laparoscopic partial nephrectomy:a decade of evolution*

Laparoscopic Partial Nephrectomy:A Decade of Evolution*

Abstract

The detection of renal tumors is increasing with the widespread use of ultrasonography and CT.

Laparoscopic partial nephrectomy (LPN) offers less pain, smaller scars, and shorter convalescence.

Expanded indications of LPN include larger and more complex tumors, including those in hilar or

central locations, multiple tumors, solitary kidneys, and patients with previous renal surgery. This

procedure is in constant evolution. We describe the technical nuances of LPN over the past decade of

evolution.

JOURNAL OF ENDOUROLOGY

Volume 25, Number 2, February 2011

ª Mary Ann Liebert, Inc.

Pp. 145–150

DOI: 10.1089=end.2010.0676

腹腔镜肾部分切除术：十年进展

摘要：

肾肿瘤的发现随着超声及 CT 的广泛应用而提高。腹腔镜肾部分切除术(LPN)有更小的痛苦，更小的

疤痕，更短的恢复期。腹腔镜肾部分切除术(LPN)的扩展适应症包括更大和更复杂的肿瘤，包括位于肾门

或中央位置的多发肿瘤，孤立肾以及有既往肾脏手术史的患者。此过程是在不断发展。我们描述了在过去

十年的发展中腹腔镜肾部分切除术 LPN 的技术差别。

Robot-Assisted Partial Nephrectomy*

Abstract

Robot-assisted partial nephrectomy (RAPN) is a viable option for patients and surgeons who desire a

minimally invasive alternative for the performance of nephron-sparing surgery (NSS). NSS has become

the norm for the management of small renal masses. Numerous series have shown favorable outcomes

for RAPN. RAPN has a shortened learning curve and eases the transition to minimally invasive NSS.

We describe the indications, preparation, instrumentation, setup, technique, and complications for

transperitoneal RAPN using a two- or three-arm approach. We also suggest strategies and tips so that

surgeons early in the learning curve can effectively anticipate, avoid, and, if inevitable, manage

complications.



a Mary Ann Liebert, Inc.

Pp. 151–157

DOI: 10.1089=end.2010.0672

机器人辅助肾部分切除术

摘要

机器人辅助肾部分切除术(RAPN)是一种患者和外科医生追求微创和替代保留肾单位手术（ＮＳＳ）

的可行性选择。NSS 已经成为处理小肾脏肿块的标准。众多研究显示 RAPN 有良好的效果。RAPN 具有更

短的学习曲线以及简化了向微创 NSS 的转变。我们总结了使用两臂或三臂方法的经腹膜 RAPN 的适应

症，准备，使用器械，安装，技术和并发症。我们还提出策略和技巧建议，使外科医生在早期学习曲线时

能有效地预测、避免，（如果不可避免）和处理并发症。

Laparoendoscopic Single-Site Surgery Radical Nephrectomy*

Abstract

The indications, instrumentation, surgical technique, and complications of laparoendoscopic single-site

radical nephrectomy (LESS-RN) are being described in detail in an attempt to familiarize urologists

with this novel laparoscopic technique. Our initial experience of 30 consecutive cases of LESS-RN is

reported. The results indicate that, in experienced hands, LESS-RN is feasible and safe, with results

comparable to those of conventional laparoscopic radical nephrectomy. Nevertheless, larger series of

patients are needed to prove if the increased technical difficulty of LESS-RN justifies its use in routine

urologic practice.




Pp. 159–165

DOI: 10.1089=end.2010.0673

单孔腹腔镜根治性肾切除术

摘要

本文祥细描述单孔腹腔镜根治性肾切除术(LESS-RN)的适应症，使用器械，外科技巧和并发症，以尝

试使泌尿外科医生熟悉这项新的腹腔镜技术。我们报告了 30 例连贯性 LESS-RN 案例的初始经验。结果显

示，有经验的外科医生手中，对比传统腹腔镜手术的结果，LESS-RN 是可行和安全的。然而，需要更大

宗的患者研究证实 LESS-RN 增加的技术难度是否适用于常规泌尿外科实践。

Transperitoneal Robot-Assisted Laparoscopic Pyeloplasty*

Abstract

Minimally invasive pyeloplasty has achieved success that has approached open pyeloplasty. Key

principles such as removal of fibrosis, extensive mobilization of the ureteropelvic junction and crossing

vessels, and creation of a tension-free, widely spatulated anastamosis are important in successful repair.

In this review, we discuss the preparation and operative steps in performing a robotic pyeloplasty.

Patient selection and diagnostic approach is discussed in the preoperative setting. Important surgical

steps described include port placement, management of crossing vessels, division and spatulation of the

ureter, and reanastamosis. Finally, management of more difficult cases is discussed.




Pp. 167–172

DOI: 10.1089=end.2010.0621 经腹膜机器人辅助腹腔镜肾盂成形术

摘要

微创肾盂成形术已经取得成功且效果接近于开放肾盂成形术。关键步骤如移除纤维条索，肾盂输尿管

连接部和横跨血管的广泛分离，以及无张力的创建，广泛楔形缝合对成功修复十分重要。在此综述中，我

们讨论机器人辅助腹腔镜肾盂成形术的术前准备及手术步骤。患者的选择以及诊断方法在术前安排中讨

论。重要的手术步骤包括通道置入，横跨血管的处理，裁剪和调整输尿管，以及重新连接。后，讨论如

何处理更困难的个案。

Laparoscopic Transperitoneal Pyeloplasty*

Abstract

Laparoscopic pyeloplasty is a first-line option for the management of ureteropelvic junction obstruction.

It has a greater success rate than endopyelotomy and is associated with a shorter and less intense

convalescence than open surgical pyeloplasty. The technique is well established and reproducible,

although the procedure is more difficult in certain situations, such as after a previous pyeloplasty.

Because laparoscopic suturing is needed, it is considered an advanced laparoscopic procedure. Suturing

devices can facilitate suturing, but they are not optimal for all repairs. This article and the

accompanying video summarize the preoperative, intraoperative, and postoperative considerations for

laparoscopic pyeloplasty.




Pp. 173–178

DOI: 10.1089=end.2010.0605 经腹膜腹腔镜肾盂成形术

摘要

腹腔镜肾盂成形术是处理肾盂输尿管连接部梗阻的一线选择。它对比腔内肾盂整形术有更高的成功

率，以及与开放肾盂成形术比较有更短和更小痛苦的愈合期。尽管在某些特定的情况手术的难度增大，如

既往有肾盂成形手术史，但这项技术已经得到很好的确立和可重复操作。由于腹腔镜缝合是必需的，因此

它被认为是一种高级的腹腔镜技术。缝合器可方便缝合，但它们不是适用于所有缝合。本文以及附带的录

像总结腹腔镜肾盂成形术的术前，术中和术后注意事项。

Pediatric Robot-Assisted Pyeloplasty

Abstract

The emergence of robot-assisted surgical technology has permitted application of laparoscopic

pyeloplasty to the pediatric age group to a much wider degree than previously possible. The

challenging learning curve for conventional laparoscopic pyeloplasty, particularly in infants, has

hindered its widespread application. Robotassisted pyeloplasty in children has been clearly shown to

provide an equally effective, safe, and reasonably efficient means to repair ureteropelvic junction

obstruction with more rapid hospital discharge and less postoperative analgesic requirements. Precise

port placement, adjusted to the child’s anatomy and size, delicate anastomosis, and use of postoperative

stent appear to be important elements for successful repair. The procedure has become reproducible

and in some centers is exclusively used over open repair. The specific procedural steps are detailed and

the potential limitations and complications are reviewed, as well as the limited available data in the

literature.




Pp. 179–185

DOI: 10.1089=end.2010.0597

小儿机器人辅助肾盂成形术

摘要

机器人辅助外科技术的出现使应用腹腔镜肾盂成形术的小儿年龄组比以往有了更广泛的程度。常规腹

腔镜肾盂成形术的具有困难的学习曲线，特别是在婴幼儿，阻碍了其广泛的应用。机器人辅助肾盂成形术

应用于小儿，已清楚地表明其同样有效，安全，以及治疗输尿管连接部梗阻能更快速出院和减少术后镇痛

需要。精确的通道设置，适应小儿的解剖结构和体型，精巧的缝合，术后内支架的应用是治疗成功的重要

因素。该手术已经得到推广，以及在一些中心其应用已超过开放手术。本文将对详细的手术步骤进行介

绍，以及对其潜在的局限性和并发症进行总结，以作为可提供有限可用数据的文献。

Laparoscopic Ablation of Renal Neoplasms*

Abstract

As a result of the widespread application of cross sectional imaging, there has been a significant rise in

the incidence of small renal cortical neoplasms. The current standard of care in the management of

these lesions is nephron-sparing extirpative surgery. In the last decade, however, image-guided or

ablative therapies have garnered significant attention as nephron-sparing alternatives to partial

nephrectomy. Although initially laparoscopic ablation was predominately intended for use as active

treatment in those patients in whom more invasive therapy was contraindicated, as experience with

laparoscopic ablation has become more robust, the indications for the procedure continue to evolve.

