The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of r...The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of;evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.展开更多
目的：比较经尿道2μm激光前列腺剜除术及前列腺电切术治疗大体积良性前列腺增生的疗效及安全性。方法收集2011～2013年间79例在我院手术治疗的前列腺体积＞80 m L患者的临床资料，其中经尿道2μm激光前列腺剜除术45例，前列腺电切术34...目的：比较经尿道2μm激光前列腺剜除术及前列腺电切术治疗大体积良性前列腺增生的疗效及安全性。方法收集2011～2013年间79例在我院手术治疗的前列腺体积＞80 m L患者的临床资料，其中经尿道2μm激光前列腺剜除术45例，前列腺电切术34例，比较两组病例的手术时间、切除的腺体组织重量、术中出血量、持续膀胱冲洗时间、留置尿管时间、手术并发症及手术前后最大尿流率（Qmax）、残余尿量（PVRU）、国际前列腺症状评分（IPSS）、以及生活质量评分（QOL）情况。结果79例患者均一次手术成功，两组患者手术时间、术中出血量、持续膀胱冲洗时间、留置尿管时间比较，差异具有统计学意义（P＜0．05）；两组术中所切除的前列腺体组织重量无统计学差异（P＞0．05）；两组术后发生暂时性尿失禁、泌尿系感染、二次出血的例数比较，差异具有统计学意义（P＜0．05），两组均无死亡病例；两组患者Qmax、PVRU、IPSS及QOL评分较术前均有明显改善（P＜0．05），但两组间比较差异均无统计学意义（P＞0．05）。结论对于前列腺体积＞80 mL的大体积BPH患者，在做好围手术期准备、术者经验丰富的情况下，经尿道2μm激光前列腺剜除术和T U RP均有明显的临床效果，特别是经尿道2μm激光前列腺剜除术更具有术中出血少、安全性高、并发症少等优点。展开更多
目的对比经尿道直出光纤绿激光前列腺锐性剜除术(green light top-firing,sharp enucleation of the prostate,GTSEP)和绿激光选择性光汽化术(photoselective vaporisation of the prostate,PVP)治疗良性前列腺增生症(benign prostatic ...目的对比经尿道直出光纤绿激光前列腺锐性剜除术(green light top-firing,sharp enucleation of the prostate,GTSEP)和绿激光选择性光汽化术(photoselective vaporisation of the prostate,PVP)治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)患者的有效性和安全性。方法选取2018年6月至2019年4月在本院诊治的154例BPH患者,按随机数字表法分为两组,每组77例,分别行GTSEP和PVP。评估两组患者术前一般情况,记录并比较术后第1个月和第6个月国际前列腺症状评分(IPSS)、生活质量评分(QoLs)、残余尿(PVR)、最大尿流率(Qmax)、前列腺体积(PV)、前列腺特异抗原(PSA)及并发症等。结果两组各有74例患者完成了随访。两组患者术前基本资料差异无统计学意义。术后1、6个月,两组患者下尿路症状均较术前明显改善,但IPSS、QoLs、PVR、Qmax、PSA差异无统计学意义。GTSEP组手术时间明显短于PVP组(41.0±16.4 vs 50.1±18.1 min,P=0.001),术后6个月GTSEP组前列腺体积小于PVP组(22.4±2.4 vs 23.3±1.9 mL,P=0.011)。两组术中和术后近期并发症差异无统计学意义。结论GTSEP与PVP治疗BPH均能获得较好的效果,GTSEP能更大程度去除增生的腺体组织,手术效率优于PVP。展开更多
目的：探讨经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生（BPH）的临床应用。方法：选择单纯BPH有手术指征患者90例,年龄59~83岁,平均71岁,随机分为2组,I组（50例）行经尿道前列腺电切术（TURP）,Ⅱ组（40例）行经尿道等离子双...目的：探讨经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生（BPH）的临床应用。方法：选择单纯BPH有手术指征患者90例,年龄59~83岁,平均71岁,随机分为2组,I组（50例）行经尿道前列腺电切术（TURP）,Ⅱ组（40例）行经尿道等离子双极电刀前列腺剜除术（PKEP）。统计每例患者术前前列腺体积、国际前列腺症状（IPSS）评分、生活质量指数（QOL）评分和最大尿流率（Qm ax）,手术时间,术中术后有无并发症、输血,术后有无膀胱持续冲洗及术后2周、术后6个月IPSS、QOL评分和Qm ax。结果：I组、II组术前前列腺体积平均为58.9、58.3 g;I组、II组手术时间平均为58.8、93.0 m in;I组患者中2例出现轻度电切综合征（TURS）,II组患者术中术后心电监护未发现异常;术后行膀胱持续冲洗分别有3例、1例;术后导尿管拔除后出现急迫性尿失禁分别有4例;90例患者术中、术后均无输血。术前、术后2周、术后6个月IPSS评分I组平均分别为19.7分、11.6分、5.1分,II组平均分别为18.6分、8.4分、4.9分;QOL评分I组平均分别为4.6分、3.3分、1.1分,II组平均分别为4.5分、2.7分、1.1分;Qm ax I组平均分别为6.3、13.0、18.1 m l/s,II组平均分别为6.9、14.2、19.0 m l/s。两组间的手术时间、术后2周IPSS、QOL评分,各组内术前与术后6个月IPSS、QOL评分、Qm ax的差异有统计学意义（P〈0.01）。两组间术前前列腺体积、术前IPSS、QOL评分和Qm ax、术后6个月IPSS、QOL评分及术后2周、术后6个月Qm ax的差异无统计学意义（P〉0.05）。结论：PKEP可安全、有效、彻底治疗BPH,可作为手术治疗BPH的一种选择。展开更多
Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, whic...Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.展开更多
