In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vap...In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vapor enucleation and resection of the prostate(TVERP),transurethral vapor enucleation of the prostate(TVEP),and ultrasound-navigated TVEP(US-TVEP)are new,innovative endoscopic enucleation procedures.These procedures are named Xie’s Prostate Enucleations(Xie’s Procedures for short).Current clinical data indicate that Xie’s Procedures are safe and effective treatment options for patients with BPH,especially for patients with larger prostates.Further prospective,randomized clinical trials compared with traditional transurethral resection of prostate(TURP)are still needed.展开更多
AIM:To evaluate clinical characteristics,treatment patterns and long-term quality of life(QoL)among children with retinoblastoma(RB)managed at a single tertiary center in China.METHODS:Totally 62 consecutive patients(...AIM:To evaluate clinical characteristics,treatment patterns and long-term quality of life(QoL)among children with retinoblastoma(RB)managed at a single tertiary center in China.METHODS:Totally 62 consecutive patients(71 eyes)diagnosed with RB were retrospectively reviewed.The mean age at first visit was 22.13±17.87mo;35(56.45%)were male.Unilateral disease occurred in 53 patients(85.48%)and bilateral disease in 9(14.52%).According to the international intraocular retinoblastoma classification(IIRC),eyes were staged as A(n=6),B(n=9),C(n=9),D(n=21),E(n=19),and extraocular(n=7).Treatments followed stagebased indications.QoL at follow-up was assessed using validated pediatric ophthalmic instruments completed by patients and/or parents.RESULTS:The mean follow-up duration was 42.9±6.49mo.Overall survival was 90.32%(56/62),mortality was 9.68%(6/62).The overall globe-preservation rate was 64.79%(46/71),and 71.88%(46/64)for intraocular RB.Eye salvage by IIRC stage was 100%for A–C,71.43%(15/21)for D,and 36.84%(7/19)for E;no eyes were preserved in extraocular disease.Compared with the globe-preservation group,enucleated children had significantly lower scores in appearance,social functioning,and role domains on QoL measures(P<0.05).Across all PedEyeQ domains,children with preserved globes scored higher than those who underwent enucleation(P<0.05).CONCLUSION:Most children in this cohort present with intermediate-to-advanced disease,which limit eyepreservation opportunities.While survival approached contemporary benchmarks,QoL deficits are most pronounced in appearance,social participation,and role functioning after enucleation.Additionally,parents of children who underwent enucleation often experience heightened anxiety about their child’s vision and social integration.These findings underscore the need for earlier detection and integrated psychosocial support alongside stage-appropriate therapy.展开更多
Decisions regarding the management of patients with esophageal gastrointestinal tumors(EGISTs)are very challenging,as there are still no clear guidelines on the treatment of these tumors due to their rarity.Surgery re...Decisions regarding the management of patients with esophageal gastrointestinal tumors(EGISTs)are very challenging,as there are still no clear guidelines on the treatment of these tumors due to their rarity.Surgery remains the standard treatment,but it is known that surgical procedures performed on the esophagus are related to a high risk of serious postoperative complications and impaired quality of life.Endoscopic resection is both safe and effective for patients with low-risk EGISTs.This article presents the current therapeutic options in patients with EGISTs,including both the endoscopic and surgical approach,and discusses the results,strengths and limitations of the recent article by Xu et al regarding the endoscopic treatment outcome of EGISTs.展开更多
Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a m...Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.展开更多
Introduction:Holmium Laser Enucleation of the Prostate(HoLEP)is a size-independent,endoscopic management option for benign prostatic hyperplasia(BPH).HoLEP offers a distinct advantage for patients who are at high-risk...Introduction:Holmium Laser Enucleation of the Prostate(HoLEP)is a size-independent,endoscopic management option for benign prostatic hyperplasia(BPH).HoLEP offers a distinct advantage for patients who are at high-risk for bleeding whilst preserving prostatic tissue for pathology analysis,unlike photoselective vaporization.Further,HoLEP avoids the need for cystotomy,unlike simple open and robotic prostatectomy,by using intravesical morcellation.We report our experience with the first 1000 HoLEP procedures at our institution.Materials and Methods:We performed a retrospective review of all HoLEP procedures performed at our institution from 2013–2021 to capture patient demographics,procedure details,and outcomes.Unpaired two sample ttestswere