The current article reviews the indications and contraindications, preoperative preparation, surgical

technique, and postoperative follow-up for laparoscopic ablative procedures. Also discussed are

techniques and patient selection criteria to avoid complications, as well as the management of

complications that do occur.




Pp. 187–194

DOI: 10.1089=end.2010.0598

腹腔镜下肾癌消融术

摘要

由于横截面成像的广泛应用，肾脏皮质小肿瘤的检出率明显提高。目前衡量治疗损伤的标准是保留肾

单位根治手术。在过去十年中，成像导引或消融治疗作为替代肾部分切除术的保留肾单位治疗已得到明显

重视。尽管一开始腹腔镜消融多倾向作为积极治疗应用于一些禁止接受过多侵入性治疗的患者上。随着腹

腔镜消融的经验逐渐成熟，手术的适应症得以扩展。本文总结腹腔镜消融的适应症和禁忌症，术前准备，

手术技巧，以及术后注意事项。同样讨论手术技巧和患者选择标准已避免并发症，以及出现并发症的处

理。

Laparoscopic Transperitoneal Nephrectomy for Renal Cancer:

The University of California, Irvine, Technique

Abstract

The first laparoscopic nephrectomy for a renal tumor was performed 20 years ago at Washington

University in St. Louis. Since that time, laparoscopic radical nephrectomy has become a standard of

care when dealing with large renal tumors or other renal cancers not amenable to partial nephrectomy

or ablative therapy. In the following article and videotape, the surgical technique of a laparoscopic

radical nephrectomy is traced and the method of approach is documented. This approach is the one that

is currently used at the University of California, Irvine, and reflects the authors’ preferred operative

technique.




Pp. 195–200

DOI: 10.1089=end.2010.0549

经腹膜腹腔镜肾切除术治疗肾癌：加州大学欧文分校，技巧

摘要

第一例腹腔镜肾切除术治疗肾肿瘤于 20 年前在圣路易洲的华盛顿大学中完成。从此以后，腹腔镜

根治性肾切除术已变成处理大肾脏肿瘤或其他不适合行肾部分切除术或消融治疗的癌的衡量标准。在以下

文章和录像带中，将对腹腔镜肾根治性切除术的手术技巧进行描述以及记录方法。这种方法是目前在加州

大学欧文分校中应用，同时反映了作者的更优秀的手术技巧。

Laparoscopic Live Donor Nephrectomy: A Technical Road

Map

Abstract

Laparoscopic live donor nephrectomy is a safe, minimally invasive alternative to the customary open

approach. During the past two decades, laparoscopic renal surgery has increased the availability of

renal allograft specimens for transplantation. Specifically, the laparoscopic approach has minimized

postoperative pain and duration of recovery, making it a more attractive option for potential altruistic

organ donors. Here we detail the techniques, challenges, and troubleshooting approaches necessary for

this technically challenging, yet valuable operation.




Pp. 201–208

DOI: 10.1089=end.2010.0529

活体捐肾者的腹腔镜下肾切除术：一种技巧指引

摘要

腹腔镜下对活体捐肾者进行肾切除术（取肾）是一种可替代传统开放手术，安全微创的手术方法。在

过去二十余年来，腹腔镜肾外科手术使得经典的同种异体肾移植手术变得更为可行。特别是腹腔镜手术径

路减少了术后的疼痛及缩短了康复时间，更为吸引一些潜在的器官捐献人群。在此我们详细介绍了这种技

术，手术的挑战和难点及解决方法，手术要点。

Laparoscopic Retroperitoneal Extirpative and Reconstructive

Renal Surgery

Abstract

Retroperitoneal laparoscopy for renal surgery is a viable and versatile alternative to transperitoneal

access. Location of the kidneys in the retroperitoneum makes it an attractive approach. The

development of both approaches paralleled during the last two decades; however, retroperitoneal

laparoscopy witnessed a steep learning curve because of the constraint of working space, lack of

obvious landmarks, and appropriate instrumentations. This approach has several advantages and is

currently being used for extirpative and reconstructive procedures for various renal pathologic

conditions. After creation of retroperitoneal space, the techniques can be tailored to the desired

indication for successful culmination. The learning curve can be shortened by adequate training;

subsequently, with experience, this can be used proficiently.




Pp. 209–216

DOI: 10.1089=end.2010.0697

后腹腔镜下肾外科的切除与重建手术

摘要

通过后腹腔镜进行肾外科手术是切实可行并且有多种形式代替经腹腔入路。这种手术方式更易到达位

于后腹腔内的肾脏。在过去二十余年，经腹腔及经后腹腹术式都有了相近的发展，然而由于操作空间的约

束，缺乏明显的解剖标志和合适的器械，学习掌握经后腹腔手术更为困难。这种术式亦具有某些优点，目

前用于对各种肾脏疾病进行切除和重建的手术治疗。建立好后腹腔操作空间后，通过调整手术技巧可获得

满意的手术效果。只要经过充分的训练可以缩短学习周期，随着经验的积累，便可以熟练运用这种术式。

Hand-Assisted Laparoscopic Radical Nephrectomy

Abstract

Laparoscopic radical nephrectomy is the standard of care for the management of most renal cancers.

The handassisted approach has bridged the gap between open nephrectomy and a pure laparoscopic

approach. Handassisted laparoscopic nephrectomy allows tactile feedback, thus shortening the learning

curve for some surgeons and allowing more experienced laparoscopists to perform more complex and

challenging procedures.




Pp. 217–223

DOI: 10.1089=end.2010.0711

手辅助腹腔镜下根治性肾切除术

摘要

腹腔镜下根治性肾切除术是作为大多数肾癌的标准治疗方式。手辅助为开放性肾切除与完全腹腔镜下

肾切除两术式之间搭建了一个桥梁，为术者提供了触觉反馈，从而缩短了学习周期，使更为有经验的术者

可以进行一些复杂及有挑战性的手术操作。

Management of the Ventriculo-Peritoneal Shunt in Pediatric

Patients During Robot-Assisted Laparoscopic Urologic

Procedures

Abstract

Introduction: Infection or malfunction of ventriculo-peritoneal (VP) shunts is a severe complication

during laparoscopic surgery involving the gastrointestinal or urinary tract. It has been recently

suggested to externalize the shunt or convert into a ventriculo-atrial shunt to prevent this complication

with laparoscopic approach. Herein, we present a novel technique for management of the VP shunt

during robot-assisted laparoscopic (RAL) urologic procedures.

Materials and Methods: After port placement and diagnostic peritoneoscopy, an Endopouch bag

(Ethicon Endo- Surgery) was inserted into the peritoneal cavity and the distal end of the shunt was

placed into the pouch. The Endopouch suture was synched around the shunt and the pouch was placed

in the subhepatic space during the surgery. The intraperitoneal pressure was maintained at 12mm Hg

during the entire procedure. Metronidazole, gentamicin, and vancomycin were administered as

prophylaxis. Following the completion of the surgery and profuse irrigation of the peritoneal cavity, the

shunt was repositioned within the peritoneum. We evaluated perioperative shunt-related complications.

Results: We used this technique in four patients with VP shunt undergoing RAL cystoplasty and

appendicovesicostomy and=or colonic enema channel formation. The average age of the patient at

surgery was 10.8 (7–14) years. One patient was converted to open because of failure to progress due to

multiple adhesions and the shunt was externalized temporarily. At a mean follow-up of 13 (3–20)

months, no shunt-related complications were seen.

Conclusions: In our preliminary experience, the use of an intracorporeal Endopouch bag with

controlled pneumoperitoneal pressure to protect the VP shunt may be an effective alternative to prevent

complications related to it during RAL urologic surgery involving the gastrointestinal or urinary tract.

Further studies will be needed to confirm our results.




