Objective To evaluate the safety and effectiveness of the Hem-o-lok in retroperitoneal laparoscopic nephrectomy.Methods A total of 178 patients underwent retroperitoneal laparoscopic nephrectomy from November 2003 to November 2006.The operation was performed through 3 lumbar ports.The renal artery and veins were blocked with the Hem-o-lok and then severed.The ureter was cut at the site near the iliac blood vessel.For living donor nephrectomy,the kidney was taken out and infused with 4℃ kidney preserving fluid immediately.Results The operation was successfully completed in all the 178 cases and there was no conversion to open surgery.No Hem-o-lok ligating clips became dislodged.The mean operation time was 100 min(60-200 min),and the mean blood loss was 95 ml(20-200 ml).Complications included renal vein injury in 1 patient and pancreatic tail injury in 1 patient.The mean length of postoperative hospital stay was 5 days(4-8 days).Pathological results showed renal clear cell carcinoma in 65 patients,renal cystadenocarcinoma in 3 patients,renal leiomyosarcoma in 1 patient,renal lymphoma in 1 patient,renal oncocytoma in 2 patients,renal hamartoma in 2 patients,ureteral transitional cell carcinoma in 12 patients,ureteral squamous cell carcinoma in 2 patients,renal pelvis transitional cell carcinoma in 31 patients,renal pelvis xanthogranuloma in 1 patient,renal tuberculosis in 4 patients,accessory kidney in 1 patient,renal calculus in 4 patients,nephrohydrosis in 4 patients,and renal abscess in 1 patient.A total of 136 patients were followed for 1-36 months(mean,25 months),involving 64 patients followed for

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 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 To evaluate the effects of postconditioning with enalapril on myocardial injury induced by hind limb ischemia-reperfusion (I/R) in rats.Methods Thirty-six healthy male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 3 groups (n =12 each):group sham operation (group S),group I/R and group enalapril postconditioning (group EP).Limb ischemia was induced by occlusion of bilateral hind limbs for 3 h followed by 3 h reperfusion in groups I/R and EP.At 30 min before reperfusion,enalapril 0.04 mg/kg was injected via the internal jugular vein in group EP,while the equal volume of normal saline was injected in groups S and I/R.The rats were sacrificed at 3 h of repeffusion and myocardial specimens were obtained for microscopic examination of pathologic changes and for determination of cell apoptosis,Bcl-2 and Bax protein expression,superoxide dismutase (SOD) activity and malondialdehyde (MDA) content in myocardial tissues.Apoptosis index was calculated.Results Compared with group S,apoptosis index and MDA content were significantly increased,Bax protein expression was up-regulated,Bcl-2 protein expression was down-regulated,and SOD activity was decreased in groups I/R and EP (P ＜ 0.05).Compared with group I/R,apoptosis index and MDA content were significantly decreased,Bax protein expression was down-regulated,Bcl-2 protein expression was up-regulated,and SOD activity was increased in group EP (P ＜ 0.05).The pathologic changes were significantly attenuated in group EP as compared with group I/R.Conclusion Enalapril postconditioning can attenuate myocardial injury induced by hind limb I/R in rats,and the mechanism may be related to reduction of apoptosis in cardiomyocytes and lipid peroxidation.

Objective To introduce our experience of organ transplant ethics committee in living related kidney transplantation.Methods To introduce the composition,operational procedure of ethics committee of transplantation.Results 45 living related kidney transplantation were inspected and censured before operation by organ transplant ethics committee,40 passed and 5 denied.Conclusion The responsibility of transplant ethics committee is highly important,ethics committee has the responsibility to ensure the safety and interests of both donor and recipient.

