Objective To discuss the curative effect and the prognosis of patients with renal cell carcinoma after laparoscopic radical nephrectomy. Methods One hundred and twenty-seven cases of renal cell carcinoma treated with laparoscopic radical nephrectomy between October 2002 and Decem-ber 2006 were reviewed. The perioperative complications and postoperative renal function were recor-ded and analyzed. Post-operative 1-year and 3-year actuarial survival rates, disease-free survival rates and tumor-specific survival rates were caculated respectively with Kaplan-Meier analysis. Quality of life(QOL) was compared before and after surgery by Karnofsky Performance Status measuring scale. Results Among the 127 patients, 107 cases were followed up of mean 23 months (4-51 months). 1-year and 3-year actuarial survival rates, disease-free survival rates and tumor-specific survival rateswere 95.6%, 95.6%; 95.8%, 95.8% and 96.8%, 96.8%, respectively. 3-year actuarial survival rate, disease-free survival rate and tumor-specific survival rate were 97.1%,98.6%, 98.6% in pT1-2 tumors, and were 90.2%, 85.6%, 90.2%in pT3a, tumors. Disease-free survival rate and tumor-spe-cific survival rate had significant differences between patients in stage pT1-2 and patients in stagepTa3a.91.6% of the patients scored the post-operative QOL above 80 by Karnofsky Performance Sta-tus measuring scale. Conclusions Patients who underwent laparoscopic radical nephrectomy have high survival rate, low complication incidence and good QOL. Post-operative survival rate is correlated with pathologic stage.

Surgical treatment is the only cure treatment for patients with inferior vena cava tumor thrombus in hepatic segment and upper hepatic segment.The accurate diagnosis of tumor thrombus is very important.In preoperative imaging examination,the abdominal enhanced CT scan and the inferior vena cava MRI scan were the best methods for the diagnosis and evaluation of the tumor thrombus in hepatic segment and upper hepatic segment.Compared with the tumor thrombus below the liver,the tumor thrombus in hepatic segment or above hepatic segment extend widely,and the operation are more difficult.For simple inferior vena cava tumor thrombus (the top of the thrombus has reached the level of hepatic vein),Retroperitoneal approach combined with transperitoneal approach should be used.Open surgery is the standard procedure for other tumor thrombus in hepatic segment and upper hepatic segment.In addition to exposure of inferior vena cava below the hepatic vein,the liver and the first hepatic hilum should be exposed.For tumor thrombus in the atrium,after the longitudinal incision of diaphragm,we use Milking technology to squeeze thrombus into inferior vena cava.Then we use catheterization technology to remove thrombus.For difficult atrial tumor thrombus,an extracorporeal circulation should be performed.The median incision in the chest should be performed to open the chest and open the pericardium and remove the tumor thrombus.Patients with tumor thrombus in hepatic segment or upper hepatic segment should be diagnosed as early as possible and they need actively treated by operation.

Objective: To explore the correlation among plasma fibrinogen (Fg), serum uric acid (SUA) level, severity of premature coronary heart disease (PCHD) and major adverse cardiovascular events (MACE).Methods:A total of 195 PCHD patients diagnosed by coronary angiography (CAG) were selected, including 72 cases with stable angina pectoris (SAP), 67 cases with unstable angina pectoris (UAP) and 56 cases with acute myocardial infarction (AMI).Another 75 healthy subjects were enrolled as normal control group.Plasma Fg and serum urea acid(SUA)levels were compared among four groups, and their relationship with coronary disease severity and incidence of MACE during six-month follow-up were analyzed.Then ROC curve was used to assess predictive value of plasma Fg and SUA levels for PCHD.Results: Compared with normal control group and SAP group, there were significant rise in levels of plasma Fg[(2.80±0.26) g/L, (2.85±0.32) g/L vs.(3.44±0.32) g/L, (4.25±0.35) g/L]and SUA[(306.56±15.55) μmol/L, (308.81±16.77) μmol/L vs.(349.48±15.59) μmol/L, (368.86±20.72) μmol/L]in UAP group and AMI group (P<0.05 or <0.01), and those of AMI group were significantly higher than those of UAP group (P<0.05 both);Spearman correlation analysis indicated that plasma Fg and SUA levels were significant positively correlated with Gensini score (r=0.750, 0.743, P<0.01 both);levels of plasma Fg and SUA in those suffering from MACE during follow-up were significantly higher than those of patients without MACE, P<0.05 or <0.01.Meanwhile, ROC curve suggested that plasma Fg and SUA possessed certain diagnostic value for PCHD[area under the curve (AUC) =0.867, 0.736].Conclusion: Plasma fibrinogen and serum uric acid detection can provide certain evidence for diagnosing PCHD and determining disease severity.