Pp. 225–229

DOI: 10.1089=end.2010.0181

脑室分流患者行机器人腹腔镜尿路手术时分流管的处理

摘要

前言：腹腔镜下进行胃肠及尿路手术时造成脑室腹腔分流管的感染和堵塞是一种严重的并发症。近有

学者建议将分流管外置或者改行脑室心房分流以防止该并发症。在此，我们介绍一种新颖的方法—如何在

进行机器人腹腔镜泌尿外科手术时管理脑室腹腔分流管道。

材料和方法：建立好通道后进行腹腔镜镜检，将一囊袋（Ethicon Endo-sugery 公司）放入腹腔并将分流

管的远端置入囊袋，术中将围绕分流管的袋口收紧后置于肝下方。手术全程的气腹压力维持在 12mmHg。

术中同时预防给予灭滴灵、庆大霉素和万古霉素。手术结束时充分冲洗腹腔，随后将分流管重新放回腹腔

内。对围手术期分流管相关并发症进行统计分析。

结果：对四名脑室腹腔分流的患者在行膀胱扩大术、回盲肠膀胱扩大术和/或（顺行）结肠灌洗术时使用

了该技术，患者平均年龄 10.8（7-14）岁，其中一名患者因为腹腔广泛粘连改为开放手术，分流管临时置

于体外。平均随访 13（3-20）个月，没有出现分流管相关的并发症。

结论：我们的初步经验是，对脑室腹腔分流的患者在机器人腹腔镜手术中有涉及胃肠道及尿路的操作时

使用囊袋保护分流管并且控制好气腹压力或许能有效预防分流管相关的并发症。我们的结果须要进一步的

研究证实。

Use of a Telerobotic Arm to Perform Ultrasound Guidance

During Renal Biopsy in Transplant Recipients:A Preliminary

Study

Abstract

Background: Renal biopsies are usually performed by a nephrologist and require ultrasound guidance

from an expert. This procedure can be time-consuming and expensive.

Patients and Methods: We propose using a robotic arm, controlled from a remote location, to perform

ultrasound guidance during renal biopsies in postrenal transplant patients. The procedure would be

performed under ultrasound guidance from a radiologist, controlling a robotic arm from one institution,

while the nephrologist would perform the biopsy at another. This would allow biopsies to be performed

under the guidance of an expert in ultrasonography, without requiring him to leave his institution.

Results: Four patients underwent teleoperated renal biopsy. None of the patients had any postbiopsy

complication. Total time used to perform the renal biopsies was significantly increased when compared

with conventional biopsy technique. Compared with conventional ultrasound guidance, the

nephrologists performing the biopsies reported discomfort with the robotic arm carrying out the

ultrasonography.

Conclusions: We demonstrated the feasibility of teleoperated ultrasound-guided renal biopsies. This

technique can be used to compensate for the absence of an ultrasonography expert and save time.

Additional invasive urologic procedures using the ESTELE robot arm, including renal punctures before

percutaneous nephrolithotomy and prostate biopsies, are planned.




Pp. 231–234

DOI: 10.1089=end.2010.0287

利用遥控机械臂操作超声引导对移植肾的肾穿刺活检：一项初步研究

摘要：

背景：通常肾内科医生进行肾穿刺活检须要超声医生的协助引导，其过程费时费力。

病例及方法：我们利用一可遥控的机械臂操作引导超声对肾移植术后的患者进行肾穿刺活检。由一名

超声医生远程控制机械臂进行超声引导，肾内科医生则在另一个中心里实施活检操作。使活检可以在一名

熟练的超声医生的（远程）引导下进行而不须要其离开其单位。

结果：四名患者进行了视频监视下肾穿刺活检，无出现手术并发症。与常规的穿刺活检术相比，手术时

间明显延长。有肾内科医生反映，与常规的超声引导相比，机械臂操作超声引导活检时较为不适。

结论:我们介绍了一种可行的（远程）视频 B 超监视、引导下的肾穿刺活检。这种方法可以替代了一名超

声医生并且节省了时间。我们正计划利用 ESTELE 机械臂进行其他一些有创泌尿外科操作，包括经皮肾取

石术的肾穿刺，前列腺穿刺活检。

Robotic Repair of Access-Related Aortic Injuries:

Unexpected Complication of Robot-Assisted Prostatectomy

Abstract

Robot-assisted surgery is becoming more widespread, but despite adoption by most academic

institutions, curricula for training residents in robotics have yet to be developed fully. Even after

teaching surgeons have mastered robotic techniques, an inherent risk of avoidable injuries may persist

as they seek to impart their knowledge of this relatively new surgical modality to trainees. Two cases

of aortic injury during access for robot-assisted prostatectomy are described along with their successful

robotic repair with root-cause analysis of the events. Robotic surgeons who are involved in training

programs should be prepared to handle evenmajor potential complications of robot-assisted surgery

regardless of their own expertise or experience.




Pp. 235–238

DOI: 10.1089=end.2010.0367

机器人处理前列腺切除术中的意外并发症：通道相关动脉损伤

摘要

机器人手术正广为开展，尽管该手术方式已被大多数学会所接受，但对住院医师进行机器人手术的

技能培训教材仍未完善。即使教学老师已经掌握了机器人手术的技能，并且尝试将这一新颖的外科技术与

新手分享时，一些潜在的本可避免的手术损伤仍可能发生。本文中两例行机器人前列腺切除术时，在建立

通道时发生了动脉损伤，对此作了原因分析并介绍如何成功的利用机器人进行修复。机器人外科医生包括

正在接受相关培训的医生，无论他们的经验和技术水平如何，都应该作好处理各种主要的潜在的手术并发

症的准备。

Robot-Assisted Laparoscopic Pyeloplasty With and Without a

Ureteral Stent

Abstract

Objective: Robot-assisted laparoscopic pyeloplasty (RALP) has been shown to be an efficacious

treatment for ureteropelvic junction obstruction. Although the use of a ureteral stent is commonplace,

the water-tight anastomosis possible with robotic assistance may obviate its need. We report a

feasibility study of unstented RALPs and present our experience with both the stented (SRP) and

unstented (URP) approach.

Materials and Methods: A retrospective review of RALPs completed at our institution from 2003 to

2008 was performed. Thirty-five patients had postoperative stents. Seventeen RALPs were completed

without ureteral stents. Narcotic requirements, operative time, estimated blood loss, daily drain output,

length of stay, and complications were examined.

Results: Fifty-two patients underwent RALP without conversion to open procedure (35 SRP, 17

URP). Operative time was significantly less in the URP group ( p¼0.01). URPs required less narcotics

and had shorter length of stay. Three complications were reported after SRP, whereas two patients with

URP experienced transient ureteral obstruction, which resolved after 4 weeks with an indwelling

ureteral stent. Postoperative renograms showed improved drainage in all but four patients (two SRPs

and two URPs), each of whom had subjective improvement in symptoms postoperatively.

Conclusions: Our data suggest that URP is a safe and feasible procedure for the treatment of

ureteropelvic junction obstruction. There were no clinically significant differences between the stented

and unstented groups. Further prospective evaluation is needed; however, URP can be performed by an

experienced surgeon in a carefully selected patient.




Pp. 239–243

DOI: 10.1089=end.2010.0192

机器人腹腔镜下留置输尿管支架管和无管的肾盂成形术

摘要

目的：机器人腹腔镜下肾盂成形（RALPs）术已成为治疗肾盂输尿管移行处梗阻的有效方法。虽然通常

会留置输尿管支架管，但由于机器人能做到水密性良好的吻合，使得不留置输尿管支架管成为可能。对此

我们进行一项可行性研究，介绍了我们对有管（SRP）和无管(URP)术式的经验。

材料和方法：回顾分析了我们中心 2003 年到 2008 年间完成的 RALPs 术，35 例患者留置了输尿管支架

管，17 名患者无置管。麻醉药使用量，手术时间，失血量，（引流管）每日引流量，住院时间及并发症

均作统计。

结果：52 例病例（35 例 SRP，17 例 UPR）均无中转开放手术。UPR 组的手术时间明显较短( p=0.01).，

UPR 组麻醉药使用量较少并且住院时间较短。SRP 术后出现了三种并发症，而 URP 组有两例出现了短暂

的常见的输尿管梗阻，术后四周通过内置输尿管支架管解决。除了四名患者（两名 SRPs 和两名 URPs）

外，所有病例术后造影显示（上尿路）引流改善，术后每个患者主观感觉症状有改善。

结论：我们的数据显示 URP 术式治疗肾盂输尿管连接处梗阻是安全和可行的，留管组和无管组无明显临

床差别。但须要进一步的前瞻性研究证实；然而，URP 术仍须由有经验的外科医生仔细选择合适的病例

进行。

Hybrid Transureteral Natural Orifice Translumenal Endoscopic

Nephrectomy: A Feasibility Study in the Porcine Model

Abstract

Background and Purpose: Natural orifice approaches for nephrectomy have included access via the

stomach, vagina, bladder, and rectum. The use of the ureter as a natural orifice for natural orifice

translumenal endoscopic surgery (NOTES) nephrectomy has not been previously reported. The

purpose of this study is to test the feasibility of transureteral laparoscopic NOTES nephrectomy.

