Objective:To retrospectively analyze and summarize the clinical experience and therapeutic effect of anterograde Needle-perc combined with RIRS, namely N+ R (Needle perc + RIRS) technique in the treatment of complex calyceal diverticular stone.Methods:Retrospective analysis of 23 cases of complex renal caliceal diverticulum stones admitted to our hospital from January 2020 to December 2022. The complex factors mainly include the invisible cervical orifice of diverticulum, large stone volume, and special anatomical location, which makes single RIRS or PCNL treatment difficult or unsuccessful. There were 14 males and 9 females with an average age of (42.3±6.1) years. Three cases were upper calyceal diverticular stone, average size was (0.9±0.2)cm. Nine patients had diverticular stone in the middle posterior calyx, and the average size was (1.2±0.3)cm. The average size of four diverticular stone was (1.8±0.2)cm in the anterior middle calyx. Seven patients had diverticular stone with an average size of (1.3±0.1)cm in lower calyx. Among them, 12 patients underwent RIRS which were difficult or stone undiscovered, and 3 patients underwent PCNL and the operation was terminated due to failure of channel establishment. In our center, oblique supine lithotomy position (male) or prone split-leg position (female) was adopted, and the combined treatment of Needle-perc and RIRS was performed. Needle-perc puncture was completed under the guidance of full ultrasound. During the operation, methylene blue reagent or mutual guidance of two endoscopes was used to find the diverticulum neck and expand the outlet with holmium laser incision. Depending on the size and location of the stones, a single Needle-perc laser lithotripsy combined with stone removal in flexible ureteroscope was used, or dual lasers were be used simultaneously for stone removal under double endoscopes. The first stage stone free rate, operation time, hemoglobin decrease, complications, postoperative hospital stay and other conditions were analyzed.Results:All the 23 operations were completed successfully. The stone free rate within 48 hours and one month after surgery was 78.2% and 100.0% respectively. The average operation time was (61.5±12.2)min. The mean postoperative hospital stay was (2.8±0.6) days. The mean decrease of hemoglobin was (3.6±0.4)g/L. Three patients had fever and one patient had renal subcapsular effusion. After anti-inflammatory and symptomatic treatment, the patient was discharged. There was no incidence of Clavien-Dindo≥Ⅱcomplications such as blood transfusion, abdominal organ injury or urosepsis.Conclusions:Treatment of complex renal caliceal diverticulum stones using N+ R technique of anterograde needle-perc combined with RIRS can effectively improve the success rate of first-stage surgery. Overall, it is safe, efficient and feasible with the advantages of high stone free rate, lower damage, and few postoperative complications.

Objective:To investigate the impact of age,various hormonal levels,and biochemical markers on penile cavernous body vascular function in patients with erectile dysfunction(ED).Me-thods:A retrospective analysis of clinical data from male patients with ED who underwent color duplex Doppler ultrasonography(CDDU)and intracavernosal injection test(ICI)at the Reproductive Medicine Center of Peking University Third Hospital from January 2020 to August 2023.Data were managed and processed using SPSS 29.0,and a multivariable Logistic regression analysis was conducted.Results:A total of 700 ED patients were included,with 380 showing negative ICI results and 320 positive.In the study,84 patients had a peak systolic velocity(PSV)＜25 cm/s,while 616 had PSV ≥ 25 cm/s;202 patients had end-diastolic velocity(EDV)＞5 cm/s,and 498 had EDV ≤5 cm/s.264 patients had ab-normal PSV and/or EDV results,and 436 had normal results for both.Patients with vascular ED had sig-nificantly lower estrogen levels(t=-3.546,P＜0.001),lower testosterone levels(t=-2.089,P=0.037),and a higher rate of hyperglycemia(x2=12.772,P=0.002)compared with those with non-vascular ED.The patients with arterial ED were older(t=3.953,P＜0.001),had a higher rate of hyperglycemia(x2=9.518,P=0.009),and a higher estrogen/testosterone ratio(t=2.330,P=0.020)compared with those with non-arterial ED.The patients with mixed arteriovenous ED had higher age(t=3.567,P＜0.001),lower testosterone levels(t=-2.288,P=0.022),a higher rate of hyperglycemia(x2=12.877,P=0.002),and a larger estrogen/testosterone ratio(t=2.096,P=0.037)compared with those with normal findings.Multifactorial Logistic regression analysis indicated that higher levels of estrogen were a protective factor for vascular ED(OR=1.009,95％CI:1.004-1.014),and glucose 7.0 mmol/L was a risk factor(OR=0.381,95％CI:0.219-0.661).Older age was a risk factor for arte-rial ED(OR=0.960,95％CI:0.938-0.982).Additionally,older age(OR=0.976,95％CI:0.958-0.993)and glucose levels of 5.6-6.9 mmol/L(OR=0.591,95％CI:0.399-0.876)were also risk fac-tors for mixed arterio-venous ED.Conclusion:Hyperglycemia and aging may impair penile cavernous body vascular function,while higher levels of estrogen may have a protective effect on it.

