目的 探討腹腔鏡聯合膽道鏡保膽取石術的臨床價值。方法 回顧性分析我院2009年2月至2010年2月期間95例腹腔鏡聯合膽道鏡保膽取石術患者的臨床資料。結果 95例患者均順利完成保膽取石術，平均手術時間49 min，術中平均出血量9 ml，除8例發生切口脂肪液化外無其他手術并發癥發生，1年內隨訪無復發。結論 在嚴格掌握適應證的前提下，對膽囊結石患者有選擇性地采用腹腔鏡聯合膽道鏡保膽取石術，是一種可供選擇的安全的微創治療方法。
ObjectiveTo investigate the feasibility and safety of percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent type Ⅱa hepatolithiasis.MethodsAll of 293 patients with recurrent type Ⅱa hepatolithiasis admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2010 to December 2017 were collected retrospectively, 82 of whom were treated with the PTCSL (PTCSL group), 211 of whom were treated with traditional open surgery (open group). The patients were matched according to the ratio of 1∶1 by using the method of propensity score matching, then the patients were compared after matching.ResultsA total of 59 pairs were successfully matched, that was, there were 59 patients in the PTCSL group and open group, respectively. Compared with the open group, the PTCSL group had the similar conditions such as the gender, age, preoperative Child-Pugh classification, and times of previous biliary operations, etc. (P>0.050). There was no perioperative death in both groups. There were no significant differences between the two groups in the success rate, operation time, times of operations, time of T tube removal after operation, stone residual rate, and stone recurrence rate (P>0.050). Although the hospital costs of the PTCSL group was higher than that of the open group (P<0.050), the PTCSL group had various advantages, such as less intraoperative bleeding, smaller incisional scar, shorter hospital stay and postoperative ventilation time, and lower rate of total postoperative complications (P<0.050).ConclusionsAfter learning curve, PTCSL has many advantages over traditional open surgery in treatment of recurrent type Ⅱa hepatolithiasis. PTCSL is a minimally invasive surgery, which is safe and effective.
目的:探討腹腔鏡膽囊切除術(LC)與內鏡十二指腸乳頭括約肌切開術(EST)聯合應用治療膽囊結石合并膽總管結石的臨床效果。方法:回顧性分析我院開展的LC聯合EST治療膽囊結石合并膽總管結石76例,其中56例先行EST后行LC,20例先行LC后行ERCP/EST。結果:本組全部治愈,先行EST組56例,3例并發胰腺炎,3例出血,2例再發膽總管結石,先行LC組20例行EST11例,6例取石后未做括約肌切開,3例結石自行掉入腸道,1例出現膽道感染,1例胰腺炎,無出血及穿孔。結論:內鏡治療膽囊結石繼發膽總管結石具有創傷小、效果好、并發癥少、恢復快的的特點;先作EST可解除膽道梗阻、減輕炎癥,并為LC創造條件,選擇性先行LC后可減輕創傷,甚至不必做EST。
ObjectiveTo summarize experience of endoscopic reverse biliary tract stent placement via choledochus in treatment of situs inversus totalis complicated with choledocholithiasis.MethodThe clinical data of one patient with situs inversus totalis complicated with choledocholithiasis in the Department of Tumor Surgery of Lanzhou University Second Hospital were retrospectively analyzed.ResultsThe ERCP was failed at the first admission, followed by the cholecystectomy plus choledocholithotomy plus T-tube drainage, the stones were removed. Two months later, choledochoscopy revealed multiple choledocholithiasis, then the holmium laser lithotripsy and bile duct stent placement was performed at the secondary admission, the postoperative recovery was good, it had been more than 2 months after the surgery, no stone recurrence occurred.ConclusionEndoscopic reverse biliary tract stent placement via choledochus is feasible, which can be used as an option for treatment of patient with situs inversus totalis complicated with choledocholithiasis.