Materials and Methods: Three female farm pigs (29.2–30.8 kg) were placed into the lithotomy

position. A cystoscopically placed extra-stiff guidewire was used to place a prototype dilating sheath

into the left ureter. After dilation of the ureter and urethra, the sheath was exchanged for a 12-mm

bariatric laparoscopic trocar. A 10.5-inch long 10-mm offset operating laparoscope with an internal 5-

mm working port was used for the nephrectomy. One 2-mm and one 2=3-mm port were placed

transabdominally to facilitate in situ morcellation. The kidney was cut into slices using the bipolar

device and extracted via the ureteral port using the housing of a 12-mm bariatric stapling device.

Results: All three transureteral nephrectomies were successfully completed. The total mean operative

time was 220 minutes (range 113–346 min). Component portions of the procedure were: Ureteral

access (mean 21 min), nephrectomy (mean 70 min), and kidney morcellation (mean 103 min). Mean

estimated blood loss was 20mL (range 5–50 mL). There were no intraoperative complications.

Conclusions: This nonsurvival porcine feasibility study demonstrates the successful performance of

transureteral nephrectomy. This approach shows promise as a way to decrease the invasiveness of

NOTES nephrectomy by using the ureteral orifice as an access site.




Pp. 245–250

DOI: 10.1089=end.2010.0311

杂交式经输尿管自然腔道的内镜下肾切除术：猪模型上的可行性研究

摘要：

背景和目的：经自然腔道行肾切除术的腔道包括经胃、阴道和直肠。利用输尿管腔这一自然腔道进行

肾切除术作为一种自然腔道内镜手术（NOTES）之前未见报道。本研究的目的是检验经输尿管腔腹腔镜

下肾切除术的可行性。

材料和方法：三头雌性农场猪（29.2-30.8KGg）置于膀胱截石位。在膀胱镜下置入超硬导丝入左侧输尿

管内，并在其引导下利用扩张器进行输尿管和尿道扩张，扩张成功后改置入一 12mm 腹腔镜套管。采用一

10.5 英寸长，外径 10mm，工作通道为 5mm 的侧视式内镜用于进行肾切除术。另建立一内径 2mm 和

2/3mm 的经腹通道以协助进行原位切碎肾组织，利用双极设备将肾脏切成碎片，然后通过一 12mm 的大号

网套装置经输尿管腔将碎片取出。

结果：所有三例经输尿管腔的肾切除术均成功完成。平均手术时间为 220 分钟（113-346 分钟）。手术

各个步骤为：输尿管通道建立（平均 21 分钟），肾切除（平均 70 分钟）和肾毁损（平均 103 分钟）。平

均失血量估计为 20ml（5-50ml）。无术中并发症。

结论：在猪身上的手术可行性研究证明经输尿管腔的肾切除术是成功的，该术式利用输尿管腔道进行肾

切除术，是一种可望减少手术创伤的 NOTE 手术。

Laparoscopic Pyeloplasty Outcomes of Elderly Patients

Abstract

Background and Purpose: Laparoscopic pyeloplasty (LP) has been described as the new gold

standard operation for patients with ureteropelvic junction obstruction (UPJO). As life expectancy

continues to increase, we will be faced with the need to counsel older patients on the risks and benefits

of undergoing surgery. It is clear that laparoscopic renal surgery has significant benefits over open

renal surgery. Avoidance of open surgery would seem particularly beneficial in elderly patients who

receive a diagnosis of this condition, although results in this group have not been formally studied. We

compared the perioperative and medium-term outcomes of LP for primary UPJO in patients who are 70

years and older with those who are under age 70.

Patients and Methods: Between January 2006 and June 2009, 74 consecutive patients underwent LP

for UPJO performed by one surgeon. A four-port extraperitoneal approach was used in all but one case.

Patient demographic and perioperative data were recorded prospectively. Outcome measures were

success rate at a median follow-up of 12 months, complications, and length of hospital stay.

Results: Fifteen (20%) patients were aged 70 years or older. Older patients had a higher median

American Society of Anesthesiologists score (2 vs 1). Moreover, older patients often presented with

compromised renal function than their younger counterparts (median split renal function on the

affected kidney 35% vs 45%, serum creatinine level 130 vs 90 mmol=L, P<0.001). The success rate in

the older group was 87%, with no treatment failures in the younger patients. Median hospital stay was

longer for older patients (3 days vs 2 days, P¼0.01). Frequency of complications were not

significantly different between the groups; however, there was a postoperative death in an elderly

patient with a solitary kidney and preoperative renal failure.

Conclusions: LP is feasible with generally good results for managing UPJO in patients 70 years or

older. Older patients, however, are likely to need a longer hospital stay compared with their younger

counterparts, and their co-morbidities should be carefully assessed preoperatively to minimize

morbidity. Advanced chronologic age should not be a contraindication for LP in patients with

symptomatic UPJO.




Pp. 251–256

DOI: 10.1089=end.2010.0384

老年患者行腹腔镜肾盂成形术后临床结效果

摘要：

背景及目的：腹腔镜肾盂成形术（LP）已成为治疗肾盂输尿管连接部狭窄（UPJO）的手术金标准。随

着人口平均寿命的增加，接受手术治疗老年患者增多，我们将面临如何告之手术风险和益处的问题。显然

腹腔镜肾外科手术与开放肾外科手术相比，对确诊为 UPJO 的老年患者而言有更明显的益处，然而，该人

群没被正式的随访研究。我们比较了 70 以上和 70 岁以下 UPJO 患者行 LP 术的围手术期及中期随访结

果。

患者与方法：2006 年 1 月到时 2009 年 6 月的 74 例（连续病例）由同一名外科医生进行的治疗 UPJO

的 LP 手术，除一人外其余病例均采用四个套管手术通道。记录患者的人口统计学及围手术期资料。结果

评价包括中位随访 12 个月的成功率、并发症及住院时间。

结果：15 名（20%）患者年龄为 70 岁或以上。年老组的美国麻醉协会评分平均数更高（2 比 1）。而

且，年老组与年轻组患者相比常有更为明显的肾功能损害（患肾的平均分肾功能为 35%比 45%，血肌酐

水平为 130 比 90mmol/L,P<0.01）。年老组治疗成功率为 87%，相对年轻组无出现治疗失败。年老组平均

住院时间较长（3 天比 2 天，P=0.01），两组的手术合并症发生率无明显差别；但是年老组有一例死亡病

例，患者为孤立肾且术前已出现肾功能衰竭。

结论：对于 70 岁或以上的 UPJO 患者，LP 术是一种可行且疗效良好的治疗。然而，与年轻患者相比，

年老的患者往往须要更长的住院时间，术前应仔细评估病情以减少并发症的发生率。对有症状的 UPJO 患

者，年老、慢性病程不应成为 LP 手术的禁忌症。

Laparoendoscopic Single-Site Urological Surgery Using

a Homemade Single Port Device: The First 70 Cases

Performed at a Single Center by One Surgeon

Abstract

Purpose: Laparoendoscopic single-site (LESS) surgery was used to treat various urological operations

by a single surgeon who was skilled in conventional laparoscopic surgery. The effectiveness and safety

of the procedure were examined.

Patients and Methods: LESS surgery was performed on 70 patients by using a homemade single port

device composed of an Alexis_ wound retractor and a powder-free surgical glove. There were 29 cases

of varicocelectomy (including two bilateral cases), 21 cases of renal cyst marsupialization (including

one bilateral case), 16 cases of ureterolithotomy, 3 cases of radical nephrectomy, and 1 case of radical

nephroureterectomy. The mean patient age was 42.90_17.58 years (range, 11 to 74 years), and the

male-to-female ratio was 55:15.

Results: In two cases (one ureterolithotomy and one radical nephrectomy), the LESS surgery was

converted to conventional laparoscopic surgery. The mean operative time was 96.02 minutes (range, 30

to 285 minutes), the estimated blood loss was 60.80mL (range, 0 to 500 mL), and the mean hospital

stay was 5.10 days (range, 3 to 15days). Only one patient had to use patient-controlled anesthesia due

to pain; none of the patients developed major complications; and all patients were satisfied, with 85.7%

expressing a high degree of satisfaction.

Conclusion: In the urological field, LESS surgery using a homemade single-port device appears to be

a feasible and safe surgical treatment option that could replace conventional laparoscopic surgery.