Objective:According to the EAU Guidelines,transurethral resection of the prostate(TURP)has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostat...Objective:According to the EAU Guidelines,transurethral resection of the prostate(TURP)has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia(BPH).However,its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique.We reported the patient outcomes with our technique.Methods:We retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate(B-TUERP)between March 2015 and September 2015.Pre-and perioperative parameters were obtained from medical charts.Postoperative follow-ups were administrated at 1,3,6,12 and 24 month(s)after surgery,respectively.Results:All the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%.Qmax was significantly improved immediately after surgery,followed by a continuous improvement throughout the follow-ups.Following a steep decrease in mean prostate specific antigen(PSA)and post void residual(PVR)observed within the first half year after surgery,the serum PSA was then maintained at a constant level of 0.61 ng/mL.Temporary urinary retention was found in four cases(7.7%).Stress urinary incontinence occurred in five patients(9.6%),with the condition resolved in 1e2 weeks without extra treatment.Urethral strictures and bladder neck contractures,as the most commonly observed long-term complications,developed in four patients(7.7%).No recurrence was found during 2 years of follow-ups.An improvement in International Index of Erectile Function(IIEF-5)scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery,and sustained throughout the 24-month period.Conclusions:Enucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practic展开更多
基金the National Key Research and Development Program of China(grand number 2017YFC0110405)the National Natural Science Foundation of China(grant number 81500499).
文摘The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO Handbook for Guideline Development, a Consensus Steering Group* and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of;evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.
文摘目的：比较经尿道2μm激光前列腺剜除术及前列腺电切术治疗大体积良性前列腺增生的疗效及安全性。方法收集2011～2013年间79例在我院手术治疗的前列腺体积＞80 m L患者的临床资料，其中经尿道2μm激光前列腺剜除术45例，前列腺电切术34例，比较两组病例的手术时间、切除的腺体组织重量、术中出血量、持续膀胱冲洗时间、留置尿管时间、手术并发症及手术前后最大尿流率（Qmax）、残余尿量（PVRU）、国际前列腺症状评分（IPSS）、以及生活质量评分（QOL）情况。结果79例患者均一次手术成功，两组患者手术时间、术中出血量、持续膀胱冲洗时间、留置尿管时间比较，差异具有统计学意义（P＜0．05）；两组术中所切除的前列腺体组织重量无统计学差异（P＞0．05）；两组术后发生暂时性尿失禁、泌尿系感染、二次出血的例数比较，差异具有统计学意义（P＜0．05），两组均无死亡病例；两组患者Qmax、PVRU、IPSS及QOL评分较术前均有明显改善（P＜0．05），但两组间比较差异均无统计学意义（P＞0．05）。结论对于前列腺体积＞80 mL的大体积BPH患者，在做好围手术期准备、术者经验丰富的情况下，经尿道2μm激光前列腺剜除术和T U RP均有明显的临床效果，特别是经尿道2μm激光前列腺剜除术更具有术中出血少、安全性高、并发症少等优点。