Objective:To study the risk factors of intra-abdominal infection after hepatectomy in patients with primary liver neoplasms.Methods:The clinical data of patients with primary liver neoplasms who underwent hepatectomy at the Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2019 to December 2021 were retrospectively analyzed. Of 1 229 patients who were enrolled, 48 patients developed postoperative abdominal infection. There were 45 males and 3 females, with age of 58.0 (45.0, 66.0) years old in the infected group. Forth-eight patients without postoperative abdominal infection were selected based on the random number formula to be allocated to the uninfected group to include 44 males and 4 females with age of 58.5 (48.5, 64.8) years old. The general data, preoperative and postoperative laboratory test results, types of liver neoplasms and hepatectomy, pathogenic infective microorganisms and their drug sensitivity tests were collected. Univariate analysis was used to analyze the related factors of intra-abdominal infection after hepatectomy, and significant factors were included in logistic multivariate regression analysis.Results:Of 24 pathogenic strains which were detected in the 143 samples of abdominal infection, the positive rate of culture was 16.78%(24/143). Multivariate logistic regression analysis showed that prealbumin <180 mg/L ( OR=3.757, 95% CI: 1.117-12.634), intraoperative blood transfusion ( OR=6.363, 95% CI: 1.301-31.113) and the time of drainage tube placement ≥7 d ( OR=31.098, 95% CI: 6.906~140.029) were independent risk factors of intra-abdominal infection after hepatectomy. Conclusion:Prealbumin <180 mg/L, intraoperative blood transfusion and the time of drainage tube placement ≥7 d were independent risk factors of intra-abdominal infection after hepatectomy for primary liver neoplasms.

Objective:To summarize the preliminary clinical experience of endoscopic treatment of upper urinary tract urothelial carcinoma, and to analyze its indications and efficacy.Methods:The clinical data of 14 patients underwent endoscopic treatment for upper urinary tract urothelial carcinoma in our hospital from December 2014 to December 2019 were retrospectively analyzed. Among them, there were 5 males and 9 females, with a median age of 75.5(44-84) years. There were 11 patients with hematuria, 2 patients with flank pain and one asymptomatic patient. Five patients had a history of bladder cancer and one had a history of contralateral UTUC. There were 4 patients with solitary kidney, 3 patients with renal insufficiency, 1 patient with bilateral renal pelvis carcinoma, 4 patients prohibitory to nephroureterectomy because of poor general condition (American Society of Anesthesiologists score ≥3), and 2 patients were pathologically diagnosed as low-grade non-invasive urothelial carcinoma and requested renal preservation therapy. A total of 15 renal units included. The main tumor sites were renal pelvis in 6 renal units, upper calyx in 4 renal units, middle calyx in 3 renal units, and lower calyx in 2 renal units. The median tumor diameter was 2.0 (0.8-4.0) cm. All patients were diagnosed with urothelial carcinoma by preoperative computed tomography (CT/CTU), magnetic resonance imaging (MRI), and cytological or pathological biopsy. In 13 patients, ultrasond-guided percutaneous renal access and tract dilation were performed to establish a F24 standard tract. The tumor tissues were vaporized by 1470 semiconductor laser (60-80 W) or thulium laser (15-20 W) under nephroscopy, and electrocoagulation was used to coagulate the bleeding when necessary. Two patients were treated with felxible ureteroscope, under which tumor ablation was performed with 200 μm holmium laser fiber, and neodymium laser was used for hemostasis. The range of tumor vaporization ablation included 0.5-1.0 cm normal renal pelvis mucosa around the tumor, deep to the fatty layer of renal sinus. Biopsy was taken again at the base of the wound after vaporization ablation when necessary.Results:In this study, six sites were pathological high grade, 9 sites were pathological low grade tumors. Eight were in pathological T a stage, 5 in T 1 stage, and 2 in T 2 stage. The median blood loss was 20.0 (2-50) ml. There were 5 postoperative complications, including one patient with fever (body temperature >38.5℃) and 4 patients with hemorrhage requiring blood transfusion (postoperative hemoglobin <70 g/L) with 2-4 U suspended red blood cells.No patient underwent embolization. The median follow-up time were 31(11-70)months. Ten patients experienced recurrence, and the median time to recurrence was 11.3 (4-41) months. Four of them received conservative treatment after recurrence, including immunotherapy and radiotherapy in 1 patient, systemic chemotherapy in 1 patient, and watchful waiting in 2 patients. Three of them received repeated endoscopic treatment after recurrence, including 2 patients with percutaneous nephroscopic laser ablation and 1 patient with transurethral resection of bladder tumor, all of them survived during the follow-up period. Three patients underwent full-length nephroureterectomy after recurrence, 2 died and 1 survived during the follow-up period. Six patients eventually died, and the median time of death after surgery was 21(9-33) months. Five of them died from tumor-specific death and one died from gastric perforation. The median tumor-free survival interval were11 (4-41) months during the follow-up period. The 2-year tumor-specific survival rate was 78.6%, 50% for high-grade patients and 100% for low-grade patients. Conclusions:In patients who were in early stage (≤T 2) and intolerant to the nephroureterectomy, or with solitary kidney, renal insufficiency, or bilateral tumors, endoscopic treatment could be used as an alternative treatment approach for upper urinary tract epithelial carcinoma, especially for low-grade non-invasive patients.

