The Research And Application Of Endoscopic Surveillance System In The Percutaneous Nephrolithotomy

Objective We used the endoscopic surveillance system to monitor the fluid absorption and blood loss in percutaneous nephrolithotomy. We also evaluated the change and influence factors of fluid absorption, blood loss, hemodynamics, electrolytes and renal function of the percutaneous nephrolithotomy.Method We analyzed the data of 22 patient who undergone percutaneous nephrolithotomy at our hospital between February 2014 and March 2015. Before PCNL, we monitor the accuracy test of endoscopic surveillance system firstly. Then we used the endoscopic surveillance system to monitor the fluid absorption and blood loss in percutaneous nephrolithotomy. We also need to record the change of heart rate, mean arterial blood pressure, pulse oxygen saturation, hemoglobin, hematocrit, electrolytes and renal function.Result In this study, all of the PCNL used the single channel, and all of the operation were successful. The irrigation time is 27-104 min(54.86±21.61 min), irrigation fluid volume is 10380-33945ml(19474.86±6572.15ml), the volume absorbed is 468-1696ml(933.36±318.19ml), the volume of blood loss is 27.5-113.lml(72.50±25.33ml). The fluid absorption was observed when the irrigation fluid volume, total irrigation time and the volume of blood loss exceeded 18L, 50 min and 80ml, respectively. There was significant difference in the volume of blood loss when the irrigation fluid volume exceeded 60 min, and in the data of hemoglobin, hematocrit and Ca2+. The residual data of hemodynamics, electrolytes and renal function had not significant difference.Conclusion All of the 22 operations had found fluid absorption. The fluid absorption was increased when the irrigation fluid volume, total irrigation time and the volume of blood loss were added. And there was significant relation between the volume of blood loss and irrigation time. The endoscopic surveillance system can monitor the fluid absorption and blood loss in time, accurately and non-invasively, and provides information to the performer. So it can reduce the risk of surgery and complications.Objective To evaluate the tumor recurrence and prostatic fossa/bladder neck tumor recurrence rate of simultaneous transurethral resection of non-muscle invasive bladder cancer with benign prostatic hyperplasia.Method Search the literature of domestic and foreign comparative studies of simultaneous TURBT and TURP versus TURBT alone. According to the Cochrane system evaluation method, two independent Evaluator evaluate the data, using Review Manager version 5.3 statistical technical software to Meta analysis.Result 10 clinical trials were eligible. Totally 1603 patients were involved. In treatment group,57 cases had the recurrence of prostatic fossa/bladder neck,293 cases had tumor recurrence. Average follow-up time was 43.55 months (range 12 to 130 months). In control group, 67 cases had the recurrence of prostatic fossa/bladder neck,396 cases had tumor recurrence. Average follow-up time was 47.24 months (range 12 to 191 months). There was no statistically significant differences between treatment group and control group in the recurrence of prostatic fossa/bladder neck. Compare the two groups of tumor recurrence, the OR value of 0.74 (0.60, 0.91) (P= 0.005), showed that the simultaneous surgery has a low rate at tumor recurrence. And compare the two groups of prostatic fossa/bladder neck recurrence, the OR value of 0.25 [0.12, 0.52] (P= 0.0002), showed that the multiple tumors cases has a high rate at prostatic fossa/ bladder neck recurrence.Conclusion The simultaneous TURBT and TURP can not grow the risk of prostatic fossa/ bladder neck tumor recurrence. In the follow-up period, the simultaneous surgery has a low rate at tumor recurrence. TURBT and TURP can be performed at the same time.