文摘目的对比经尿道直出光纤绿激光前列腺锐性剜除术(green light top-firing,sharp enucleation of the prostate,GTSEP)和绿激光选择性光汽化术(photoselective vaporisation of the prostate,PVP)治疗良性前列腺增生症(benign prostatic hyperplasia,BPH)患者的有效性和安全性。方法选取2018年6月至2019年4月在本院诊治的154例BPH患者,按随机数字表法分为两组,每组77例,分别行GTSEP和PVP。评估两组患者术前一般情况,记录并比较术后第1个月和第6个月国际前列腺症状评分(IPSS)、生活质量评分(QoLs)、残余尿(PVR)、最大尿流率(Qmax)、前列腺体积(PV)、前列腺特异抗原(PSA)及并发症等。结果两组各有74例患者完成了随访。两组患者术前基本资料差异无统计学意义。术后1、6个月,两组患者下尿路症状均较术前明显改善,但IPSS、QoLs、PVR、Qmax、PSA差异无统计学意义。GTSEP组手术时间明显短于PVP组(41.0±16.4 vs 50.1±18.1 min,P=0.001),术后6个月GTSEP组前列腺体积小于PVP组(22.4±2.4 vs 23.3±1.9 mL,P=0.011)。两组术中和术后近期并发症差异无统计学意义。结论GTSEP与PVP治疗BPH均能获得较好的效果,GTSEP能更大程度去除增生的腺体组织,手术效率优于PVP。
文摘目的：探讨经尿道等离子双极电刀前列腺剜除术治疗良性前列腺增生（BPH）的临床应用。方法：选择单纯BPH有手术指征患者90例,年龄59~83岁,平均71岁,随机分为2组,I组（50例）行经尿道前列腺电切术（TURP）,Ⅱ组（40例）行经尿道等离子双极电刀前列腺剜除术（PKEP）。统计每例患者术前前列腺体积、国际前列腺症状（IPSS）评分、生活质量指数（QOL）评分和最大尿流率（Qm ax）,手术时间,术中术后有无并发症、输血,术后有无膀胱持续冲洗及术后2周、术后6个月IPSS、QOL评分和Qm ax。结果：I组、II组术前前列腺体积平均为58.9、58.3 g;I组、II组手术时间平均为58.8、93.0 m in;I组患者中2例出现轻度电切综合征（TURS）,II组患者术中术后心电监护未发现异常;术后行膀胱持续冲洗分别有3例、1例;术后导尿管拔除后出现急迫性尿失禁分别有4例;90例患者术中、术后均无输血。术前、术后2周、术后6个月IPSS评分I组平均分别为19.7分、11.6分、5.1分,II组平均分别为18.6分、8.4分、4.9分;QOL评分I组平均分别为4.6分、3.3分、1.1分,II组平均分别为4.5分、2.7分、1.1分;Qm ax I组平均分别为6.3、13.0、18.1 m l/s,II组平均分别为6.9、14.2、19.0 m l/s。两组间的手术时间、术后2周IPSS、QOL评分,各组内术前与术后6个月IPSS、QOL评分、Qm ax的差异有统计学意义（P〈0.01）。两组间术前前列腺体积、术前IPSS、QOL评分和Qm ax、术后6个月IPSS、QOL评分及术后2周、术后6个月Qm ax的差异无统计学意义（P〉0.05）。结论：PKEP可安全、有效、彻底治疗BPH,可作为手术治疗BPH的一种选择。
文摘Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.
文摘Objective:According to the EAU Guidelines,transurethral resection of the prostate(TURP)has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia(BPH).However,its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique.We reported the patient outcomes with our technique.Methods:We retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate(B-TUERP)between March 2015 and September 2015.Pre-and perioperative parameters were obtained from medical charts.Postoperative follow-ups were administrated at 1,3,6,12 and 24 month(s)after surgery,respectively.Results:All the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%.Qmax was significantly improved immediately after surgery,followed by a continuous improvement throughout the follow-ups.Following a steep decrease in mean prostate specific antigen(PSA)and post void residual(PVR)observed within the first half year after surgery,the serum PSA was then maintained at a constant level of 0.61 ng/mL.Temporary urinary retention was found in four cases(7.7%).Stress urinary incontinence occurred in five patients(9.6%),with the condition resolved in 1e2 weeks without extra treatment.Urethral strictures and bladder neck contractures,as the most commonly observed long-term complications,developed in four patients(7.7%).No recurrence was found during 2 years of follow-ups.An improvement in International Index of Erectile Function(IIEF-5)scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery,and sustained throughout the 24-month period.Conclusions:Enucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practic
