BACKGROUND: Urethral fistula following renal transplantation accounts for 40%-70% of urinary complications, owing to surgical and medical factors. OBJECTIVE: To effectively decrease and avoid attack of urethral fistula after renal transplantation, and prolong the survival of kidney. METHODS: Clinical data from 68 cases following renal transplantation were retrospectively analyzed at the levels of pathogeny, diagnosis and treatment. There were 47 males and 21 females, aging 20 58 years. Urethral fistula occurred at 3 31 days after renal transplantation, and the amount was 60-2 000 mL per day. Based on the principle of the urethral injury classification method, urethral fistula was divided into simple and complex categories, while according to the fistula site, etiology and extent, urethral fistula was divided into low, high and multiple fistula. Attack rate of simple urethral fistula and complex urethral fistula was detected following renal transplantation so as to analyze the pathogeny of urethral fistula. RESULTS AND CONCLUSION: Of 68 cases with urethral fistula following renal transplantation, 47 cases (69.1%) were simple urethral fistula, including 42 cases with ureteral end necrosis, 4 cases with lax anastomotic suture of ureter bladder, and 1 case with ureteral anastomotic badness caused by wound infection, and 21 cases (30.9%) were complex urethral fistula, including 2 cases with renal pelvis fistula, 2 cases with ureter, 11 cases with ureterovesical anastomosis region, 6 cases with ureteral necrosis longer than 2 cm. A lot of causes may induce urethral fistula following renal transplantation. The blood stream, edema, size of fistula, length of the ureter, and operative procedures are selected to ensure free of strain. Urethral fistula can be treated on time on the basis of different situations.

Objective To investigate the medium- and long-term effects and safty of Pipeline embolization device ( PED) for the treatment of large and giant intracranial anterior circulation aneurysms. Methods From December 2014 to December 2016,the data of 36 consecutive patients with large and giant aneurysm ( 36 large and giant intracranial anterior circulation aneurysms ) treated with PED in Donglei Brain Doctor Group were analyzed retrospectively. The diameter of the aneurysms was 12 -33 mm, (mean16.6±4.5mm),andthenecksizewas4-10mm(mean6.1±1.5mm).Eightaneurysmswere located in the carotid cavernous sinus segment,22 in the ophthalmic artery segment,5 in the internal carotid artery posterior communicating segment, and 1 in the M1 segment of middle cerebral artery. Seven aneurysms were only treated by PED,28 aneurysms were treated by PED in combination with coil embolization,and 1 aneurysm was treated by double PEDs. The modified Rankin scale ( mRS) score was used to evaluate the prognosis of the patients. Results (1) The clinical prognosis of the patients was followed up by telephone and outpatient department for 6-33 months. Twenty-five patients were followed up by DSA,23 aneurysms (92%) were occluded totally (Raymond gradeⅠ) and 2 (8％) were occluded near totally ( Raymond grade Ⅱ) . ( 2 ) Seven patients were treated with PED alone. Four patients were cured totally after 6 months follow-up,1 was occluded subtotally,2 were not cured;6 were cured in the last follow-up (33 months),and the other aneurysm was gradually reduced;17 of 28 patients treated with PED in combination with coils received DSA follow-up. They were followed up for 6-8 months. All the aneurysms were totally occluded ( Raymond grade Ⅰ) . 1 aneurysm was treated by 2 PEDs, DSA revealed micro-aneurysm-like development at 8 months after procedure. The aneurysms were basically occluded after 15-month follow-up. (3) MRI confirmed after operation that 10 patients had asymptomatic scattered spotted ischemic foci,4 had cerebral parenchymal hemorrhage,1 of them died,1 recovered well after treatment (mRS 1),and the other 2 were asymptomatic cerebral hemorrhage. The occupying effect of 24 cases disappeared, 8 had obvious improvement,and 3 did not have any obvious change. Conclusions The occlusion rate of the treatment of large and giant intracranial aneurysms with PED was high. The results of medium-term follow-up showed that the occlusion rate of PED in combination with coils in the treatment of aneurysms was higher than that of PED alone. The long-term follow-up results showed that the occlusion rate of patients treated with PED alone (including one or more) was gradually increased with time. The safety of the surgery needs to be further confirmed by a large sample study.

Surgical resection in patients with advanced primary carcinoma of liver has high risks of early recurrence and incidence of portal vein tumor thrombus, caused by insufficient resi-dual liver volume after two-steps hepatotomy. At present, the treatment for patients with advanced primary carcinoma of liver is limited, thus can't satisfy the requirement of patient for treatment. The authors introduce the clinical experience of a patient with hepatocellular carcinoma and insufficient residual liver volume who underwent preventive immunotherapy plus target therapy after associa-ting liver partition and portal vein ligation for staged hepatectomy, in order to provide reference for relevant treatment.

Objective To evaluate the efficacy and safety of Willis covered stent in the treatment of traumatic carotid cavernous fistulae (tCCF).Methods The imaging and clinical data of 7 patients with tCCF treated with Willis covered stent in Shanghai Punan Hospital from November 2015 to June 2018 were analyzed retrospectively.Results Seven Willis covered stent were used in 7 patients.Immediately after stent release,angiography showed that the fistulae completely disappeared in 6 cases.One patient had a small amount of endoleak,and there was still a small amount of endoleaks after balloon dilatation.It was not further treated.There were no operative complications.During 3-12 months follow-up,no new neurological deficits were found in all patients.Angiographic follow-up of 2 patients showed that the fistulae completely disappeared without recurrence.The internal carotid arteries were patent,no in-stent stenosis and stent displacement.Conclusions Wills covered stent can be used as a treatment for tCCF.Its efficacy is satisfactory and the safety is good.