Objective To present the primary effectiveness and morbidity of metallic ureteral stent in treating the patients with malignant ureteral obstruction .Methods The retrospective study enrolled 11 patients received metallic ureteral stent placement because of malignant ureteral obstruction at our hospital between Jul.2012 and Jan.2014.Total of 16 stents were inserted including 5 bilateral stent insertion. There were 4 males and 7 females, with a mean age of 56 years (range 28 to 88 years).Mild to moderate hydronephrosis were identified by ultrasound and CTU in all patients , including 2 recurrent fever and 1 renal colic in affected side , however serum creatinine level is normal .There were 10 patients received stents insertion through cystoscopic or nephroscopic retrograde approach and 1 through nephroscopic antegrade approach,under superficial , spinal or intravenous anesthesia .Patients were scheduled for follow-up at 6 months intervals by KUB and ultrasound and would be examined ahead of time if there were any obstructive symptoms including recurrent fever or renal colic of the affected side .Outcomes and complications were observed during follow-up.Results In total,11 patients underwent 13 operations,including 2 by staging operations.Hydronephrosis , recurrent fever and renal colic were relieved in all patients after operation , showing 100%success rate.The mean follow-up was 9 months,in which,9 patients had not reached the scheduled time (1 year) while 2 patients exceed the time limit of stent exchange because of poor physical status.During the follow-up, 1 patient died of the progression of urothelial carcinoma .Nine stents of 5 patients keep alleviating the obstruction without hydronephrosis evaluated by ultrasonography .Stents failure occurred in 6 ureters of 5 patients, including 3 encrustation and 2 migration, presenting of progressive hydronephrosis and recurrent fever . Functional restoration was achieved in one of the encrusted stent undergoing ESWL .One stent with encrustation fail to be removed and a polymer double-J stent replacement in the same side was required for drainage .The other 3 nonfunctional stents were removed and replaced by polymer double-J stents.Conclusions Ureteral obstruction secondary to extrinsic compression contributing to relatively stable malignant tumor could be treated safely and sufficiently with the resonance metallic stent . Surveillance on schedule and regularly change within 1 year is critical to achieve successful outcomes .Tumor progression with ureteral invasion as while as encrustation can cause stent failure ,and in these cases the stent should be changed every 6 months or less.