Pp. 257–264

DOI: 10.1089=end.2010.0445

利用自制的单孔装置行单孔腹腔镜泌尿外科手术：一名外科医生在单中心的 70 例病例

摘要

目的：由一名熟练掌握常规腹腔镜手术的外科医生进行各种单孔腹腔镜（LESS）泌尿外科手术，评估手

术的安全性及效率。

患者与方法：利用自制单孔装置对 70 名患者进行 LESS 手术，该单孔装置由一 Alexis 术口牵开器和无

粉外科手套组成。有 29 例精索精静曲张高位结扎（包括两例两侧病例）病例，21 例肾囊肿去顶（包括一

例两侧病例）病例，16 例输尿管切开取石，3 例根治性肾切除，1 例根治性肾输尿管切除。患者平均年龄

为 42.9±17.58（11 岁至 74 岁），男女比例为 55：15。

结果：两例（一例输尿管切开取石和一例根治性肾切除术）LESS 术中转为常规腹腔镜手术。平均手术

时间为 96.02 分（30 至 285 分），估计失血量为 60.80ml（0 到 500ml）,平均住院时间为 5.10 天（3 至 15

天）。仅一名患者因疼痛使用了术后自控镇痛；无出现严重的手术并发症；所有患者均对手术效果满意，

有 85.7%患者认为非常满意。

结论：在泌尿外科领域，利用自制的单孔装置进行 LESS 手术是安全可行的，可以取代传统的腹腔镜手

术。

The Alternative to Laparoendoscopic Single-Site Surgery:

Small Strategic Laparoscopic Incision Placement (SLIP)

Abstract

Background: The latest attempt to improve the cosmesis of laparoscopic surgery is laparoendoscopic

single-site surgery (LESS). We present our initial experience with an alternative procedure with similar

cosmetic benefit but without technical limitations.

Methods: Small strategic laparoscopic incision placement (SLIP) nephrectomy is performed

transperitoneally, generally using three 5-mm ports (one in the umbilicus) and one 12-mm port placed

below the pubic hairline, such that only two 5-mm scars are visible without close inspection. We

assessed our first 21 procedures, which included all but five of the standard transperitoneal

nephrectomies by a single surgeon from June 2008 through July 2009. These were matched 1:2

(exactly by gender and American Society of Anesthesiology score, and then closest in age and body

mass index) from 96 patients undergoing similar standard transperitoneal laparoscopic

procedures from 2005 through 2008.

Results: The SLIP and control groups were well matched, with mean age and body mass index

differing by only 3.6 years and 1.1, respectively. Of the SLIP patients, 34% were obese or morbidly

obese, and a trainee was the primary surgeon in 81% of cases. Mean operative time was 23 minutes

longer in the SLIP cases. There was no difference between groups in estimated blood loss,

complication rate, or convalescence.

Conclusions: Like LESS, SLIP nephrectomy provides improved cosmesis. Unlike LESS, it is only

slightly more difficult to perform than standard laparoscopic nephrectomy and can be performed in

technically challenging cases (obesity, large specimen, etc). Similar to the literature on LESS, there is

no convalescence benefit to SLIP nephrectomy; the advantage over standard laparoscopy is purely

cosmetic.




Pp. 265–270

DOI: 10.1089=end.2010.0340

一种单孔腹腔镜手术的替代术式：小切口腹腔镜外科手术（SLIP）

摘要：

背景：单孔腹腔镜（LESS）是近发展起来的尝试改良美容效果的一种腹腔镜术式。我们介绍了一种有

相似美容效果但操作简单的替代术式及其初步经验。

方法：小切口腹腔镜（SLIPA）肾切除术建立四个经腹通道，三个常规的 5mm 通道（一个在脐部），在

耻骨阴毛线处建立一个 12mm 通道，因此若非仔细观察术后仅能看到两个 5mm 的疤痕。我们评估了初期

的从 2008 年 6 月到 2009 年 7 月的 21 例手术，除了 5 例外全部均由同一名外科医生进行标准的经腹肾切

除术。从 2005 年到 2008 年 96 例按 1：2 比例（根据性别和美国麻醉协会评分，接近的年龄和肥胖指数）

选择，以类似的标准行经腹肾切除术。

结果：SLIP 组和对照组配对良好，平均年龄和肥胖指数仅分别相差 3.6 岁和 1.1。SLIP 组患者，34%存

在肥胖或或病态肥胖，81%的手术主要由一名培训期医生完成。SLIP 组平均手术时间长 23 分钟。两组间

失血量，并发症发生率，预后无差别。

结论：如 LESS 手术一样，SLIP 肾切除术有着同样的（术后）美容效果。但与 LESS 不同的是，其操作

仅比标准的腹腔镜肾切除术稍为困难，而且可用于高难度的病例（如肥胖，巨大肾等）。与 LESS 相关文

献报道相似，SLIP 肾切除术无给患者带来康复的益处，与标准的腹腔镜手术相比，仅术口外观较美观。

Nephrectomy Improves Cosmesis

Without Technical Restrictions

Abstract

We describe a modern use of laparoscopic renal descensus during the reconstruction of the upper

urinary tract. The patient is a 76-year-old mononephric man with recurrent carcinoma in situ in the

distal ureter. Using the described technique, we produced an additional 8 to 10 cm of ureteral length

and performed a simple ureteroneocystotomy instead of using a traditional psoas hitch and Boari flap

creation, bowel interposition, or autotransplantation. Laparoscopic renal descensus is an uncommonly

used but simple procedure that may prevent the need for bladder mobilization or Boari flap creation,

particularly in the setting of a hostile pelvis.




Pp. 271–272

DOI: 10.1089=end.2010.0022

腹腔镜下肾下移进行上尿路重建

摘要

我们阐述应用腹腔镜肾下移进行上尿路重建。76 岁孤立肾输尿管远端原位癌复发患者。采用上述用

腹腔镜肾下移方法，我们增加 8-10cm 额外的输尿管进行简单地输尿管膀胱吻合，而不需要应用传统的腰

大肌瓣和膀胱瓣，肠间置修补或自身移植。腹腔镜下肾下移的方法应用罕见但手术过程简单，特别是在骨

盆条件不适宜的情况下，它可以不需膀胱分离移位或行 Boari 皮瓣术。

Does Simultaneous Transurethral Resection of Bladder Tumor

and Prostate Affect the Recurrence of Bladder Tumor?

A Meta-Analysis

Abstract

Purpose: To evaluate the efficacy and safety of simultaneous resection in the treatment of nonmuscle

invasive bladder cancer (NMIBC) with benign prostatic hyperplasia (BPH).

Patients and Methods: Combined published data from comparative studies on simultaneous

transurethral resection of bladder tumor=transurethral resection of the prostate (TURBT=TURP) vs

TURBT alone in NMIBC were analyzed, considering possible confounding factors. Odds ratios (ORs)

and 95% confidence intervals (CIs) were used as the primary effect size to estimate the outcome of

overall tumor recurrence, recurrence in bladder neck=prostatic fossa.

Results: In six eligible clinical trials, 483 patients were treated with simultaneous resection and 500

with TURBT alone. Within the follow-up period, tumor recurrence developed in 203 (42%) patients in

the simultaneous resection group and 256 (51.2%) patients in the control group. The combined analysis

indicated that the recurrence rate in the simultaneous resection group was statistically significantly

lower than in the control group in the overall pooled data (combined OR¼0.67; 95% CI 0.52 to 0.88,

P¼0.003). Tumor recurrence of bladder neck=prostatic fossa developed in 37(7.7%) patients in the

simultaneous resection group and 42 (8.4%) patients in the control group. No statistically significant

difference was found between the two groups (combined OR 0.92; 95% CI 0.57 to 1.49, P¼0.74).

Potential confounders, such as mean age, mean follow-up duration, multiplicity of tumor, and year of

publication did not significantly influence the results.

Conclusion: There was at least the evidence that simultaneous TURBT=TURP did not increase the

overall recurrence rate and recurrence rate in bladder neck=prostatic fossa. Simultaneous

TURBT=TURP might be preferable for patients with NMIBC and BPH.