目的 探討腹腔鏡膽總管切開取石術的優勢，總結手術操作經驗及常見并發癥的預防與處理。方法回顧性分析我院1999年6月至2010年4月期間收治的108 例膽管結石患者行腹腔鏡膽總管探查取石術的手術方法、操作要點及并發癥的處理。結果 腹腔鏡手術成功 105例, 中轉開腹3例; 手術時間（120±20） min,出血量（25±5） ml,住院時間（9±1） d; 術后發生膽道出血3例,漏膽7 例,殘余結石6 例; 全組無死亡病例。結論 腹腔鏡膽總管切開取石術具有創傷小、痛苦輕、恢復快、對腹腔臟器干擾小、住院時間短等優點，值得臨床推廣。
ObjectiveTo evaluate the efficacy and safety of the third-generation super-mini percutaneous nephrolithotomy (SMP) for the treatment of kidney calculi with diameter of ≤2.5 cm and CT value of ≥700 Hu, and discuss the feasibility of adopting the technology in primary hospitals.MethodsThe clinical data of 64 patients with unilateral kidney calculi (CT value ≥700 Hu, diameter ≤2.5 cm) treated in the People’s Hospital of Leshan Central District between July 2017 and July 2018 were retrospectively analyzed. After random assignment, 30 patients were treated with SMP and 34 were with mini percutaneous nephrolithotomy (MPCNL). The pre-, intra-, and post-operative data were compared and analyzed to evaluate the efficacy and safety.ResultsThe unilateral lesion operations of both groups were successfully completed in the first phase. All patients were given double J tubes after operation, and there were no major complications such as post-operative hemorrhage and sepsis. There was no statistically significant difference in the post-operative hemoglobin decrease, post-operative immediate stone removal rate, post-operative stone removal rate after one month, or the rate of procalcitonin >0.1 μg/L between the two groups (P>0.05). The differences in the lithotripsy time [(29.63±6.28) vs. (25.21±5.19) minutes], post-operative hospital stay [(5.33±0.61) vs. (9.44±0.96) days], rate of indwelling renal fistula (3.3% vs. 50.0%), analgesic demand rate (10.0% vs. 58.8%), and postoperative infectious fever rate (6.7% vs. 26.5%) between SMP group and MPCNL group were statistically significant (P<0.05).ConclusionsSMP has the advantages of less trauma, low systemic inflammatory response syndrome incidence, less pain, quick rehabilitation, short hospital stay, tubeless after surgery, etc. It is worthy of extensive promotion in primary hospitals.
ObjectiveTo analyze the causes and characteristics of massive hemorrhage secondary to percutaneous nephrolithotomy (PCNL) and assess the value of superselective renal artery embolization in the management of this condition. MethodsThe imaging data and prognosis of 28 patients who developed repeated massive hemorrhage secondary to PCNL and underwent superselective renal artery embolization between April 2005 and June 2013 were reviewed. ResultsFollowing superselective renal artery embolization, hemorrhage was effectively controlled in all the 28 patients. Follow-up lasted from 6 to 62 months, averaging 41.6 months. No hematuria or other complications occurred during the follow-up period. ConclusionSuperselective renal artery embolization is safe and effective in managing massive hemorrhage secondary to PCNL, and it may be used as a preferred treatment for patients who are refractory to expectant treatments.
Objective To compare clinical outcomes of percutaneous nephrolithotomy (PCNL) in patients who initially presented with and without urosepsis. Methods The study included patients who underwent PCNL for renal and ureter urolithiasis removal from January 2010 to December 2014 in our hospital. A 1∶1 matched-pair analysis was performed to compare outcomes and complications of patients who had obstructive urolithiasis with urosepsis initially (OUU) with patients who had obstructive urolithiasis with no urosepsis initially (NOUU) before PCNL. Results A total of 172 patients were included involving 122 (71%) males and 50 (29%) females with a mean age of 46.2 years (range 32 to 65 years). There were no significant differences between two groups in age, gender, BMI, complications, the size of the stones, stone's number and stone location (P>0.05). OUU groups had the similar stone-free rates (86.0%vs. 84.8%, P=0.829) as the NOUU group. OUU group had higher overall complications rate, longer duration of nephrostomy tube (NT), longer hospital length of stay (LOS), longer courses of postoperative antibiotics and higher grade of antibiotics after PCNL (all P<0.05). Higher fever developed postoperatively (11.6%vs. 3.5%, P=0.043), higher asymptomatic bacteriuria (11.6% vs. 3.5%, P=0.043) and symptomatic urinary tract infections (10.5% vs. 2.3%, P=0.029) were also found in OUU groups. There was no significant difference between two groups in sepsis (2.3% vs. 1.2%, P=0.560). Conclusion PCNL after decompression for urolithiasis-related urosepsis has similar success but higher complication rates than obstructive urolithiasis with no urosepsis initially.
目的 探討與評價術中B超定位下經肝膽管取石在肝內膽管結石治療中的手術指征及優劣性。方法 總結2002～2006 年29例肝內膽管結石行肝葉切除+經肝膽管取石患者的臨床資料,對其手術效果及并發癥進行分析。結果 無膽管損傷及手術死亡病例, 并發癥發生率為37.93%，殘石率為10.34%。結論 術中B超定位下經肝膽管取石結合肝葉切除對肝內膽管結石是一種較好的治療方式，主要適用于Ⅱb型肝內膽管結石患者。