Objective: To summarize our preliminary clinical experience of ultrasound-guided needle-perc combined with standard percutaneous nephrolithotomy (PCNL) in the treatment of staghorn stones, and to analyze its safety and efficacy. Methods: The clinical data of 65 patients with staghorn stones treated by ultrasound-guided needle-perc combined with standard PCNL under general anesthesia with the patient in prone position from December 2017 to June 2019 were retrospectively reviewed. A total of 41 males and 24 females were included. The mean age was (53.5+ 8.9) years. The mean body mass index (BMI) was (25.1±2.9) kg/m², and the mean stone diameter was (10.9±3.1) cm. Among them, there were 3 cases with bilateral staghorn stones, 38 cases with complete staghorn calculi, 36 cases with non- or mild preoperative hydronephrosis, 12 cases with previous ipsilateral renal surgery, and 9 cases with solitary kidneys. Ultrasound-guided renal access and tract dilation were used to establish F24 standard channel. Pneumatic combined with ultrasonic lithotripsy with suction system was used to treat staghorn stones under nephroscope. Needle-perc consists of F4.2 needle-like metal sheath connected with a three-way tube. A 0.6 mm diameter video fiber, 200 um holmium laser fiber and liquid perfusion device can be connected through the three-way tube respectively. The residual stone in the parallel calyx after standard PCNL were punctured by needle-perc under ultrasound guidance, and then the holmium laser fiber was used for lithotripsy. Results: In this study, a total of 68 renal units were included. The median operative time was 79.8 minutes, ranging 45-129 minutes. The median decrease of hemoglobin on postoperative day 1 was 10.6 g/L, ranging 0-25.9 g/L. The median length of postoperative hospital stay was 5.5 days, ranging 4-7 days and the median time of tract establishment was 4.8 minutes, ranging 2.5-9.6 minutes. The median number of standard tract established was 1.5, ranging 1-3 and the median number of needle-perc punctured was 1.0, ranging 1-3. The total complication rate was 10.3% (7 cases), including 5 cases of Clavien grade Ⅰ, 2 cases of postoperative fever, 3 cases of analgesic use. There were 2 cases of Clavien grade Ⅱ. All of them were blood transfusion. The initial stone free rate was 79.4%(54/68). Of the 14 patients with residual stones, 9 patients underwent second-stage operation, 7 patients were stone free, and the final stone free rate was 89.7%(61/68). Conclusions Ultrasound-guided needle-perc combined with standard PCNL is safe and effective in the treatment of staghorn stone.

