Objective:To investigate the feasibility of combination of en-bloc resection of bladder tumor (ERBT) with the NBI(narrow band imaging) flexible cystoscopy, immunotherapy and chemotherapy in bladder-preserving treatments(called as TMT) for patients with stage T 2 bladder carcinoma. Methods:We retrospectively reviewed and analyzed a series of 16 patients with pT 2N 0M 0 pathologically confirmed. All patients are male with a median age of 63yr(56, 73yr). The American Association of Anesthesiologists scored ≤Ⅱ in 12 cases and Ⅲ in 4 cases. There were 9 cases with smoking history, 5 cases with hypertension, 3 cases with diabetes, and 2 cases with heart disease. The results of preoperative tissue biopsy were all urothelial carcinoma. All patients were taken lithotomy position and performed ERBT with NBI imaging technique and thulium-laser energy platform under general anesthesia. The tumor was brown and the surrounding normal mucosa was cyan in color. The procedure was ensured with a minimal tumor margin of 1cm and minimal rection depth to the deep musculi, and with the acquirement for the en-bloc specimen of which the basal site was marked afterwards, the patients all took a full length of chemoimmunotherapy (four cycles of Tislelizumab combined with Gemcitabine and cisplatin regimens) followed by a secondary ERBT. The perioperative data from sequential operations including complications were comprehensively analyzed for evaluating the therapeutic outcome and safety. All patients received a follow-up to detect efficacy and safety of the treatment with the primary end point of pCR, downgrading rate and objective response rate. Results:All operations were successfully completed. There was no obturator reflex, severe bleeding or grade Ⅱ bladder perforation, only 4 patients got a grade Ⅰ bladder perforation. The postoperative 30-day complication occured in 2 cases(1 pt with hematuresis, 1 pt with bladder irritation). The pathologic complete response rate and tumor downstaging rate were 100%. One patient recurred during a median follow-up of 13.0 months (6, 36 months).Conclusions:The En Bloc Resection of Bladder Tumor with the narrow band imaging (NBI) flexible cystoscopy has several remarkable advantages, including a better intra-operative visual, a lower complication rate and tumor residual. The combination of ERBT with immunotherapy and chemotherapy lead to affirmative curative effect and the feasibility for clinical application is relatively high.

Objective:To evaluate the efficacy and safety of endoscopic biliary drainage for biliary fistula.Methods:Data of consecutive 409 biliary fistula patients who were treated and diagnosed at the First Medical Center of Chinese PLA General Hospital from November 2002 to November 2022 were reviewed, and 53 patients who received endoscopic retrograde cholangiopancreatography (ERCP) drainage were finally included. General information, procedural conditions, clinical outcomes and adverse events were analyzed. The patients were categorized into two groups: the endoscopic retrograde biliary drainage (ERBD) group ( n=46) and the endoscopic nasobiliary drainage (ENBD) group ( n=7). Procedural characteristics, operation outcomes, and operation time were compared between the two groups. Results:There were 36 males and 17 females, with the age of 52.2±12.7 years, among whom 58.5% (31/53) were secondary to cholecystectomy. Clinical success was achieved in 83.0% (44/53) patients, with the operation time of 27.0 (13.5, 33.5) minutes and the treatment session of 1 (1, 2). The time to resolution was 89 (47, 161) days. The success rate of ERCP for low-grade biliary fistula was higher compared with that of high-grade biliary fistula [96.4% (27/28) VS 68.0% (17/25), χ2=7.57, P=0.006]. Bridging drainage achieved higher success rate compared with that of non-bridging drainage [91.7% (33/36) VS 64.7% (11/17), χ2=5.95, P=0.015], while different diameters of stents (≥10 Fr VS <10 Fr) achieved similar success rate [81.8% (27/33) VS 84.6% (11/13), χ2=0.05, P=0.822]. Adverse events occurred in 10 patients (18.9%), including 6 pancreatitis, 2 bleeding, 1 cholangitis and 1 death. Except for 1 death, 9 other adverse events were mild and managed with conservative treatment without interventions. There was no significant difference in clinical success rate [6/7 VS 82.6% (38/46), χ2=0.04, P=0.838] or the median operation time [28.0 min VS 23.0 min, Z=0.38, P=0.774] between ENBD group and ERBD group. Conclusion:Endoscopic biliary drainage is safe and effective for biliary fistula. ENBD and ERBD have comparable clinical efficacy. ERCP for low-grade biliary fistula may achieve a higher success rate, and bridging drainage may facilitate fistula resolution.