Pp. 291–296

DOI: 10.1089=end.2010.0314

同时行经尿道膀胱肿瘤和前列腺切除术对膀胱肿瘤复发有影响吗？一项荟萃分析

摘要

目的：评估对非肌浸润性膀胱癌及前列腺增生症同时切除治疗的有效性和安全性。

患者与方法：对同时行经尿道膀胱肿瘤切除术和经尿道前列腺电切术与非肌浸润性单独行经尿道膀胱肿

瘤切除术的数据进行对比研究，考虑到可能存在的混杂因素。ORs 和 95%可信区间（CIs）用于作为原发

作用大小估计所有肿瘤复发的结局，膀胱颈/前列腺窝肿瘤的复发。

结果：在 6 个入选的临床试验中，483 名患者同时进行（TURBT 和 TURP）切除治疗和 500 名患者单独

行经尿道膀胱肿瘤切除术（TURBT）。在随访期内，同时行切除术组有 203 名患者肿瘤复发（42%），而

对照组有 256 人复发（51.2%）。联合分析结果表明，在所有数据中同时进行切除术组肿瘤复发率低于对

照组，差异具有统计学意义（联合 OR=0.67；95%CI 0.52 至 0.88,P=0.003）。在同时进行切除术组有 37 人

（7.7%）存在膀胱颈/前列腺窝肿瘤复发，而对照组有 42 人（8.4%）复发。两组差异无统计学意义（联合

OR=0.92；95%CI 0.57 至 1.49，P=0.74）。潜在影响因素如平均年龄，平均随访时间，肿瘤的多样性和公

布的时间对结果的影响不大。

结论：至少有证据表明同时进行 TURBT/TURP 不增加膀胱颈/前列腺窝肿瘤的总复发率和复发率。同时

进行 TURBT/TURP 可能对 NMIBC 和 BPH 患者更有益。

Retroperitoneal Migration of a Double-J Stent:

An Unusual Occurrence

Abstract

Double-J stents that are inserted to span the ureterovesical anastomosis at ureteoneocystostomy may be

associated with problems such as coiling or migration. An unusual occurrence of retroperitoneal

migration of a Double-J stent after bilateral open ureteroneocystostomy is reported. The migrated stents

were retrieved laparoscopically with construction of a laparoscopic ureteroneocystostomy.




Pp. 297–299

DOI: 10.1089=end.2010.0281

双 J 管腹膜后移位罕见事件

摘要

输尿管膀胱吻合术中双 J 管超越输尿管膀胱吻合处可出现相关问题如卷曲或移位。本文报道双侧开

放性输尿管膀胱吻合术后发生双 J 管腹膜后移位的罕见事件。此移位双Ｊ管通过腹腔镜取出并行腹腔镜输

尿管膀胱吻合重建术。

An Unexpected Resident in the Ileum Detected During

Robot-Assisted Laparoscopic Radical Cystoprostatectomy

and Intracorporeal Studer Pouch Formation: Taenia Saginata

Parasite

Abstract

A case of moving ileal Taenia saginata parasites is presented with demonstrative images. We came

across the parasites surprisingly while performing robot-assisted laparoscopic radical

cystoprostatectomy with intracorporeal Studer pouch urinary diversion. We recommend stool sample

evaluation in the preoperative period for possible presence of intestinal parasitic diseases, particularly

in patients with bladder cancer who are admitted from areas with an increased incidence of intestinal

parasitic diseases, before opening the bowel segments during surgery to perform radical cystectomy

and urinary diversion.




Pp. 301–303

DOI: 10.1089=end.2010.0477

在机器人辅助腹腔镜根治性膀胱前列腺切除术中行体内 Studer 膀胱成型时在回肠内意外

发现牛肉绦虫寄生物

摘要

移动的回肠牛肉绦虫病例呈现于论证图像上。在机器人辅助腹腔镜根治性膀胱前列腺切除和 Studer 膀

胱尿流改道术时我们惊奇地发现有活的寄生虫。我们建议术前要进行大便标本检查以发现可能存在肠内寄

生虫病，特别是那些来自肠内寄生虫病发生率高的地区的膀胱癌患者，在进行根治性膀胱切除和尿流改道

术打开肠管前要进行检查。

Robot-Assisted Partial Nephrectomy: Early Unclamping

Technique*

Abstract

Robot-assisted partial nephrectomy (RAPN) is emerging as a viable minimally invasive surgical

technique for small renal tumors. The warm ischemia time (WIT) during laparoscopic partial

nephrectomy has been reduced using an early unclamping (EU) technique. We present our technique of

EU technique in RAPN. From November 2009 to June 2010, 12 consecutive RAPNs were performed

by a single surgeon (A.W.) using EU technique. The median operative time was 227 minutes (176–

315); median WIT, 16 minutes (11–25). Median estimated blood loss was 150mL (50–500) and length

of stay 2 days. There were no intraoperative or postoperative complications. RAPN using EU technique

is a safe and feasible option in experienced hands, allowing for a shorter WIT without increasing blood

loss. This approach requires a highly skilled bedside assistant who is imminently familiar with the

robotic system and advanced laparoscopic techniques.




Pp. 305–309

DOI: 10.1089=end.2010.0436

机器人辅助肾部分切除术：早期松解技术

摘要：

机器人辅助肾部分切除术（RAPN）治疗小肾肿瘤是一项新出现的微创外科技术。腹腔镜肾部分切除

术时的热缺血时间（WIT）在利用早期松解技术（EU）时减少。我们在 RAPN 时提出利用 EU 技术。从

2009 年 11 月到 2010 年 6 月，一个外科医生（A.W.）利用 EU 技术进行连续 12 台 RAPN 手术。手术时间

中位数是 227min(176-315);WIT 中位数，16min(11-25)。估计失血量中位数是 150ml(50-500)，住院时间 2

天。无术中或术后并发症。RAPN 利用 EU 技术是一项安全可行的选择，允许 WIT 更短而不会增加失血

量。这种方法还要求有一位具有高技巧的手术台旁的助手，其对机器人极其熟练和拥有高超的腹腔镜技术.

Advanced Diagnostics in Renal Mass Using Optical

Coherence Tomography: A Preliminary Report

Abstract

Objective: To avoid unnecessary surgical treatment of small renal masses (_4 cm), a more accurate

diagnostic method would be desirable since radiological differentiation between malignant and benign

is difficult and nondiagnostic biopsies account from 9% to 37%. Optical coherence tomography (OCT)

measures backscattered light versus depth, with an attenuation coefficient (mt) that may vary among

different histological types. We hypothesize that quantitative measurements of mt using OCT can

differentiate between normal renal parenchyma and renal cell carcinoma (RCC).

Materials and Methods: Both normal and tumor renal tissues (RCC) were harvested after partial or

radical nephrectomy. Analysis of mt was based on difference of (1) mt between normal and tumor tissue

across all patients and (2) mt between normal and tumor tissue within individual patients.

Results: Tissue samples of 18 patients were measured, of which 4 were excluded (urothelial carcinoma,

oncocytoma, and benign lesion without normal tissue available). Of the remaining 14 patients, 8

contributed with both normal and RCC tissue and 6 with only normal or RCC tissue. Independent

observation showed a significant difference between the median mt of normal renal tissue (4.95mm_1)

and the median mt of RCC (8.86mm_1). No statistically significant difference was found when

comparing the difference in mt between normal renal parenchyma and RCC within individual patients.

Conclusion: There is a significant difference in mt between normal and RCC tissue across all patients.

These results overpower the lack of significant difference within individuals, encouraging further

research and suggesting a possible role for OCT in the diagnostic work-up of renal masses.




Pp. 311–315

DOI: 10.1089=end.2010.0408

利用光学相干断层成像术（ＯＣＴ）检查早期诊断肾肿瘤：初步报告

摘要

目的：为了避免不必要的手术治疗小肾肿瘤（≤4cm），由于放射学方法难以区分恶性和良性以及不能

诊断的活组织检查准确率为 9%-37%，渴望更精确的诊断方法。OCT 检查方法测量反向散射的光对比深

度，不同的组织学类型其衰减系数（mt ）可能不同。我们假设定利用 OCT 定量测定 mt 能区分正常肾实

质和肾细胞癌（RCC）。

患者与方法：部分或根治性肾切除术后取正常和肿瘤肾组织（RCC）。分析基于所有病人的正常和肿瘤

组织 mt 和个别病人的正常和肿瘤组织间的 mt

结果：检测了 18 名患者的组织样本，4 名患者被排除（膀胱上皮癌，嗜酸粒细胞腺瘤，无正常组织的良

性病变）。其余的 14 名患者，8 名有正常和 RCC 组织，6 名仅是正常或 RCC 组织。独立观察发现正常肾

组织的 mt 中位数（4.95mm-1）和 RCC 的 mt 中位数（8.86mm-1）之间有显著差异。个别患者的正常肾实

质和 RCC 的 mt 对比，差异无统计学意义。

结论：所有患者的正常和 RCC 组织之间的 mt 差异有统计学意义。这些结果显示个别患者正常和 RCC 组

织之间的 mt 的显著差异的缺乏，需要进一步研究，表明 OCT 在肾肿瘤的诊断中可能发挥着重要的作用。

Polyscope: A New Era in Flexible Ureterorenoscopy

Abstract

Introduction: Despite improvements in instrumentation and technology in flexible ureteroscopy, the

issue of procedural and off-procedural damage remains a problem. The aim of our study was to

highlight our initial experience in flexible ureteroscopy using polyscope, a new advancement in the era

of flexible ureterorenoscopy.