Objective To investigate the feasibility of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL),and the risk factors for its failure.Methods A retrospective study was conducted on patients underwent PCNL with only one access (F24) using balloon dilator and sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to December 2018 in Beijing Tsinghua Changgung Hospital.A total of 231 patients (130 males and 101 females) underwent ultrasound-guided PCNL with a mean age of (52.3 ± 9.8) years were included in our study.Mean BMI was (25.8 ± 3.1) kg/m2.Mean size of stone was (3.9 ± 1.1)cm,51.1％ (118/231) of which were staghorn stones.Under ultrasound guidance,after puncture of the target calyx,the balloon dilator was advanced through the guide wire,and inflated to establish the F24 standard renal access.Patients' clinical parameters such as age,gender,BMI,stone diameter,history of open nephrolithotomy were collected.Risk factors for the failure of ultrasound guided balloon dilation were analyzed by logistic regression analysis.Results Tract dilation succeed in 89.2 ％ cases (206 succeed,25 failed) at first attempt.Median tract dilation time was 4.2 min (2.2-8.0 min).Mean operation time was 85.5 min(45.0-120.0 min).Median hemoglobin drop at the first postoperative day was 16.0 g/L (5.0-25.8 g/L).The total rate of complication was 9.1％ (21 cases),including 18 cases Clavien Ⅰ and 3 cases Clavien Ⅱ.The stone free rate was 89.6％ (207/231).Logistic regression analysis revealed that lower pole access (P =0.014) was a risk factor for the failure of access establishment,while the presence of hydronephrosis of target calyx (P ＜ 0.001) would significantly increase the success rate.Conclusions Tract dilation using balloon catheter can be safely monitored by ultrasound with high success rate and low complication rate.Lower pole puncture will make tract establishment difficulty.Patients with a hydronephrotic target calyx are more suitable for this procedure.

Objective To describe and introduce the initial clinical application of a novel instrument needle-perc for percutaneous nephrolithotomy (PCNL) in upper urinary tract stones.Methods 24 patients with upper urinary stone treated by PCNL were collected retrospectively between August 2017 and January 2018.Sixteen patients were male and 8 were female.Average age was 41.2 years,ranging 26-65 years.Eight cases had upper pole stones,6 cases had pelvic stones,8 cases had lower pole stones and 4 cases had the stone in UPJ.The mean calculus size was 1.2 cm,ranging 0.5-1.4 cm.All patients were punctured under total ultrasound with needle-perc.Six cases had upper calyceal puncture,10 cases had middle calyceal puncture and 8 cases had lower calyceal puncture.The needle-shaped nephroscope consists of a puncture sheath and a needle handle.The puncture sheath is a hollow metal sheath with an outer diameter of F4.2,an inner diameter of F3.6,and a length of 15 cm.The tip of the sheath is beveled to facilitate puncture.The outer end of sheath is connected to the needle handle through a screw interface.And the three interfaces of the three-way tube can be respectively connected with a liquid irrigation device,a video optical fiber and a 200 μm holmium laser fiber.The needle-perc integrated image system,the irrigation system,and the nephroscope channel are integrated.The tissue passing through the needle can be simultaneously observed through video optical fiber during puncturing.After the tip of the sheath is inserted into the target calyx,the holmium laser fiber is connected for fragmenting or dusting.Results Needle-perc was successful in 22 cases,2 patients were converted to larger tract(F16).The mean opeartive time was 49.2 min,ranging 22-75 min and the mean hemoglobin loss was 5.2 g/L,ranging 0-13.8 g/L.Mean postoperative hospital stay was 3 days,ranging 1 to 6 days.No Double-J stents or nephrostomy tube was placed in the 22 patients.Complications (Clavien Ⅱ) occurred in 4 cases,including fever in 2 cases and renal colic in 2 cases.Plain film of KUB or CT scan was done and stone free rate at 1 month was 90.9％ (20/22),2 patients needed ESWL to remove the residual stones.Conclusions Needle-perc is efficient and safe for small renal stones (size ＜ 1.5 cm) from our initial experience,with high stone-free rate and low complication rate in early follow-up.