used to compare outcomes,p<0.05 considered statistically significant.Results:The average patient age and BMI were 71.1 y(±8.1 y)and 27.9 kg/m^(2)(±4.9 kg/m^(2)),respectively.69.4%of patients were on an alpha blocker and 33.3%of patients were on a 5-alpha reductase inhibitor preoperatively.11.2%of cases were redo outlet procedures including after prior Urolift.Average prostate volume was 108.0 mL(±66.5 mL)and average enucleation time was 119.7 min(±56 min).On average,65 g(±53.2 g)prostate tissue was resected.Pre-operative and postoperative flow,post-void residual(PVR),AUAsymptom score(AUA-SS),and quality of life(QoL)score showed notable improvement.Complication rates remained low,with the most common including blood transfusion(2.8%),urethral stricture(1.9%),and persistent stress urinary incontinence(1.3%).Conclusions:HoLEP is emerging as the new surgical gold standard for BPH.A steep learning curve remains for urologists.Nonetheless,this procedure holds great promise in improving patient experiences with BPH.展开更多
[Objective] The study aimed to provide references for the time of oocyte maturation in vitro and enucleation in the course of sheep nuclear transfer(NT).[Method] Compared the effects of different maturation time of oo...[Objective] The study aimed to provide references for the time of oocyte maturation in vitro and enucleation in the course of sheep nuclear transfer(NT).[Method] Compared the effects of different maturation time of oocytes on enucleation efficiency and reconstructed embryo development by means of blind enucleation and fluorescence microscopy.[Result] Treatment of IVM(in vitro maturation)19-21 h was significantly higher than IVM 16-18 h treatment in oocyte maturation rate(P<0.05)and was significantly higher than IVM 22-24 h treatment in enucleation rate(P<0.05).Three treatments had no significant difference in cleavage rate and blastocyst rate(P>0.05),but IVM 19-21 h treatment was significantly higher than the other 2 treatments in average cell number of blastocysts(P<0.05).[Conclusion] The appropriate in vitro maturation time of oocytes was 19-21 h for sheep nuclear transfer,which could significantly improve the quality of blastocysts according to the cell number per blastocyst(P<0.05).展开更多
AIM: To investigate the eligible management of the cystic neplasms of the liver. METHODS: The charts of 9 patients who underwent surgery for intrahepatic biliary cystic liver neoplasms between 2003 and 2008 were revie...AIM: To investigate the eligible management of the cystic neplasms of the liver. METHODS: The charts of 9 patients who underwent surgery for intrahepatic biliary cystic liver neoplasms between 2003 and 2008 were reviewed retrospectively. Informed consent was obtained from the patients and approval was obtained from the designated review board of the institution. RESULTS: All patients were female with a median (range) age of 49 (27-60 years). The most frequent symptom was abdominal pain in 6 of the patients. Four patients had undergone previous laparotomy (with other diagnoses) which resulted in incomplete surgery or recurrences. Liver resection (n = 6) or enucleation (n = 3) was performed. The final diagnosis was intrahepaticbiliary cystadenoma in 8 patients and cystadenocarcinoma in 1 patient. All symptoms resolved after surgery. There has been no recurrence during a median (range) 31 (7-72) mo of follow up. CONCLUSION: In spite of the improvement in imaging modalities and increasing recognition of biliary cystadenoma and cystadenocarcinoma, accurate preoperative diagnosis may be difficult. Complete surgical removal (liver resection or enucleation) of these lesions yields satisfying long-term results.展开更多
Pancreatic schwannomas are rare neoplasms. Authors briefly describe a 64-year-old female patient with cystic pancreatic schwannoma mimicking other cystic tumors and review the literature. Databases for PubMed were sea...Pancreatic schwannomas are rare neoplasms. Authors briefly describe a 64-year-old female patient with cystic pancreatic schwannoma mimicking other cystic tumors and review the literature. Databases for PubMed were searched for English-language articles from 1980 to 2010 using a list of keywords, as well as references from review articles. Only 41 articles, including 47 cases, have been reported in the English literature. The mean age was 55.7 years （range 20-87 years）, with 45% of patients being male. Mean tumor size was 6.2 cm （range 1-20 cm）. Tumor location was the head （40%）, head and body （6%）, body （21%）, body and tail （15%）, tail （4%）, and uncinate process （13%）. Thirty-four percent of patients exhibited solid tumors and 60% of patients exhibited cystic tumors. Treatment included pancreati- coduodenectomy （32%）, distal pancreatectomy （21%）, enucleation （15%）, unresectable （4%）, refused opera- tion （2%） and the detail of resection was not specified in 26% of patients. No patients died of disease with a mean follow-up of 15.7 mo （range 3-65 too）, although 5 （11%） patients had a malignancy. The tumor size was significantly related to malignant tumor （13.8 ＋ 6.2 cm for malignancy vs 5.5 ＋ 4.4 cm for benign, P = 0.001） and cystic formation （7.9 ~ 5.9 cm for cystic tumor vs 3.9 ＋ 2.4 cm for solid tumor, P = 0.005）. The preoperative diagnosis of pancreatic schwannoma remains difficult. Cystic pancreatic schwannomas should be considered in the differential diagnosis of cystic neoplasms and pseudocysts. In our caset intraoperative frozen sec- tion confirmed the diagnosis of a schwannoma. Simple enudeation may be adequate, if this is possible.