Objective To explore the correlation of S100 protein with the prognosis of patients with primary retroperitoneal liposarcoma. Methods Analyzed the clinical data about 108 patients with primary retroperitoneal liposarcoma managed with surgery from January 2009 to June 2014. All patients were followed up. Patients were divided into S100-positive group(58 patients) and S100-negative group (50 patients) according to the immunohistochemical staining results. The overall survival time and all clinical data between two group were compared. Results All patients with primary retroperitoneal liposarcoma received radical surgical resection for the first time. The overall 5-year recurrence rate were 88.9%(96/108), and the median recurrence time was 32.7 months. The 1-year, 2-year, and 5-year recurrence rates of the S100- positive group were 25.9% (15/58), 53.4% (31/58), 96.6% (56/58), respectively, and the median recurrence time were 26.2 mouths. The 1-year, 2-year, and 5-year recurrence rates of the S100-negative group were 10.0%(5/50), 36%(18/50), 80.0%(40/50) and the median recurrence time were 40.0 mouths. Log-rank test showed that S100 protein expression was significantly associated with postoperative recurrence rates (c2=9.931, P=0.002) and survival time (c2=4.571, P = 0.033). The difference between gender, age, removal of the joint organs and tumor size showed no statistical significance on disease special survival (P>0.05). Cox regression analysis showed that S100 protein expression (OR=1.582, 95%CI:1.005-2.491) and histologic subtype (OR=1.531, 95%CI: 1.254-1.870) were independent risk factors of the prognosis of primary retroperitoneal liposarcoma patients. Conclusions S100 protein played a critical role in retroperitoneal liposarcoma carcinogenesis and its expression may be used as a potential survival predictor in patients with primary retroperitoneal liposarcoma.

Objective:To evaluate the safety and efficacy of retroperitoneal laparoscopic nephrectomy with autotransplantation in cases of severe iatrogenic proximal ureteral damage.Methods:From July 2011 to March 2015,two patients,aged 44 (female)and 54 years (male),underwent retroperitoneal laparoscopic nephrectomy and autotransplantation for treatment of severe iatrogenic proximal ureteral inju-ries.Both injuries were proximal ureteral avulsion during ureterolithotomy with the holmium laser for ure-teral calculi.computed tomography angiography (CTA)and computed tomography urography (CTU)was performed in both patients before operation.A 3-port retroperitoneal technique was used for the patients placed in a lateral decubitus position.A retroperitoneal laparoscopic nephrectomy with autotransplantation approach was used in both the patients,and the kidneys were removed to the right iliac fossa.Case 1’s kidney was removed through the right Gibson incision,while Case 2’s kidney was removed through the left lumbar incision.The renal artery and renal vein were ligated using the Hem-o-lok.The kidneys were taken out quickly from the patients and infused with 4 ℃ kidney preserving fluid immediately.Results:The retroperitoneal laparoscopic nephrectomy with autotransplantations was performed 4 hours in Case 1 and 2 years in Case 2 after atrogenic proximal ureteral injuries.Case 2 was associated with dense peri-nephric and perihilar fibrosis.The procedures were successful,with immediate return of renal function in both the patients.After ex vivo graft preparation,ureteral and vessel length and quality were adequate for transplantation in both the cases.A direct ureterovesical anastomosis was performed in both patients.In the 2 patients,the warm ischemia time was 3 and 5 minutes,the total operation time 185 and 246 mi-nutes,and the estimated blood loss 70 and 200 mL,respectively.No perioperative complications oc-curred.At the end of the follow-up,the transplanted kidneys were functional,and the patients had re-turned to their normal activity.Conclusion:Retroperitoneal laparoscopic nephrectomy with autotrans-plantation is an excellent alternative to nephrectomyor bowel interposition in patients with proximal urete-ral loss.This procedure is associated with acceptable morbidity and preserves the renal function.This re-port supports the safety and efficacy of retroperotoneal laparoscopic nephrectomy with autotransplantation in experienced hands.