Objective To improvethe control of infection source by improving the continuous quality of sputum disposal management. Methods PDCA method based on the management of tuberculosis sputum disposal of the hospital quality improvement. The cross-sectional survey of tuberculosis ward in 32 cases of hospital patients, as control group.PDCA first round of "sputum cup distribution and use of work flow" for quality improvement,the reason leading the work flow of workers to nurse led work flow,the improved cross-sectional survey in 36 cases of hospital patients as experimental group 1.Aiming at the problem of low utilization rate of special sputum cup in the improvement of the first round of PDCA,the improvement of the sputum cup was carried out,On this basis, the "special sputum disposal Cup" was designed to obtain the national patent authorization. After the second round of improvement, the cross-sectional investigation in 35 patients in the hospital,as the experimental group 2.Results After two rounds of PDCA improvement,experimental group 2 groups compared with control,bedside sputum cup configuration was not in place rate decreased from 53.1% (17/32)to 0,the difference was statistically significant(Χ2=24.916,P<0.05);configuration after the sputum cup unused rate from 53.1%(17/32)down to 8.6%(3/35),the difference was statistically significant(Χ2=15.846,P<0.05).Conclusion PDCA method can improve the quality of management standard sputum disposal. Ward sputum cup ration is standardized sputum disinfection ward-based nurse intervention and leading sputum cup release, ward can improve the sputum cup ration, improved sputum containers (sputum cup) can improve patient compliance standard of spitting.

Objective To explore the safety and efficacy of fusion imaging technique and traditional ultrasound guidance in percutaneous nephrolithotomy,and to compare the difference of two methods for PCNL.Methods Patients with renal calculus,who underwent percutaneous nephrolithotomy from January 2016 to August 2016,were enrolled in the study.The patients were randomly divided into two groups by SAS software.The control group was treated with traditional ultrasound guided puncture technique (Ultrasound group).Experimental group was treated with fusion imaging method (CT-US group).Preoperative patient CT image data was uploaded to the image fusion ultrasound machine for data synchronization.Both groups used the same way to establish a standard channel (F24).Lithoclast system from EMS was used to remove stones.Intraoperative parameters (time to define the target calyx,access establishment time,operative duration) and postoperative perioperative data (estimated blood loss,stone-free rate,severe complications) were compared between the two groups.Results 65 cases of patients were enrolled into the study.There was no significant difference in age (P =0.72),body mass index (P =0.78),stone size (P =0.53) and so on.Compared with the control group,the time duration to define the target calyx in CT-US group is significantly decreased in experiment group(50.4 ± 18.1) s vs.(82.1 ± 37.7) s,(P =0.02).The time to establish the access and fulfill the procedure shows no significant difference between the two groups,respectvely(P =0.45,0.61).Also,significant differences can be found in the hemoglobin loss during and after the surgery(1.1 ± 0.5) g/L vs.(1.4 ± 0.4) g/L (P =0.04).The difference in severe complications (Clavien Ⅲ and above),stone-free rate (P =0.60) and transfusion rate (P =1.00) was not significant.Conclusions Our primary study shows CT-altrasound image fusion guide PCNL is a safe and reliable technology.The time duration to define the target calyx was decreased compared with traditional US guidance method.The target calyx chosen was more accurate,with lower blood loss during the perioperative period.

Objective To investigate the safety, feasibility and results of laparoscopic assisted distal radical gastrectomy for gastric cancer. Methods Twenty-three cases of gastric cancer were subjected to laparoscopic assisted distal radical gastrectomy, D_(1+α)/D_(1+β) lymphadenectomy on 3 cases and D_2 lymphadenectomy on 20 cases. All cases received Billroth I reconstruction. Results Laparoscopic assisted distal radical gastrectomy was carried out in all cases successfully. The mean operative time was (205 ±38 )min, mean blood loss was (105 ± 66) ml and mean number of lymph nodes dissected was 19.7 ± 6.2 each case. The mean postoperative time of recovery of bowel function was (3.5 ±1.2) d,mean postoperative time of liquid intake was (4.9 ±0.9) d and mean hospitalization was (10.2 ± 2.7) d. No postoperative death or anastomotic fistula was found. Postoperative upper gastrointestinal bleeding occurred in 1 case and was cured by conservative treatment. Follow-up for 1-12 months revealed no recurrence or metastasis. Conclusions Laparoscopic assisted distal radical gastrectomy is a safe and feasible procedure with satisfactory short-term outcomes.Moreover,the short-term outcomes may be improved if the patients are treated under the notion of fast track surgery.