Objective:To explore the clinical feasibility of extra-peritoneal laparoscopic radical cystectomy based on the concept of 3D membrane anatomy.Methods:The clinical data of 10 male patients with bladder cancer who underwent 3D extra-peritoneal laparoscopic radical cystectomy + ileal-orthotopic-neobladder surgery from October 2020 to June 2021 were retrospectively analyzed. The median age was 67 years. The ASA score was 1-2 in 8 cases and 3 in 2 cases. There were 4 cases of hypertension, 2 cases of diabetes, 1 case of heart disease, no case of abdominal surgery history. During the operation, the concept of 3D membrane anatomy was used to identify the important fascia in the pelvic cavity and to find the key layers and structures in the pelvic cavity.It was separated from the prevesical fascia to the laterovesical space, and confluenced with Retzius space and Bogros space. It was dissected in the layer surrounded by the prevesical fascia, the vesicohypogastric fascia, and the urogenital fascia to complete the process of cystectomy.Results:The operations of 10 patients were completed successfully and there was no conversion to open operation. The median operation time was 276(237-325) minutes, and the median blood loss was 160(50-280)ml. The postoperative bowel recovery median time was 1.8(1-3)days, and the patients were out of bed about 1.3(1-2) days. The median postoperative hospital stay was 9(5-12) days. The number of median lymph node dissection in all patients was 10(6-20). Positive lymph nodes was found in 3 cases. Positive margin was found in no case. Postoperative tumor pathological stages were T 2 stage in 7 cases, T 3 stage in 3 cases. During the follow-up, all patients had no obvious complications. Conclusions:It is feasible to apply the concept of 3D membrane anatomy to identify and locate the key fascia structures and levels in extra-peritoneal laparoscopic radical cystectomy. The operative complications were less and the postoperative recovery was faster. The anatomy is clear during the operation, which has good safety and reduces the difficulty of the operation.

Objective:To discuss the feasibility and clinical efficacy of laparoscopic ureteroplasty with buccal mucosa graft for ureteral stricture.Methods:The clinical data of 10 patients with ureteral stricture admitted to the Second Affiliated Hospital of Anhui Medical University from July 2018 to November 2019 were retrospectively analyzed, including 7 males, 3 females, 5 cases on each side, with an average age of (47.9±7.8)years. All patients had a history of operation related to ureteral calculi. The median value of preoperative serum creatinine was 71(68~610)μmol/L. The status of hydronephrosis and ureteral stricture was evaluated by ultrasonography, CTU and ureteral retrograde angiography.The separation of the renal pelvis on the affected side was (3.1±0.7)cm.There were 7 cases of upper segment stenosis, 2 cases of middle segment stenosis, and 1 case of multiple stenosis. The length of ureteral stenosis was (3.2±0.7)cm. Laparoscopic buccal mucosa ureteroplasty was performed in all 10 cases under general anesthesia. After the stricture ureter segment was separated during the operation, the ureteral stenosis segment was longitudinally cut. According to the stenosis, the buccal mucosa with a length of 3.0-4.5 cm and a width of 1.0-1.5 cm was cut. Buccal mucosa grafts were harvested and placed in the ureter as an anterior onlay with omental wrapping.Results:Ureteral repair was performed laparoscopically in all cases, with no conversion to open and no serious complications. The operative time was (199.2±27.4)min, the blood loss was (101.5±54.7)ml, the median postoperative indwelling time of the drainage tube was 4.5(3.0-7.0)d, and the postoperative hospital stay was (7.9±1.9)days. The patients had clear pronunciation and barrier-free eating one week after the operation.The double J tube was removed one to two months after surgery. The patients were followed up for (11.3±4.2)months after the operation. Follow-up patients underwent imaging and other examinations, which showed significant improvement in hydronephrosis on the affected side, and the median value of renal pelvis separation on the affected side was 1.8(0-2.2)cm. The median value of serum creatinine was 82(66~235)μmol/L. The serum creatinine in 2 patients with renal insufficiency decreased significantly after operation.Conclusions:Laparoscopic buccal mucosa graft ureteroplasty could be a safe and feasible option for the treatment of ureteral stricture with less trauma and rapid recovery. The results of the initial experience are encouraging.

Objective:To evaluate the therapeutic effect of radiofrequency ablation in the treatment of severe hemangioma with thrombocytopenia and coagulation abnormality (Kasabach-Merritt phenomenon, KMP).Methods:From April 2018 to April 2021, 11 cases of KMP in our department were retrospectively analyzed. The patients underwent MRI, color ultrasound and hematology examination. Radiofrequency ablation was performed for all patients under general anesthesia. The comprehensive, multi-level and multi-point ablation was accurately implemented under the whole-process intraoperative monitoring of color ultrasound. Postoperative ice pad was applied for the treatment area, and dressing change was carried out every day.Results:All 11 cases of KMP were treated with radiofrequency ablation, including 5 males and 6 females, aged 1 d to 2 months, with a median age of 15 d. Intraoperative color Doppler ultrasound monitoring showed that the tumor was completely ablated in the single operation. All patients were followed up for 0.5 to 2 years. The tumor was cured without recurrence. The local function was unaffected. The local scar formation was mild and the appearance was satisfactory.Conclusions:Radiofrequency ablation has great clinical value in the treatment of KMP. It makes up the shortcomings and avoids the disadvantages of traditional surgery and other conservative treatment methods. Good clinical results can be achieved by radiofrequence ablation with satifactory function and appearance.