Objective To analyze the efficacy, safety, and learning curve of holmium laser enucleation of prostate (HoLEP). Methods From June 2014 to June 2015, there were 45 consecutive patients with benign prostatic hyperplasia who underwent HoLEP performed by one experienced urologic doctor ( having surgical experience of transurethral resection of prostate in more than 500 cases) in our hospital. The patients were divided into three groups:group A (patient 1-15), group B (patient 16-30), and group C (patient 31-45). The patient age, prostate specific antigen (PSA) and prostatic volume evaluated by ultrasound were similar among the 3 groups (P>0. 05). Clinical data including operative time, hemoglobin decrease, and catheterization duration were compared among the 3 groups. The efficiency for enucleation was calculated as prostatic volume divided by operation time. Results The average enucleation efficiency of 3 groups was 0. 34 ± 0. 14, 0. 36 ± 0. 16, and 0. 49 ± 0. 18 ml/min, respectively, with a significant difference among the 3 groups (F =4. 025, P =0. 025). The group C obtained significantly improved efficiency as comparing with the group A and group B (P=0. 013 and 0. 028, respectively). No significant difference was found in operative time, hemoglobin decrease, catheterization duration, and rate of blood transfusion and complication among the 3 groups (P>0. 05). There were several surgery-related complications, including 2 cases of conversion to TURP, 5 cases of postoperative temperature more than 38℃, 4 cases of severe stress incontinence, 1 case of bladder mucosal injury by morcellator, 1 case of urethral stricture, and 1 case of postoperative hemorrhage. It took 30 cases to overcome learning curve of HoLEP by self-taught modality. Conclusions For experienced endourologist, HoLEP can be learn by self-taught modality after 30 cases training. Cases with small prostatic volume less than 60 ml should be selected in the early stage of the learning curve.

Based on literature review determining evaluation dimensionality,and with the relevant policies,the original index system is determined.Through using two rounds of focus group discussion and two rounds of expert consultation method,a set of county hospitals comprehensive reform of index system,which consists of 3 primary,14 secondary indicators and 64 tertiary indexes,is established.The analytic hierarchy process is used to determine the weight of evaluation index.At the same time,the reliability and validity of index system are tested.This proves that the established evaluation index system can give scientific and reasonable assessment results for comprehensive reform of county-level hospitals.

Objective To determine relative risk factors for positive surgical margins in extraperitoneal laparoscopic radical prostatectomy(LRP). Methods From February 2004 to September 2007,33 patients(mean age 70 years old)with prostate cancers underwent extraperitoneal LRP.All patients were diagnosed by pathology preoperatively.Gleason score:3+3 14 cases(43%),3+4 11 cases(33%),4+3 6 cases(18%),4+4 2 cases(6%).Clinical stage:T1a-T1b 4 cases(12%),T1c 14 cases(43%),T2a-T2b 5 cases(15%),T2c10 cases(30%).Logistic regression analyses were performed. Results LRP was successfully performed on 31 cases.There were 2 cases converted to open surgery.Nine cases(27%)had PSMs.There were 6 cases(67%)and 4 cases(17%)of clinical stage T2c in PSM and negative surgical margin(NSM)groups respectively(P=0.010).There were 3 cases(33%)and 0(0)with high Gleason score(higher than 7)in PSM and NSM cases(P=0.015).There were 4 cases(44%)and 5 cases(21%)with t-PSA higher than 20dg/ml in PSM and NSM cases respectively(P=0.178).In these 9 cases,there were 4 cases(44%)positive with DRE.However there were 9 in the 24 NSM cases(38%)(P=0.509).Clinical stage T2c was independently positively correlated with PSM(OR=24.69).High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml were positively correlated with PSM. Conclusions Clinical stage is positively correlated with PSM.It is an independent factor.High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml mignt be the risk factors in predicting PSM and should be used together with clinical stage.Positive DRE findings may be also useful to predict PSM.