ObjectiveTo report the methods and clinical efficacy of bridging severed thumbs and fingers with foot joint compound flaps.Methods Ten patients with completely amputated thumbs and fingers with extensive defects in the proximal phalanx had bridged and repaired by using composite-free flap with joints from foot. Three of 4 cases of thumb amputation were repaired by using composite flaps of the second metatarsophalangeal and proximal interphalangeal joints in foot,and the other was used composite flap of the second metatarsophalangeal joints in foot.Donor sites underwent the second metatarsals distal osteotomy associated with free skin graft. And 6 cases with absent fingers by using composite-free flaps of the proximal interphalangeal joint to repair. The donor site in foot underwent metatarsophalangeal and toe joints osteotomy.ResultsAll flaps and replanted thumbs and fingers survived. Hand wounds recovered by primary repair.Donor site in foot all healed by primary repair except for 1 case,which healed after several dressing changes.All 10 cases were followed-up from 6 to 28 months,averaged of 9 months.The metacarpophalangeal joint of 4 replanted thumbs extension between -10° and 0°,and flexion between 20° and 50°.The function of fullfield digital mammography recovered well in 3 replanted thumbs, as well as the function of thumb-middle in the other. Three of them could completely 2-5 fingers tapping,one case could complete middle finger tapping,four cases could complete radial abduction.The proximal interphalangeal joints of 6 replanted fingers extension between -10° and 0°,and flexion between 30° and 90°,averaged of 50°.Sensory recovery of 1 case reached S4,two cases reached S3+,five cases reached S3,and 2 cases of S2.All replanted bones and joints healed after transplantations(bone healing time was 6 to 16 weeks), with no occurrence of re-fracture nor nonunion. Walking function was not significantly affected. According to the evaluation criteria of replanted severed fingers by Chinese Medical Association,one was excellent,eight were good,and 1 was poor.The excellent and good rate was 90％. Conclusion Repairing amputated thumbs and fingers with foot joint compound flaps could not only maximize the recovery of replanted fingers shape,but also get some function,which to meet everyday needs of patients.

Objective To review the clinical characteristics of paraganglioma of the urinary bladder with 5 cases reprt.Methods The clinical data of 5 patients (2 males and 3 females,age 23-68 years)with paraganglioma of the urinary bladder were reported.Two cases were diagnosed by ultrasonography during health examination,1 case was found by hematuria,1 had difficulty of voiding,and 1 presented with palpitation,chest discomfort while urination.Two cases were clinical diagnosed as bladder paraganglioma,1case urachal carcinoma,and 2 cases bladder tumor.Cystoscopy showed a protruding tumor within the bladder or bladder had compressed changes.One case of tumor located in the triangle,1 in the posterior wall,1in the top,2 in the anterior wall.Three cases of biopsy were negative.Three cases of preoperative endocrine examinations showed norepinephrine significantly higher.Results Laparoscopic partial cystectomy was performed in 3 cases,open partial cystectomy in 1 case,and transurethral resection of bladder tumor (TURBT) in 1 case.One case had the complication of stress cardiomyopathy during TURBT,3 cases found intraoperative hypertensive crisis.The bleeding volume was 20-800 ml (average 126 ml),and I case received blood transfusion.During the follow-up period for 3-48 months,the blood pressure was normal,and no recurrence was found.Conclusions Bladder paraganglioma is uncommon and easily misdiagnosed.For the patients with bladder tumor,accompanied by changes in blood pressure,palpitations during urination should be highly suspicious of bladder paraganglioma.Partial cystectomy is the main treatment method.

Objective We report our initial experience with laparoendoscopic single-site surgery (LESS) for radical cystectomy and urinary diversion performed by a single surgeon using homemade singleport device.Methods From December 2010 and April 2011,7 LESS radical cystectomy were performed using a home-made single-port device composed of an inverted cone device of polycarbonate and a powderfree surgical glove.7 patients were all male,mean age was 66 (54-81) years and mean BMI (Body mass index) was 23.1 (20.9-25.3) kg/m2.The port was placed into a 5 cm periumbilical skin incision.The conventional laparoscope and laparoscopic instruments were inserted through the single-port.No additional ports were needed for radical cystectomy and bilateral standard pelvic lymphadenectomy.Cutaneous ureterostomy (3 cases) and ileal conduit urinary diversion (4 cases) were used for patients.Operative time,estimated blood loss,postoperative recovering time,oncologic data and complications were collected and analyzed.Results All the procedures were completed successfully.The mean operative time was 210.1 (155-280) minutes.The estimated blood loss was 300 (100-500) ml.The bowel recovering time 8 (4-12) days and postoperative hospital stay was 20 (13-34) days.One patient required a transfusion of 400 ml red blood cells.The pathologic evaluation revealed that there were one case of pT1N0M0,two of pT2aN0M0,two of pT2bN0M0 and two of pT3aN0M0.The high grade tumor in 4 cases and low grade in 3 cases.The surgical margins were negative in all the patients.All patients were node negative.After the operations,one case had a small bowel obstruction after three days and was treated by abrosia,fluid infusion and gastrointestinal decompression.Another patient died of cardiac disease at first day postoperative.Conclusions In our experience,LESS for radical cystectomy could be clinically feasible for selected patients,but it requires the learning curve.