Objective:To investigate the outcomes of therapeutic radiofrequency ablation (RFA) in unilateral intra-articular venous malformations (IAVMs) of the knee.Methods:The clinical data of 15 patients with intravascular venous malformation in the Third Affiliated Hospital of Zhengzhou University from February 2018 to May 2019 were retrospectively analyzed. There were 7 males and 8 females with an average age of 16 years (range, 5—25 years). All patients had unilateral knee involvement, ranging from localized lesions to diffuse extensive lesions. The radiofrequency ablation electrode needle with a diameter of 0.5 mm was selected and the power was adjusted to 25 W. Under the guidance of color ultrasound monitoring, the whole operation was carried out. The RFA electrode needle was inserted into the deepest site of the lesion and extracted by 1-mm graded movements until a point 1 mm from the surface of the lesion. Each ablation point was ablated for 10 to 30 seconds and multi-point ablation was done until the lesions were completely eliminated. Patients were followed up for 6 months to 1 year. Treatment outcomes were evaluated by functional activity, including extension, flexion, abduction, and adduction at the knee joint, and MRI findings, including intensity, shape, boundary, and degree of aggressiveness in the intra- and extraarticular cavities.Results:Included 15 patients; 12 had VMs in the knee joint cavity, and 3 had VMs involving both the intraarticular and extraarticular cavities (1 from the joint cavity to the calf, 1 from the joint cavity to the lower femur, and 1 from the intraarticular to the extraarticular cavity). All subjects underwent RFA, and the lesions were completely ablated and eradicated in a single operation. No recurrence was reported in the 6 months to 1 year follow-up. The knee joint remained symmetrical with the contralateral knee joint, without scarring, after the RFA.Conclusions:Radiofrequency ablation for the treatment of intra-articular venous malformation of the knee joint is a valuable minimally invasive surgical method with complete ablation, no complications, good prognosis and aesthetic appearance.

Objective:To evaluate the therapeutic effect of radiofrequency ablation in the treatment of severe hemangioma with thrombocytopenia and coagulation abnormality (Kasabach-Merritt phenomenon, KMP).Methods:From April 2018 to April 2021, 11 cases of KMP in our department were retrospectively analyzed. The patients underwent MRI, color ultrasound and hematology examination. Radiofrequency ablation was performed for all patients under general anesthesia. The comprehensive, multi-level and multi-point ablation was accurately implemented under the whole-process intraoperative monitoring of color ultrasound. Postoperative ice pad was applied for the treatment area, and dressing change was carried out every day.Results:All 11 cases of KMP were treated with radiofrequency ablation, including 5 males and 6 females, aged 1 d to 2 months, with a median age of 15 d. Intraoperative color Doppler ultrasound monitoring showed that the tumor was completely ablated in the single operation. All patients were followed up for 0.5 to 2 years. The tumor was cured without recurrence. The local function was unaffected. The local scar formation was mild and the appearance was satisfactory.Conclusions:Radiofrequency ablation has great clinical value in the treatment of KMP. It makes up the shortcomings and avoids the disadvantages of traditional surgery and other conservative treatment methods. Good clinical results can be achieved by radiofrequence ablation with satifactory function and appearance.

Objective:To investigate the outcomes of therapeutic radiofrequency ablation (RFA) in unilateral intra-articular venous malformations (IAVMs) of the knee.Methods:The clinical data of 15 patients with intravascular venous malformation in the Third Affiliated Hospital of Zhengzhou University from February 2018 to May 2019 were retrospectively analyzed. There were 7 males and 8 females with an average age of 16 years (range, 5—25 years). All patients had unilateral knee involvement, ranging from localized lesions to diffuse extensive lesions. The radiofrequency ablation electrode needle with a diameter of 0.5 mm was selected and the power was adjusted to 25 W. Under the guidance of color ultrasound monitoring, the whole operation was carried out. The RFA electrode needle was inserted into the deepest site of the lesion and extracted by 1-mm graded movements until a point 1 mm from the surface of the lesion. Each ablation point was ablated for 10 to 30 seconds and multi-point ablation was done until the lesions were completely eliminated. Patients were followed up for 6 months to 1 year. Treatment outcomes were evaluated by functional activity, including extension, flexion, abduction, and adduction at the knee joint, and MRI findings, including intensity, shape, boundary, and degree of aggressiveness in the intra- and extraarticular cavities.Results:Included 15 patients; 12 had VMs in the knee joint cavity, and 3 had VMs involving both the intraarticular and extraarticular cavities (1 from the joint cavity to the calf, 1 from the joint cavity to the lower femur, and 1 from the intraarticular to the extraarticular cavity). All subjects underwent RFA, and the lesions were completely ablated and eradicated in a single operation. No recurrence was reported in the 6 months to 1 year follow-up. The knee joint remained symmetrical with the contralateral knee joint, without scarring, after the RFA.Conclusions:Radiofrequency ablation for the treatment of intra-articular venous malformation of the knee joint is a valuable minimally invasive surgical method with complete ablation, no complications, good prognosis and aesthetic appearance.