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
The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (L...The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons’ experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve.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 practice.Currently,bipolar resection is a commonly employed procedure in clinical settings,and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists.Based on these findings,we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.展开更多
Esophageal gastrointestinal stromal tumors(GISTs) are extremely uncommon,representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction(EGJ).The treatment option...Esophageal gastrointestinal stromal tumors(GISTs) are extremely uncommon,representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction(EGJ).The treatment options available for these GISTs are fairly controversial.Many different options are nowadays at our disposal.From surgery to the target therapies we have the possibility to treat the majority of GISTs,including those which are defined as unresectable.The EGJ GISTs represent a stimulating challenge for the surgeon.The anatomical location increases the possibility of postoperative complications.As the role of negative margins in GIST surgery is still controversial and the eff icacy of target therapy has been demonstrated,why not treat EGJ GISTs with enucleation and,where indicated,adjuvant target therapy?展开更多
Objective： The aim of this study was to evaluate the safety and efficiency of enucleation（EU） for proximal pancreatic non-invasive neoplasms.Methods： Patients with solitary non-invasive neoplasms in the proximal p...Objective： The aim of this study was to evaluate the safety and efficiency of enucleation（EU） for proximal pancreatic non-invasive neoplasms.Methods： Patients with solitary non-invasive neoplasms in the proximal pancreas from January 1998 to April 2014 at the Second Affiliated Hospital of Zhejiang University, Hangzhou, China were included.Different operations and outcomes were analyzed.Results： A total of 123 patients were enrolled.Forty patients（32.5%） underwent EU including 18 patients who had tumors close to the main pancreatic duct（MPD）.Sixty-one patients（49.6%） had pancreaticoduodenectomy（PD） performed and 22（17.9%） underwent central pancreatectomy（CP）.Pathological outcomes included neuroendocrine tumors, cystic lesions, and solid pseudopapillary tumors.Operation time, intra-operative blood loss, and duration of hospital stay were significantly reduced in the EU group.PD was associated with the greatest complication rate（55.7%）, followed by EU（50%） and CP（40.9%）, though the pancreatic fistula rate after EU was the highest（50%）, especially in patients with tumors larger than 3 cm and tumors close to the MPD.EU had advantages in the preservation of pancreatic parenchyma and endocrine and exocrine function.Conclusions： EU can be carried out safely and effectively for tumors in the proximal pancreas with improved outcomes compared with standard resections, even if the tumor is larger than 3 cm and close to the MPD.展开更多
·AIM: To assess main indications, postoperative complications and clinicopathological correlation of ocular enucleation-evisceration.·METHODS: A total of 107 subjects who underwent enucleation and/or eviscer...·AIM: To assess main indications, postoperative complications and clinicopathological correlation of ocular enucleation-evisceration.·METHODS: A total of 107 subjects who underwent enucleation and/or evisceration and received hydroxyapatite implants(Scleral wrap or mesh) were assessed. For each patient clinicopathological data was collected which included demographic information,clinical history, primary clinical diagnosis, main cause of ophthalmic surgery(traumatic, non-traumatic), type of surgical procedure(enucleation, evisceration) and pathological report. Patients’ postoperative clinical visits were checked for procedure-related complications during first year after surgery.