疗输尿管结石合并尿脓毒血症中的效果.方法 选取2011年1月～2017年1月韶关市第一人民医院急诊室收治的80例输尿管结石合并尿脓毒血症患者作为研究对象,将其平均分成两组,每组各40例,对照组采用经皮肾穿刺造瘘引流进行急诊处理,研究组采用经逆行置管引流进行急诊处理,比较两组患者术后尿脓毒血症的控制时间、引流成功率以及并发症发生率.结果 两组患者术后尿脓毒血症控制时间、并发症发生率比较,差异无统计学意义(P＞0.05);研究组患者引流成功率明显高于对照组,差异有统计学意义(P＜0.05).结论 在输尿管结石合并尿脓毒血症急诊处理中,应用经逆行置管引流和经皮肾穿刺造瘘引流均能有效控制患者尿脓毒血症的进展和避免患者术后发生较多的不良并发症,但经逆行置管引流的成功率更高,因此,为保证患者能够得到及时的急诊治疗,可首选经逆行置管引流.

目的 探讨与传统经尿道前列腺电切术相比,采用经尿道前列腺剜除术治疗大体积前列腺的临床疗效.方法 选取我院于2014年4月至2016年6月收治的100例前列腺增生患者,并将之随机分成实验组(n=50,行经尿道前列腺剜除术)和对照组 (n=50,行传统经尿道前列腺电切术).比较分析两组患者术后Q-max(最大尿流率)、PVR(残余尿量)、IPSS评分(国际前列腺症状评分)、QOL评分(生活质量评分)以及手术前后红细胞压积(HCT).结果 两组患者Q-max、PVR、IPSS评分、QOL评分比较,实验组患者各项指标均优于对照组患者,存在统计学差异(P<0.05);两组患者手术前后HCT差值存在统计学差异(P<0.05).结论 与传统经尿道前列腺电切除术相比,采用经尿道前列腺剜除术治疗大体积前列腺具有显著的优势,有临床推广的价值.

Objective To analyze the clinical effects of minimally invasive percutaneous lithotripsy (MPCNL) and ureteroscopic lithotripsy (URL) in the treatment of impacted upper ureteral calculi.Methods One hundred and ten patients were enrolled in the study from January 2013 to August 2015 in our hospital,who were diagnosed as impacted upper ureteral calculi.Fifty-five cases were treated with minimally invasive percutaneous nephrolithotomy lithotripsy,while the remaining cases were treated with ureteroscopic lithotripsy as control group.Results There was no significant difference in the operation time between the two groups (P＞0.05).The incidence of the open operation was significantly lower in MPCNL group,compared with URL group (P＜0.05).The incidences of fever,renal colic and ureteral perforation between the two groups were not statistically different (P＞0.05).The hospital stays were shorter than the URL group (P＜0.05).The stone clearance rate was higher in the 3rd day and 1 month after operation than in the URL group (P＜0.05).Conclusion MPCNL in the treatment of impacted upper ureteral calculi can achieve a high stone clearance rate,and can be developed as the first choice for treatment of impacted upper ureteral calculi.

Objective To analyze the clinical effect of minimally invasive treatment of benign prostatic hyperplasia(BPH) combined with bladder calculi.Methods A total of 98 patients with BPH and bladder stones were admitted to our hospital from January 2014 to January 2016 Forty nine cases in control group were treated with transurethral resection of prostate and suprapubic cystolithotomy,and the study group were treated with transurethral resection of prostate and bladder pneumatic lithotripsy.The clinical efficacy and complications of the two groups were observed and compared.Results The effective rate of the study group was 95.92％ (47/49),significantly higher than the control group [73.47％(36/49),(P＜0.05)].The operation time,bleeding volume,indwelling catheter time,bladder irrigation time and length of stay in the observation group were significantly shorter than those in the control group (P＜0.05).The total complication rate in study group was 6.12％ (3/49),significantly lower than the control group [30.61％ (15/49),(P＜0.05)].Conclusion Minimally invasive surgery in the treatment of benign prostatic hyperplasia with bladder stones is effective,and is worth to be popularized and applied in clinical practice.

评价和探讨睾丸切除去势联合多西他赛治疗晚期前列腺癌的效果.选取2014年2月～2016年8月在我院住院治疗的晚期前列腺癌患者60例,随机分为观察组33例和对照组27例.观察组采取睾丸切除去势联合多西他赛治疗,对照组采用睾丸切除去势治疗.比较两组患者生活质量评分变化情况,比较两组患者的PSA水平、临床疗效、副作用发生及疼痛评分等情况,比较患者临床疗效.结果治疗后两组患者生活质量评分高于治疗前,且观察组显著高于对照组(P＜0.05);两组患者PSA水平、疼痛评分治疗后均明显降低,且观察组低于对照组(P＜0.05);观察组患者不良反应发生率显著低于对照组(P＜0.05);观察组患者的临床疗效明显高于对照组(P＜0.05).晚期前列腺癌使用多西他赛联合睾丸切除去势治疗的效果理想,能改善患者生活质量水平、减少疼痛和副作用发生情况,提高患者临床疗效,值得推广使用.

Objective To investigate the application value of percutaneous nephrolithotomy (PCNL) for obese patients with renal calculi in recumbency lithotomy position. Methods Eighty-four obese cases with renal calculi were involved and divided randomly into three groups (n=28 for each group). Patients in three groups were treated by PCNL in prone,total supine and recumbency lithotomy positions. Operative time,intra-operative blood loss,stage I clearance rate of stone,length of postoperative hospital stay and incidence of post-operative complications were statistically compared among three groups. Results Operative time,volume of blood loss and length of postoperative hospital stay in the recumbency lithotomy position group were (134 ±19) min,(73 ±6)ml and (6 ±1 )d,respectively,significantly improved than those in other groups (all P<0. 05 ). The stage I clearance rate of stone in the recumbency lithotomy position group was 93%with no statisti-cal significance compared with those in other two groups (both P>0. 05 ). The incidence of surgical complica-tions in the recumbency lithotomy position group was 4%,significantly improved than that in supine group (P<0. 017). Conclusions PCNL in recumbency lithotomy position could shorten operative time,reduce blood loss and lower the incidence of complications,which is an efficacious and safe surgical position for obese pa-tients diagnosed with renal calculi.