Objective:To investigate the effect of radiofrequency ablation in the treatment of severe tongue′s lymphatic vascular malformation, and evaluate the value and aesthetics of the operation.Methods:The 33 cases′ data of lingual lymphatic vascular malformation from February 2018 to February 2019 in Department of Hemangioma Surgery of Third Affiliated Hospital of Zhengzhou University were analyzed retrospectively. There were 18 males and 15 females, aged from 1 month to 50 years old, with a median age of 5 years. From unilateral lesions to diffuse and extensive lesions, 33 of them received radiofrequency ablation.24 cases were unilateral and 9 cases were bilateral. 18G radiofrequency ablation needle was selectedwithworking tip diameter of 1mm and heating 5 mm tip , and the power was adjusted to 25 W. Monitoring by color Doppler ultrasound, the working tip was inserted into the bottom of the lesion part which is about 1 mm from the deepest part. The ablation was performed for 5-20 s after being electrified. Then the electrode needle was withdrawn 1 mm in turn until it was 1 mm from the lesion surface, and respectively performed multi-point ablation withinterval of 5 mm.Results:One-stage radiofrequency ablation was performed in 24 patients with unilateral lesions and 9 patients with bilateral lesions. One-stage radiofrequency ablation was performed in one side of the lesions. After three to six months later, two-stage radiofrequency ablation was performed in most of the lesions. 33 cases were followed up from 6 months to 2 years.18 cases of unilateral lesions and 6 cases of bilateral lesions had no recurrence, and the tongue was symmetrical on both sides; 9 cases of full-thickness involvement of the tongue (6 cases on one side and 3 cases on both sides) had a small amount of lesions near the lingual artery, which were asymptomatic, nearly cured, without obvious scars, and satisfactory in appearance.Conclusions:Radiofrequency ablation is an important supplement for the treatment of lingual lymphatic vascular malformation, which makes up for the shortcomings of traditional surgery. Clinically, it can primarily achieve the treatment′s goal, with unobvious complication and aesthetical outcome.

Objective:To investigate the effect of radiofrequency ablation in the treatment of severe tongue′s lymphatic vascular malformation, and evaluate the value and aesthetics of the operation.Methods:The 33 cases′ data of lingual lymphatic vascular malformation from February 2018 to February 2019 in Department of Hemangioma Surgery of Third Affiliated Hospital of Zhengzhou University were analyzed retrospectively. There were 18 males and 15 females, aged from 1 month to 50 years old, with a median age of 5 years. From unilateral lesions to diffuse and extensive lesions, 33 of them received radiofrequency ablation.24 cases were unilateral and 9 cases were bilateral. 18G radiofrequency ablation needle was selectedwithworking tip diameter of 1mm and heating 5 mm tip , and the power was adjusted to 25 W. Monitoring by color Doppler ultrasound, the working tip was inserted into the bottom of the lesion part which is about 1 mm from the deepest part. The ablation was performed for 5-20 s after being electrified. Then the electrode needle was withdrawn 1 mm in turn until it was 1 mm from the lesion surface, and respectively performed multi-point ablation withinterval of 5 mm.Results:One-stage radiofrequency ablation was performed in 24 patients with unilateral lesions and 9 patients with bilateral lesions. One-stage radiofrequency ablation was performed in one side of the lesions. After three to six months later, two-stage radiofrequency ablation was performed in most of the lesions. 33 cases were followed up from 6 months to 2 years.18 cases of unilateral lesions and 6 cases of bilateral lesions had no recurrence, and the tongue was symmetrical on both sides; 9 cases of full-thickness involvement of the tongue (6 cases on one side and 3 cases on both sides) had a small amount of lesions near the lingual artery, which were asymptomatic, nearly cured, without obvious scars, and satisfactory in appearance.Conclusions:Radiofrequency ablation is an important supplement for the treatment of lingual lymphatic vascular malformation, which makes up for the shortcomings of traditional surgery. Clinically, it can primarily achieve the treatment′s goal, with unobvious complication and aesthetical outcome.