Materials and Methods: In this study, we used an 8F modular flexible, steerable polyscope for

diagnostic purposes and Dormia basket removal for small renal stones. Three outer disposable catheters

were used with proper sterilization in 22 cases.

Results: The polyscope was used in six cases of undiagnosed hematuria, and biopsy was taken from

pelvic growth in one patient, which turned out to be transitional-cell carcinoma. Polyscope was used

for removal of residual stones or small stones (<1 cm) using Dormia basket in 16 cases (from August

2008 to July 2009). The mean stone size was 7.5 mm. The vision achieved was excellent in all the

cases.

Conclusions: Minimally invasive techniques are preferred for treatment of renal stones. The problem

of lower caliceal stone access has been solved with the primary and secondary deflection of modern

flexible ureteroscopes. The modular design of polyscope makes it a more cost-effective option.

Relatively cheap and disposable multilumen catheters preclude the need for sterilization of optic cable,

thus decreasing the chances of handlingrelated damages. The chance of instrument-related infection is

minimal. Besides, it can be used as a semirigid ureteroscope should the need arises.




Pp. 317–321

DOI: 10.1089=end.2009.0584

电光透照镜：软性输尿管肾镜的新纪元

摘要

目的：尽管软性输尿管镜仪器和技术得到了改善，程序性和非程序性损害仍然是一个问题。我们研究的

目的是强调用电光透照镜的软性输尿管镜术中的初经验，软性输尿管肾镜的时代新的进展。

材料与方法：本研究中，我们采用 8F 标准型软性容易操作的电光透照镜用于诊断目的，以及用输尿管

取石网除去小的肾结石。22 例患者使用 3 个适当消毒过的一次性外鞘导管。

结果：电光透照镜用于 6 例未诊断的血尿，1 例患者行肾盂组织活检，后诊断为移行细胞癌。16 例患

者利用输尿管取石网兰通过电光透照镜除去残留结石或小结石（＜1cm＝。（从 2008 年 8 月到 2009 年 7

月）。平均结石大小为 7.5mm。电光透照镜视野在所有病例的手术中均十分清晰。

结论：微创技术首先用于治疗肾结石。下盏结石问题已通过现代软性输尿管镜一级和二级已屈曲技术得

到解决。电光透照镜的标准设计使其成为更合算的选择。相对便宜的和一次性使用的多孔导管，排除光纤

消毒的需要，这样可减少手操作相关的损坏的机会。仪器相关的感染机会是小。除此之外，它可用于作

为一个半硬式输尿管镜。

Management of Complete Ureteral Avulsion

and Literature Review: A Report on Four Cases

Abstract

Objective: The aim of this study was to investigate the treatment modality of complete ureteral

avulsion.

Patients and Methods: This study retrospectively analyzed the data of four patients with complete

ureteral avulsion who were treated between November 2003 and March 2008 in our hospital. Of the

four patients, one had ureteropelvic junction avulsion, one had proximal ureteral avulsion, and the other

two had distal ureteral avulsion. One patient underwent autotransplantation of kidney for treatment of

severe proximal ureteral avulsion. Pyeloureterostomy plus greater omentum investment outside the

native distal ipsilateral ureter was performed in the patient with ureteropelvic junction avulsion. The

other two patients underwent ureterovesical anastomosis. All four patients were followed up for an

average time of 29 months (16–45 months).

Results: Renal function recovered well in the patient who underwent autotransplantation of kidney and

ureterovesical anastomosis and the two patients who underwent ureterovesical anastomosis. The other

patient who underwent pyeloureterostomy developed hydronephrosis and nonfunctioning kidney. The

patient then underwent nephrectomy.

Conclusions: Complete ureteral avulsion is a rare but severe complication. Autotransplantation of

kidney and ureterovesical anastomosis may result in positive outcomes in patients with proximal

ureteral avulsion.




Pp. 323–326

DOI: 10.1089=end.2010.0303

输尿管完全撕脱的治疗及文献回顾：4 例病案报告

摘要

目的：本研究的目的是调查输尿管完全撕脱的治疗方式。

患者与方法：本研究回顾性分析了从 2003 年 11 月至 2008 年 3 月在我院治疗的 4 例输尿管完全撕脱患

者的数据。4 例患者中，有 1 例是肾盂输尿管交界处撕脱，1 例输尿管近端撕脱，其他 2 例为输尿管远端

撕脱。1 例患者接受自体肾移植手术治疗严重输尿管近端撕脱。对肾盂输尿管交界处撕脱的患者进行肾盂

输尿管吻合术加大网膜复盖在患侧输尿管远端外。其他 2 例患者进行输尿管膀胱吻合术。4 例患者平均随

访时间均为 29 个月（16-45 个月）。

结果：接受自体肾移植和输尿管吻合术以及 2 例接受输尿管膀胱吻合术的患者其肾功能恢复良好。一例

行肾盂输尿管吻合术发展为肾盂积水和无功能肾的患者接受肾切除术。

结论：输尿管完全撕脱是一种罕见而又严重的并发症。对输尿管近端撕脱的患者进行自体肾移植和输尿

管吻合术可能会起到正面的治疗效果。

Factors Affecting Bleeding During

PercutaneousNephrolithotomy: Single Surgeon Experience

Abstract

Purpose: To investigate variables that affect bleeding during percutaneous nephrolithotomy (PCNL),

focusing on the experience of a single surgeon.

Patients and Methods: The records of 649 PCNL procedures that were performed by the same

surgeon were reviewed retrospectively. The effect of surgical experience; patient and stone-related

factors, including age, sex, hypertension, and diabetes, serum creatinine level, history of ipsilateral

renal procedures, stone surface area and type, degree of hydronephrosis, preoperative hemoglobin level;

operative factors, such as the calix of puncture, number of accesses, operative time; and intraoperative

complications, such as pelvicaliceal system perforation on bleeding (described as decrease in

hemoglobin level and need for blood transfusion), were investigated. For statistical assessment,

univariate analyses and multivariate stepwise regression analyses were used.

Results: A 92.3% success rate was achieved after one session PCNL. The overall blood transfusion

rate was 10.8%. The number of accesses, stone type, diabetes, preoperative hemoglobin level, and

operative time were the most important factors for blood transfusion requirement. In the receiver

operating characteristic curve, the best cutoff point of operative time was 58 minutes for the blood

transfusion requirement. Multivariate stepwise regression analyses showed that there was an

association between diabetes, operative time, number of accesses, and stone type with the decrease in

hemoglobin levels. No correlation between surgical experience and decrease in hemoglobin level as

well as blood transfusion necessity was found.

Conclusions: Depending on the results achieved by a single surgeon, multiple access tracts, staghorn

calculi, presence of diabetes, and prolonged operative time, but not surgical experience, significantly

increased blood loss during PCNL.




Pp. 327–333

DOI: 10.1089=end.2010.0302

经皮肾镜取石术中出血的影响因素：单一外科医生的经验

摘要

目的：研究经皮肾镜取石术（PCNL）中出血的影响因素，集中于单一外科医生的经验。

患者与方法：由同一外科医生完成的 649 例接受 PCNL 的患者进行回顾性分析。手术经验的影响；患者

与结石相关因素，包括年龄，性别，高血压，糖尿病，血清肌酐水平，患侧肾脏手术史，结石表面积和类

型，肾积水的程度，术前血红蛋白水平；手术因素如穿刺盏，通道数目，手术时间；术中并发症如对肾盂

肾盏系统穿孔出血（血红蛋白水平降低而需要输血）进行了调查。统计分析采用单因素分析和多元回归分

析。

结果：一期 PCNL 后成功率达 92.3%。总输血率为 10.8%。通道数目，结石类型，糖尿病，术前血红蛋

白水平和手术时间是需输血重要的因素。在受试者的工作特征曲线中，对于输血要求其手术时间的佳

分界点是 58 分钟。多元回归分析表明糖尿病，手术时间，通道数目和结石类型与血红蛋白水平的降低之

间存在相关性，而发现手术经验与血红蛋白水平的降低以及输血必要性之间无相关性。

结论：根据从一个外科医生得到的结果，多个通道，鹿角形结石，糖尿病的存在和手术时间的延长，而

没有手术经验，在 PCNL 中失血量显著增加。

Clinical Usefulness of the Memokath Stent

as a Second-Line Procedure After Sphincterotomy Failure

Abstract

Purpose: To assess the clinical usefulness of Memokath_ stent placement in the external sphincter

region in men with neurogenic bladder dysfunction from spinal cord injury after failed sphincterotomy.