·RESULTS: One hundred and seven patients(male:65.4%; mean age: 26y) underwent enucleation(n=100) or evisceration(n =7) due to traumatic(n =41) and non-traumatic(n =66) causes. Disfiguring painful blind eye was the most common indication of surgery(66.4%),followed by leukocoria(19.6%) and endophthalmitis(4.7%). The main types of injury included firecracker,traffic and work accidents, and sharp object perforating injury. In 53(80.3%) subjects in non-traumatic group the initial clinical diagnosis matched the histopathologicalresults. Malignant tumors(retinoblastoma: 47.5%,malignant melanoma: 27.3%) were the most common pathological diagnoses followed by phthisis bulbi(25.8%).The most common procedure-related complications were major eye discharge(39.6%), and implant exposure and discharge(20.8%).·CONCLUSION: Trauma and malignant tumors are the leading causes of enucleation-evisceration. Despite developing new techniques and materials, enucleation is still associated with considerable postoperative complications.展开更多
AIM: To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration. METHODS: A retrospective study of 573 eye...AIM: To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration. METHODS: A retrospective study of 573 eyes removed (573 inpatients) at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed. RESULTS: Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14%) being enucleated and 406 (70.86%) eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62%) in original protopathies followed by neoplasm (13.44%) and ocular infections (5.76%). Phthisis bulbi (45.20%) was the most common direct indication, succeeded by malignant tumor (12.57%), loss/unreconstructed of intraocular tissues due to trauma (11.00%), untreatable inflammation (9.60%), intractable glaucoma (8.55%) and sclerocorneal staphyloma (5.24%). Exenteration was underwent in 20 (25.97%) cases (40% for recurrent carcinoma). Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%. CONCLUSION: Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be focused on.展开更多
In a recently published letter to the editor, we debated the proposal by Coccolini et al to treat gastrointestinal stromal tumors (GISTs) of the esophagogastric junction with enucleation and, if indicated, adjuvant th...In a recently published letter to the editor, we debated the proposal by Coccolini et al to treat gastrointestinal stromal tumors (GISTs) of the esophagogastric junction with enucleation and, if indicated, adjuvant therapy. We highlighted that, because the prognostic impact of a T1 high-mitotic rate esophageal GIST is worse than that of a T1 high-mitotic rate gastric GIST, enucleation may not be adequate surgery for esophagogastric GISTs with a high mitotic rate. In rebuttal, Coccolini et al pointed out the possible bias in assessment of the mitotic rates due to the lack of standardized methods and underlined that the site and features of the tumor need to be carefully considered in evaluation of the risk-benefit balance. Here we confirm that, apart from the problematic issue of mitotic counting, enucleation should not be indicated for GISTs at any site to reduce the risk of tumor rupture, which has been recently considered to be an unfavorable prognostic factor, and to avoid microscopic residual tumor.展开更多
We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of pat...We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.展开更多
Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resec...Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment,whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function.Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas,especially in teenagers and children.This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions.Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs.However,many questions remain unresolved,and future directions toward the best surgical indication,the prevention and intervention of complications,especially pancreatic fistula,intraoperative resection margin safety assessment,and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.展开更多
文摘In the past 2 decades,endoscopic enucleation of the prostate has become a safe and effective surgical treatment for benign prostatic hyperplasia(BPH),with comparable outcomes to traditional surgeries.Transurethral vapor enucleation and resection of the prostate(TVERP),transurethral vapor enucleation of the prostate(TVEP),and ultrasound-navigated TVEP(US-TVEP)are new,innovative endoscopic enucleation procedures.These procedures are named Xie’s Prostate Enucleations(Xie’s Procedures for short).Current clinical data indicate that Xie’s Procedures are safe and effective treatment options for patients with BPH,especially for patients with larger prostates.Further prospective,randomized clinical trials compared with traditional transurethral resection of prostate(TURP)are still needed.
基金Supported by The Key Research and Development Program of Hubei Province(No.2022BCA044)The Key Scientific Research Program of Health Commission of Hubei Province(No.WJ2023Z006).
