目的探讨经腹膜外途径C.R.P.C.四步法腹腔镜根治性前列腺切除术治疗局限性前列腺癌的安全性和疗效。方法回顾性分析2015年4月至2017年12月同济医院收治的102例前列腺癌患者的病例资料。年龄(67±5)岁。术前总PSA值(45.32±18.33...目的探讨经腹膜外途径C.R.P.C.四步法腹腔镜根治性前列腺切除术治疗局限性前列腺癌的安全性和疗效。方法回顾性分析2015年4月至2017年12月同济医院收治的102例前列腺癌患者的病例资料。年龄(67±5)岁。术前总PSA值(45.32±18.33)ng/ml。前列腺体积(42±12)cm^3。102例均行磁共振检查和前列腺穿刺活检确诊为前列腺癌,临床分期cT1c^cT3b期。102例均在全麻下行经腹膜外途径腹腔镜根治性前列腺切除术。术中采用C.R.P.C.四步法,即控制背深静脉复合体(control dorsal deep venous complex,C);识别前列腺膀胱交界面、精囊层面、狄氏间隙层面3个解剖层面(recognize three anatomical layers,R);保留尿道括约肌和膀胱颈(preserve urethral sphincter and bladder neck,P);连续行尿道吻合(continuous anastomosis between urethra and bladder neck,C),特别注意3、5、7、9点方向4针。记录手术时间、术中出血量、住院时间和术后并发症。结果本组102例手术均顺利完成。手术时间平均92(55~156)min。出血量平均105(55~185)ml。无中转开放手术。1例(0.98%)术前中度贫血患者(血红蛋白65 g/L)术后予输血治疗。病理检查结果显示15例(14.70%)切缘阳性。术后1周内2例(1.96%)发生尿外渗,经牵拉尿管并延长尿管留置时间后恢复正常。术后随访(26.4±3.5)个月。术后6个月11例(10.78%)出现PSA复发;术后12个月2例发生Ⅰ~Ⅱ度尿失禁,1例发生排尿困难。结论C.R.P.C.四步法腹腔镜根治性前列腺切除术易学易记,能够使初学者掌握根治性前列腺切除术的程序化手术操作步骤。本方法术后并发症少,肿瘤控制效果较好。展开更多
The successful application of new technologies such as remotely piloted aircraft systems,distributed electric propulsion systems,and automatic control systems on electric vertical take-off and landing(eVTOL)aircraft h...The successful application of new technologies such as remotely piloted aircraft systems,distributed electric propulsion systems,and automatic control systems on electric vertical take-off and landing(eVTOL)aircraft has prompted Urban Air Mobility(UAM)to be mentioned frequently.UAM is a newly raised transport mode of using eVTOL aircraft to transport people and cargo in urban areas,which is thought to share some of the traffic on the ground.One of the prerequisites for UAM to operate on a regular basis is that its demand can support the operating costs,so forecasting UAM demand is necessary.We conduct UAM demand forecasting based on the four-step method,focusing on improving the third-step modal split,and propose a demand forecasting model based on the logit model.The model combines a nested logit(NL)model with a multinomial logit(MNL)model to solve the problem of non-existent UAM sharing rates.We use Chengdu,China as an example,and focus on forecasting the UAM traffic demand in 2030 with the help of the four-step method.The results show that UAM is suitable for shared operation during the early stages.With a fully shared operation,the UAM share rate increases by 0.73%for every kilometer increase in distance.Moreover,UAM is more competitive than other modes for delivery distances exceeding 15 km.Finally,using the distributions of the share rate and traffic flow pattern from the simulation,we propose the routes that can be prioritized for UAM operations in Chengdu.展开更多
文摘目的探讨经腹膜外途径C.R.P.C.四步法腹腔镜根治性前列腺切除术治疗局限性前列腺癌的安全性和疗效。方法回顾性分析2015年4月至2017年12月同济医院收治的102例前列腺癌患者的病例资料。年龄(67±5)岁。术前总PSA值(45.32±18.33)ng/ml。前列腺体积(42±12)cm^3。102例均行磁共振检查和前列腺穿刺活检确诊为前列腺癌,临床分期cT1c^cT3b期。102例均在全麻下行经腹膜外途径腹腔镜根治性前列腺切除术。术中采用C.R.P.C.四步法,即控制背深静脉复合体(control dorsal deep venous complex,C);识别前列腺膀胱交界面、精囊层面、狄氏间隙层面3个解剖层面(recognize three anatomical layers,R);保留尿道括约肌和膀胱颈(preserve urethral sphincter and bladder neck,P);连续行尿道吻合(continuous anastomosis between urethra and bladder neck,C),特别注意3、5、7、9点方向4针。记录手术时间、术中出血量、住院时间和术后并发症。结果本组102例手术均顺利完成。手术时间平均92(55~156)min。出血量平均105(55~185)ml。无中转开放手术。1例(0.98%)术前中度贫血患者(血红蛋白65 g/L)术后予输血治疗。病理检查结果显示15例(14.70%)切缘阳性。术后1周内2例(1.96%)发生尿外渗,经牵拉尿管并延长尿管留置时间后恢复正常。术后随访(26.4±3.5)个月。术后6个月11例(10.78%)出现PSA复发;术后12个月2例发生Ⅰ~Ⅱ度尿失禁,1例发生排尿困难。结论C.R.P.C.四步法腹腔镜根治性前列腺切除术易学易记,能够使初学者掌握根治性前列腺切除术的程序化手术操作步骤。本方法术后并发症少,肿瘤控制效果较好。
基金supported by the National Natural Science Foundation of China(Grants No.41971359)Thanks to the Chengdu Traffic Management Bureau for providing data support for this article.
文摘The successful application of new technologies such as remotely piloted aircraft systems,distributed electric propulsion systems,and automatic control systems on electric vertical take-off and landing(eVTOL)aircraft has prompted Urban Air Mobility(UAM)to be mentioned frequently.UAM is a newly raised transport mode of using eVTOL aircraft to transport people and cargo in urban areas,which is thought to share some of the traffic on the ground.One of the prerequisites for UAM to operate on a regular basis is that its demand can support the operating costs,so forecasting UAM demand is necessary.We conduct UAM demand forecasting based on the four-step method,focusing on improving the third-step modal split,and propose a demand forecasting model based on the logit model.The model combines a nested logit(NL)model with a multinomial logit(MNL)model to solve the problem of non-existent UAM sharing rates.We use Chengdu,China as an example,and focus on forecasting the UAM traffic demand in 2030 with the help of the four-step method.The results show that UAM is suitable for shared operation during the early stages.With a fully shared operation,the UAM share rate increases by 0.73%for every kilometer increase in distance.Moreover,UAM is more competitive than other modes for delivery distances exceeding 15 km.Finally,using the distributions of the share rate and traffic flow pattern from the simulation,we propose the routes that can be prioritized for UAM operations in Chengdu.