Objective To investigate the efficacy of plasmapheresis therapy for treating the antibody-mediated acute rejection (AMR) after kidney transplantation.Methods The study group consists of 2 male patients and 3 female patients,who suffered with AMR after receiving first-time allograft renal transplantation from January 2011 to September 2013 in our hospital.The age ranged from 41 to 52 years old,average 46 years old.The preoperative diagnosis in all patients was chronic renal insufficiency (uremia stage) and the regular hemodialysis was given to them.The 5 patients received basic immunosuppressive therapy,including cyclosporine A [5 mg/(kg · d)] or FKS06 [0.1 mg/(kg · d)],mycophenolate mofetil (MMF) (1.5 g/d) and steroids.All the antibody-mediated acute rejections were diagnosed by renal allograft biopsy and serum DSA determination within 2 weeks after transplantation.Seven cycles of plasmapheresis rescue therapy were given to those patients respectively after the failure therapy of high dose of corticosteroids (1 000 mg/d) and ALG (250 mg/d).4 cases with primary glomerulonephritis,whose preoperative serum creatinine level was (784± 154) μ mol/L,were given plasmapheresis therapy within 2 weeks after transplantation.One case with primary anti-glomerular basement membrane disease,whose preoperative serum creatinine level was 935 μmol/L,received plasmapheresis 35 d after transplantation.The serum DSA in all patients was positive before plasmapheresis.Results After 7 cycles of plasmapheresis rescue therapy,the AMR was reversed in four 4 cases,whose plasmapheresis was given within 2 weeks after transplantation.Within three months follow-up,their renal function recovered well,which the mean serum creatinine level was (113± 12) μmol/L.In the case,whose plasmapheresis was given 35 days after transplantation,rejection was not reversed.His serum creatinine was 524 μmol/L and the intermittent hemodialysis was given,subsequently.With a follow-up of 12 months,the ultrasound examination showed that the atrophy of transplanted kidney and a high level of serum creatinine (758 μmol/L).Low dose of FK506 (0.5 mg/d) was given based on those results.Conclusions Active application of plasmapheresis can effectively reverse antibodymediated acute rejection within two weeks after transplantation.

Objective A kidney transplantation patient who was diagnosed with autoimmune hemolytic anemia (AIHA) caused by passenger lymphocyte syndrome (PLS) was reviewed.Method A male kidney transplantation patient aged 31 was admitted due to severe anemia.Direct antiglobulin test (DAT) was positive and reticulocyte was elevated significantly,and PLS was diagnosed.He was treated with blood transfusion,glucocorticoid and intravenous immunoglobulin,and recovered at last.Result PLS is a rare but important cause of AIHA after kidney transplantation,often occurs in blood type A patient who received a kidney from a blood type O donor.Final diagnosis depends on the detection of anti-erythrocyte antibody in recipient serum.Conclusion PLS should be considered when anemia with unknown reasons occurred in kidney transplantation patients.

Objective To analyze the risk factors that affect severe infection following flexible ureteroscope Holmium laser lithotripsy for upper urinary tract calculus,and to construct the regression model and nomogram for predicting the probability of postoperative SIRS.Methods We retrospectively analyzed the clinical data from 457 cases (male 302 and female 155) of upper urinary calculi treated by flexible ureteroscopy from January 2014 to May 2016,with mean age of 49.9 (ranged 20-76) years.The mean maximum size of stones was (16.5 ± 3.0) mm (ranged 12-22rmm).There were 51 cases (11.2％) with a recent infectious febrile history related to stones.The patients were divided into two groups as patients developing SIRS or not.Univariate and multivariate statistical analyses were performed to determine factors affecting the development of postoperative SIRS,and then a nomogram was built based on regression coefficients.Results The incidence of SIRS after flexible ureteroscopic lithtripsy was 5.9％ (27/457).Multivariable logistic regression analysis identified febrile history related to urinary stones (OR =1.5569,P =0.009),without preoperative placement of ureteral stent (OR =1.4004,P =0.004),small-caliber (F 13-14) ureteral access sheath (OR =1.1120,P =0.016),endoscopic signs of infection (OR =2.0176,P =0.000) and infectious stones (OR =1.0981,P =0.013) as independent risk factors for postoperative SIRS.The concordance index was 0.845 in the nomogram model sample and 0.79 in the validation sample.Conclusions Febrile history related to urinary stones,without preoperative placement of ureteral stent,small-caliber ureteral access sheath,endoscopic signs of infection and infectious stones would be independent risk factors to predict SIRS after flexible ureteroscope holmium laser lithtripsy.A nomogram based on perioperative clinical factors could be used to predict the risk of SIRS.