文摘AIM:To evaluate clinical characteristics,treatment patterns and long-term quality of life(QoL)among children with retinoblastoma(RB)managed at a single tertiary center in China.METHODS:Totally 62 consecutive patients(71 eyes)diagnosed with RB were retrospectively reviewed.The mean age at first visit was 22.13±17.87mo;35(56.45%)were male.Unilateral disease occurred in 53 patients(85.48%)and bilateral disease in 9(14.52%).According to the international intraocular retinoblastoma classification(IIRC),eyes were staged as A(n=6),B(n=9),C(n=9),D(n=21),E(n=19),and extraocular(n=7).Treatments followed stagebased indications.QoL at follow-up was assessed using validated pediatric ophthalmic instruments completed by patients and/or parents.RESULTS:The mean follow-up duration was 42.9±6.49mo.Overall survival was 90.32%(56/62),mortality was 9.68%(6/62).The overall globe-preservation rate was 64.79%(46/71),and 71.88%(46/64)for intraocular RB.Eye salvage by IIRC stage was 100%for A–C,71.43%(15/21)for D,and 36.84%(7/19)for E;no eyes were preserved in extraocular disease.Compared with the globe-preservation group,enucleated children had significantly lower scores in appearance,social functioning,and role domains on QoL measures(P<0.05).Across all PedEyeQ domains,children with preserved globes scored higher than those who underwent enucleation(P<0.05).CONCLUSION:Most children in this cohort present with intermediate-to-advanced disease,which limit eyepreservation opportunities.While survival approached contemporary benchmarks,QoL deficits are most pronounced in appearance,social participation,and role functioning after enucleation.Additionally,parents of children who underwent enucleation often experience heightened anxiety about their child’s vision and social integration.These findings underscore the need for earlier detection and integrated psychosocial support alongside stage-appropriate therapy.
文摘Decisions regarding the management of patients with esophageal gastrointestinal tumors(EGISTs)are very challenging,as there are still no clear guidelines on the treatment of these tumors due to their rarity.Surgery remains the standard treatment,but it is known that surgical procedures performed on the esophagus are related to a high risk of serious postoperative complications and impaired quality of life.Endoscopic resection is both safe and effective for patients with low-risk EGISTs.This article presents the current therapeutic options in patients with EGISTs,including both the endoscopic and surgical approach,and discusses the results,strengths and limitations of the recent article by Xu et al regarding the endoscopic treatment outcome of EGISTs.
文摘Objective:Thulium fiber laser enucleation of the prostate(ThuFLEP)and robot-assisted simple prostatectomy(RASP)are two options for treating large benign prostatic hyperplasia.The most appropriate technique remains a matter of debate.We evaluated the efficacy and safety of ThuFLEP compared to RASP.Methods:Between January 2020 and December 2023,all patients who underwent either RASP or ThuFLEP for a prostate volume>80 mL were retrospectively included.The surgical procedure choice was left to the surgeon’s and patient’s discretion.Preoperative patient evaluation included the assessment of functional parameters.The groups were compared.Results:A total of 234 patients were included:106(45%)underwent RASP and 128(55%)underwent ThuFLEP.The mean operative time was shorter in the ThuFLEP group compared to the RASP group(106.4 with standard deviation[SD]46.1 min vs.123.2[SD 32.8]min,p=0.012).The mean lengths of catheterization and stay were significantly longer in the RASP group(5.0[SD 3.9]days vs.1.7[SD 2.0]days,p=0.009[catheterization]and 4.9[SD 3.0]days vs.1.9[SD 1.8]days,p=0.009[stay]).The overall complication rate was significantly higher in the ThuFLEP group(12%vs.2.8%in the RASP group,p=0.022).However,we did not observe significant differences in major complications(Clavien-Dindo≥3)between the two groups(four[3.1%]in the ThuFLEP group vs.one[0.94%]in the RASP group,p=0.073).At 3 months,the rate of stress urinary incontinence was 4.7%after ThuFLEP and 1.9%after RASP(p=0.2).Finally,the quality of life score and maximum urinary flow were comparable between the ThuFLEP and RASP groups,but the International Prostate Symptom Score at 3 months postoperatively was lower in the RASP group(p=0.012).Conclusion:Both ThuFLEP and RASP are safe techniques with comparable functional outcomes for large benign prostatic hyperplasia.ThuFLEP allows a reduction in catheterization and hospitalization durations but presents more complications compared to RASP.