Patients and Methods: Twenty-two men with elevated (>100 mL) residual urine and=or voiding

difficulties= autonomic dysreflexia were treated with a Memokath stent. Follow-up examinations

comprised residual urine, video-urodynamics, renal sonography, and assessment of subjective outcome.

Results: No intraoperative complications were observed. Transient autonomic dysreflexia developed

in one patient. Stent repositioning from dislocation was necessary in four (18.2%) patients. After a

median follow-up of 10.3 months, 18 (81.8%) patients still had a stent in place. In two men, the stents

were removed because of newly diagnosed urothelial bladder cancer; in another two patients, they were

removed because of lack of success. At follow-up, residual urine was significantly reduced from 229 to

105 mL. Residual urine was <100mL in 14 of 18 (77.8%) patients. Changes in bladder capacity,

detrusor leak point pressure, bladder compliance, and maximum detrusor pressure were not statistically

significant. Renal sonography did not reveal any pathologic findings.

Conclusions: According to our data, the Memokath stent is not only an alternative treatment option to

sphincterotomy, but it is a safe and successful second-line treatment after sphincterotomy failure.




Pp. 335–339

DOI: 10.1089=end.2010.0374

Memokath 支架的临床应用价值：作为括约肌切开失败后的一个二线手术

摘要

目的：为了评估括约肌切开术失败后应用 Memokath 支架置入脊髓损伤后神经性膀胱功能障碍的男性外

括约肌中的临床应用价值。

患者与方法：采用 Memokath 支架治疗 22 名残余尿增加（＞100ml）和/或排尿困难/自主神经反射异常

患者。后续检查包括残余尿，视频尿流动力学，肾脏超声检查以及主观结果的评估。

结果：术中无并发症发生。1 名患者发生短暂的自主神经反射异常。4 名（18.2%）患者错位的支架需重

新定位。中位随访 10.3 个月后，18 名（81.8%）患者支架仍在原位。由于 2 名男性患者新诊断为膀胱上皮

癌其支架已被拆除，其他 2 名患者由于失败其支架已被拆除。在随访中，残余尿量显著减少从 229ml 到

105ml。18 名患者中有 14 名（77.8%）残余尿量＜100 ml。膀胱容量，逼尿肌漏尿点压力，膀胱顺应性和

大逼尿肌压力的改变无统计学意义。肾脏超声检查未发现任何病理改变。

结论：根据我们的数据，Memokath 支架不仅是一种替代括约肌切开术的治疗选择，而且是括约肌切开术

失败后的一种安全和成功的二线治疗方式。

Histotripsy Erosion of Model Urinary Calculi

Abstract

Background and Purpose: Histotripsy is a pulsed focused ultrasound technology in which initiation

and control of acoustic cavitation allow for precise mechanical fractionation of tissues. The present

study examines the feasibility of using histotripsy for erosion of urinary calculi.

Materials and Methods: Histotripsy treatment was delivered from a 750-kHz transducer in the form of

5-cycle acoustic pulses at a 1-kHz pulse repetition frequency. Model stones were sonicated for 5

minutes at peak negative pressures (p-) of 10, 15, 19, 22, and 24-MPa. Resulting fragment sizes and

comminution rates were assessed and compared with those achieved with a piezoelectric lithotripter

(Wolf Piezolith 3000) operated at 2-Hz pulse repetition frequency and power level 17 (p-¼14-MPa).

Results: Histotripsy eroded the surface of stones producing fine (<100 mm) particulate debris in

contrast to the progressive and incomplete subdivision of stones achieved with piezoelectric lithotripsy.

The histotripsy erosion rate increased with increasing peak negative pressure from 10 to 19 MPa and

then saturated, yielding an average rate of 87.9_12.8mg=min at maximum treatment intensity.

Piezoelectric lithotripsy achieved an average treatment rate of 110.7_27.4mg=min.

Conclusions: Histotripsy comminution of urinary calculi is a surface erosion phenomenon that is

mechanistically distinct from conventional shockwave lithotripsy (SWL), producing only fine debris as

opposed to coarse fragments. These characteristics suggest that histotripsy offers a potential adjunct to

traditional SWL procedures, and synergistic interplay of the two modalities may lead to possible

increases in both rate and degree of stone fragmentation.




Pp. 341–344

DOI: 10.1089=end.2010.0407

泌尿系结石模型的组织摧毁术

摘要

背景与目的：组织摧毁术是脉冲聚焦超声技术，利用声空化的启动和控制对组织产生精确的机械粉碎。

本研究探讨采用组织摧毁术磨损泌尿系结石的可行性。

材料与方法：组织摧毁术治疗来自 750-kHz 传感器以 5 个周期的形式声脉冲在 1-kHz 的脉冲重复频率下

产生。结石模型为超声波降解标本在 5 分钟内以 10，15，19，22 和 24-MPa 高峰的负面压力（p-）进行组

织摧毁术。由此产生的碎片大小和粉碎率进行评估，并且与压电式碎石机(Wolf Piezolith 3000)在 2-Hz 脉

冲重复频率和 17（p-1/4-MPa）功率水平中进行对比。

结果：组织摧毁术磨损结石表面产生的小颗粒（＜100um＝碎片与通过压电式碎石机碎石：逐步和不完

全细碎结石碎片形成明显的对比，随着负压从 10 到 19MPa，然后趋于饱和，组织摧毁术磨损结石率增

加。在大的治疗强度时平均结石磨损率为 87.9±12.8mg/min。压电式碎石机平均治疗率达到

110.7±27.4mg/min。

结论：组织摧毁术粉碎泌尿系结石是通过一种磨损结石表面机械作用与传统的冲击波碎石（SWL）明显

不同，其产生的是精细碎片而不是粗碎片。这些特征表明组织摧毁术提供了一个潜在的传统 SWL 的辅助

手段，如两种模式协同相互作用，可导致结石碎片率和碎石程度的增加。

ProMIS_ Can Serve as a da Vinci_ Simulator—A Construct

Validity Study

Abstract

Purpose: The purpose of this study was to investigate if the ProMIS_ simulator could serve as a

training platform for the da Vinci_ surgical system and if this constellation could prove construct

validity.

Materials and Methods: The da Vinci system was connected to the ProMIS simulator, which

registered objective data concerning how the surgeon performed in the box environment related to time,

path, and smoothness. Five experienced robotic surgeons passed four different surgical tasks with

progressive difficulty. A novice group— constituted of 13 consultants and 6 residents, none of them

with any previous experience in the da Vinci system—passed the same tasks and the data were

compared with the results from the expert group.

Results: A statistically significant difference between experts and novices was demonstrated in all

tasks concerning time and smoothness. For the parameter path, significant difference was only noted in

the more complex tasks.

Conclusions: Our study showed that ProMis could differentiate between experienced robotic surgeons

and novices, thereby proving construct validity. Smoothness appeared to be the most sensitive

objective parameter in our study. Tasks with high complexity are recommended when designing the

program for robotic training.




Pp. 345–350

DOI: 10.1089=end.2010.0220

ProMISTM 能成为一个达芬奇模拟器—一个检测正确性研究

摘要

目的：本研究的目的是调查 ProMISTM 模拟器能否成为一个达芬奇手术系统的培训平台，能否证明这一

系列检测的正确性。

材料与方法：达芬奇系统与 ProMISTM 模拟器相连，登记的客观数据涉及到外科医生如何进行与时

间，路径和流畅的环境框相关的手术。5 个经验丰富的机器人外科医生通过渐进困难的四种不同手术任

务。初学者组-由 13 个顾问和 6 个住院医生组成，他们没有任何行达芬奇系统的手术经验，通过相同的任

务和专家组的结果数据相比较。

结果：在专家组和初学者之间差异有显著统计学意义，表现在所有任务中涉及的时间和手术流畅度，对

于限定的路径，显著的区别只在更复杂的任务中。

结论：我们的研究表明 ProMis 可以区分经验丰富的机器人外科医生和初学者，从而证明检测正确性。在

我们的研究中手术流畅度是乎为敏感的参数。在制定机器人培训方案时建议进行高复杂性的任务。

laparoscopic partial nephrectomy:a decade of evolution*

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