文摘Introduction:Holmium Laser Enucleation of the Prostate(HoLEP)is a size-independent,endoscopic management option for benign prostatic hyperplasia(BPH).HoLEP offers a distinct advantage for patients who are at high-risk for bleeding whilst preserving prostatic tissue for pathology analysis,unlike photoselective vaporization.Further,HoLEP avoids the need for cystotomy,unlike simple open and robotic prostatectomy,by using intravesical morcellation.We report our experience with the first 1000 HoLEP procedures at our institution.Materials and Methods:We performed a retrospective review of all HoLEP procedures performed at our institution from 2013–2021 to capture patient demographics,procedure details,and outcomes.Unpaired two sample ttestswere used to compare outcomes,p<0.05 considered statistically significant.Results:The average patient age and BMI were 71.1 y(±8.1 y)and 27.9 kg/m^(2)(±4.9 kg/m^(2)),respectively.69.4%of patients were on an alpha blocker and 33.3%of patients were on a 5-alpha reductase inhibitor preoperatively.11.2%of cases were redo outlet procedures including after prior Urolift.Average prostate volume was 108.0 mL(±66.5 mL)and average enucleation time was 119.7 min(±56 min).On average,65 g(±53.2 g)prostate tissue was resected.Pre-operative and postoperative flow,post-void residual(PVR),AUAsymptom score(AUA-SS),and quality of life(QoL)score showed notable improvement.Complication rates remained low,with the most common including blood transfusion(2.8%),urethral stricture(1.9%),and persistent stress urinary incontinence(1.3%).Conclusions:HoLEP is emerging as the new surgical gold standard for BPH.A steep learning curve remains for urologists.Nonetheless,this procedure holds great promise in improving patient experiences with BPH.
基金Supported by School Program of Henan Institute of Science and Technology(20060516)~~
文摘[Objective] The study aimed to provide references for the time of oocyte maturation in vitro and enucleation in the course of sheep nuclear transfer(NT).[Method] Compared the effects of different maturation time of oocytes on enucleation efficiency and reconstructed embryo development by means of blind enucleation and fluorescence microscopy.[Result] Treatment of IVM(in vitro maturation)19-21 h was significantly higher than IVM 16-18 h treatment in oocyte maturation rate(P<0.05)and was significantly higher than IVM 22-24 h treatment in enucleation rate(P<0.05).Three treatments had no significant difference in cleavage rate and blastocyst rate(P>0.05),but IVM 19-21 h treatment was significantly higher than the other 2 treatments in average cell number of blastocysts(P<0.05).[Conclusion] The appropriate in vitro maturation time of oocytes was 19-21 h for sheep nuclear transfer,which could significantly improve the quality of blastocysts according to the cell number per blastocyst(P<0.05).
文摘AIM: To investigate the eligible management of the cystic neplasms of the liver. METHODS: The charts of 9 patients who underwent surgery for intrahepatic biliary cystic liver neoplasms between 2003 and 2008 were reviewed retrospectively. Informed consent was obtained from the patients and approval was obtained from the designated review board of the institution. RESULTS: All patients were female with a median (range) age of 49 (27-60 years). The most frequent symptom was abdominal pain in 6 of the patients. Four patients had undergone previous laparotomy (with other diagnoses) which resulted in incomplete surgery or recurrences. Liver resection (n = 6) or enucleation (n = 3) was performed. The final diagnosis was intrahepaticbiliary cystadenoma in 8 patients and cystadenocarcinoma in 1 patient. All symptoms resolved after surgery. There has been no recurrence during a median (range) 31 (7-72) mo of follow up. CONCLUSION: In spite of the improvement in imaging modalities and increasing recognition of biliary cystadenoma and cystadenocarcinoma, accurate preoperative diagnosis may be difficult. Complete surgical removal (liver resection or enucleation) of these lesions yields satisfying long-term results.
文摘Pancreatic schwannomas are rare neoplasms. Authors briefly describe a 64-year-old female patient with cystic pancreatic schwannoma mimicking other cystic tumors and review the literature. Databases for PubMed were searched for English-language articles from 1980 to 2010 using a list of keywords, as well as references from review articles. Only 41 articles, including 47 cases, have been reported in the English literature. The mean age was 55.7 years （range 20-87 years）, with 45% of patients being male. Mean tumor size was 6.2 cm （range 1-20 cm）. Tumor location was the head （40%）, head and body （6%）, body （21%）, body and tail （15%）, tail （4%）, and uncinate process （13%）. Thirty-four percent of patients exhibited solid tumors and 60% of patients exhibited cystic tumors. Treatment included pancreati- coduodenectomy （32%）, distal pancreatectomy （21%）, enucleation （15%）, unresectable （4%）, refused opera- tion （2%） and the detail of resection was not specified in 26% of patients. No patients died of disease with a mean follow-up of 15.7 mo （range 3-65 too）, although 5 （11%） patients had a malignancy. The tumor size was significantly related to malignant tumor （13.8 ＋ 6.2 cm for malignancy vs 5.5 ＋ 4.4 cm for benign, P = 0.001） and cystic formation （7.9 ~ 5.9 cm for cystic tumor vs 3.9 ＋ 2.4 cm for solid tumor, P = 0.005）. The preoperative diagnosis of pancreatic schwannoma remains difficult. Cystic pancreatic schwannomas should be considered in the differential diagnosis of cystic neoplasms and pseudocysts. In our caset intraoperative frozen sec- tion confirmed the diagnosis of a schwannoma. Simple enudeation may be adequate, if this is possible.
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The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons’ experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve.
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 practice.Currently,bipolar resection is a commonly employed procedure in clinical settings,and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists.Based on these findings,we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.
文摘Esophageal gastrointestinal stromal tumors(GISTs) are extremely uncommon,representing approximately 5% of GISTs with the majority of esophageal GISTs occurring at the esophagogastric junction(EGJ).The treatment options available for these GISTs are fairly controversial.Many different options are nowadays at our disposal.From surgery to the target therapies we have the possibility to treat the majority of GISTs,including those which are defined as unresectable.The EGJ GISTs represent a stimulating challenge for the surgeon.The anatomical location increases the possibility of postoperative complications.As the role of negative margins in GIST surgery is still controversial and the eff icacy of target therapy has been demonstrated,why not treat EGJ GISTs with enucleation and,where indicated,adjuvant target therapy?
基金Project supported by the National Natural Science Foundation of China(Nos.30672072 and 30872531)the Foundation of Science and Technology Department of Zhejiang Province,China(Nos.2014C 33187)the National High-Tech R&D Program(863)of China(No.2007AA02Z476)
文摘Objective： The aim of this study was to evaluate the safety and efficiency of enucleation（EU） for proximal pancreatic non-invasive neoplasms.Methods： Patients with solitary non-invasive neoplasms in the proximal pancreas from January 1998 to April 2014 at the Second Affiliated Hospital of Zhejiang University, Hangzhou, China were included.Different operations and outcomes were analyzed.Results： A total of 123 patients were enrolled.Forty patients（32.5%） underwent EU including 18 patients who had tumors close to the main pancreatic duct（MPD）.Sixty-one patients（49.6%） had pancreaticoduodenectomy（PD） performed and 22（17.9%） underwent central pancreatectomy（CP）.Pathological outcomes included neuroendocrine tumors, cystic lesions, and solid pseudopapillary tumors.Operation time, intra-operative blood loss, and duration of hospital stay were significantly reduced in the EU group.PD was associated with the greatest complication rate（55.7%）, followed by EU（50%） and CP（40.9%）, though the pancreatic fistula rate after EU was the highest（50%）, especially in patients with tumors larger than 3 cm and tumors close to the MPD.EU had advantages in the preservation of pancreatic parenchyma and endocrine and exocrine function.Conclusions： EU can be carried out safely and effectively for tumors in the proximal pancreas with improved outcomes compared with standard resections, even if the tumor is larger than 3 cm and close to the MPD.
文摘·AIM: To assess main indications, postoperative complications and clinicopathological correlation of ocular enucleation-evisceration.·METHODS: A total of 107 subjects who underwent enucleation and/or evisceration and received hydroxyapatite implants(Scleral wrap or mesh) were assessed. For each patient clinicopathological data was collected which included demographic information,clinical history, primary clinical diagnosis, main cause of ophthalmic surgery(traumatic, non-traumatic), type of surgical procedure(enucleation, evisceration) and pathological report. Patients’ postoperative clinical visits were checked for procedure-related complications during first year after surgery.·RESULTS: One hundred and seven patients(male:65.4%; mean age: 26y) underwent enucleation(n=100) or evisceration(n =7) due to traumatic(n =41) and non-traumatic(n =66) causes. Disfiguring painful blind eye was the most common indication of surgery(66.4%),followed by leukocoria(19.6%) and endophthalmitis(4.7%). The main types of injury included firecracker,traffic and work accidents, and sharp object perforating injury. In 53(80.3%) subjects in non-traumatic group the initial clinical diagnosis matched the histopathologicalresults. Malignant tumors(retinoblastoma: 47.5%,malignant melanoma: 27.3%) were the most common pathological diagnoses followed by phthisis bulbi(25.8%).The most common procedure-related complications were major eye discharge(39.6%), and implant exposure and discharge(20.8%).·CONCLUSION: Trauma and malignant tumors are the leading causes of enucleation-evisceration. Despite developing new techniques and materials, enucleation is still associated with considerable postoperative complications.
文摘AIM: To investigate the original protopathy, direct indications, clinical characteristics, complications of orbit plants and visual conditions of eye enucleation/evisceration. METHODS: A retrospective study of 573 eyes removed (573 inpatients) at Ophthalmology Department in a tertiary care center of China from January 1993 to December 2012 was completed. RESULTS: Cases underwent removal of the eye accounted for 2.15% of total ophthalmology inpatients, whose annual frequency declined from 3.80% to 0.52%. There were 167 eyes (29.14%) being enucleated and 406 (70.86%) eviscerated. Annual proportion of evisceration rose from 16.67% in 1993 to 90.48% in later years. Trauma was the top one (65.62%) in original protopathies followed by neoplasm (13.44%) and ocular infections (5.76%). Phthisis bulbi (45.20%) was the most common direct indication, succeeded by malignant tumor (12.57%), loss/unreconstructed of intraocular tissues due to trauma (11.00%), untreatable inflammation (9.60%), intractable glaucoma (8.55%) and sclerocorneal staphyloma (5.24%). Exenteration was underwent in 20 (25.97%) cases (40% for recurrent carcinoma). Following evisceration, secondary prosthesis implantation was more and earlier, implant exposure occurred in less but earlier and infection and extraction/exchange of implants were more than those following enucleation. Male, phthisis bulbi, evisceration and secondary implantation meant lower risk of implant exposure; eyes removed within 24h following trauma was an independent risk factor. There were 14.37% of eyes with vision of light perception at least as been removed. In the residual contralateral eyes, low vision accounted 5.58% and blindness 3.14%. CONCLUSION: Ocular trauma, tumor and infections were great threats to eyeball preservation. Early and effective controlling of any original protopathies was vital. Generally evisceration presented more superior and safe outcomes than enucleation did. Visual conditions of the sufferers should be focused on.
文摘In a recently published letter to the editor, we debated the proposal by Coccolini et al to treat gastrointestinal stromal tumors (GISTs) of the esophagogastric junction with enucleation and, if indicated, adjuvant therapy. We highlighted that, because the prognostic impact of a T1 high-mitotic rate esophageal GIST is worse than that of a T1 high-mitotic rate gastric GIST, enucleation may not be adequate surgery for esophagogastric GISTs with a high mitotic rate. In rebuttal, Coccolini et al pointed out the possible bias in assessment of the mitotic rates due to the lack of standardized methods and underlined that the site and features of the tumor need to be carefully considered in evaluation of the risk-benefit balance. Here we confirm that, apart from the problematic issue of mitotic counting, enucleation should not be indicated for GISTs at any site to reduce the risk of tumor rupture, which has been recently considered to be an unfavorable prognostic factor, and to avoid microscopic residual tumor.
文摘We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate(EEP)comparing en-bloc(Group 1)versus 2-lobe/3-lobe techniques(Group 2).We performed a retrospective review of patients undergoing EEP for benign prostaticenlargement in 12 centers between January 2020 and January 2022.Data were presented as median and interquartile range(IQR).Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence(SUI)and mixed urinary incontinence(MUI).There were 1711 patients in Group 1 and 3357 patients in Group 2.Patients in Group 2were significantly younger(68[62–73]years vs 69[63–74]years,P=0.002).Median(interquartile range)prostate volume(PV)wassimilar between the groups(70[52–92]ml in Group 1 vs 70[54–90]ml in Group 2,P=0.774).There was no difference in preoperativeInternational Prostate Symptom Score,quality of life,or maximum flow rate.Enucleation,morcellation,and total surgical time weresignificantly shorter in Group 1.Within 1 month,overall incontinence rate was 6.3%in Group 1 versus 5.3%in Group 2(P=0.12),and urge incontinence was significantly higher in Group 1(55.1%vs 37.3%in Group 2,P<0.001).After 3 months,the overall rate ofincontinence was 1.7%in Group 1 versus 2.3%in Group 2(P=0.06),and SUI was significantly higher in Group 2(55.6%vs 24.1%in Group 1,P=0.002).At multivariable analysis,PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI.PV,surgical time,and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.
基金Supported by the Key Research and Development Projects in Sichuan Province,No.2019YFS0043the 1·3·5 Project for Disciplines of Excellence,West China Hospital,Sichuan University,No.ZY2017302-1.3.5.
文摘Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment,whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function.Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas,especially in teenagers and children.This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions.Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs.However,many questions remain unresolved,and future directions toward the best surgical indication,the prevention and intervention of complications,especially pancreatic fistula,intraoperative resection margin safety assessment,and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.
