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.
摘要:目的:探討后腹腔鏡輸尿管切開取石術治療嵌頓性輸尿管結石的臨床價值和技術要點。 方法:2006年12月至 2009年3月,對58例嵌頓性輸尿管中上段結石采用后腹腔鏡輸尿管切開取石術,術中取石后于鏡下直接置入雙J管,間段縫合輸尿管切口。 結果:58例手術均獲成功,無中轉開放手術,結石清除率100%。術后創腔引流液量少,3～5d拔除引流管,1周出院,術后3周膀胱鏡下拔除雙J管。隨訪1～27個月,B超復查顯示腎積水明顯好轉或消失,無結石復發。 結論:后腹腔鏡輸尿管切開取石術治療嵌頓性輸尿管結石具有創傷小\療效好、術后恢復快等特點,明顯優于開放手術及其它手術,值得推廣應用。Abstract: Objective: To summarize our experience and evaluate the outcome of retroperitoneal laparoscopic ureterolithotomy of the upper ureter impacted stone. Methods: Between December 2006 and March 2009, 58 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. After removal of the stones, the double J was put in and interrupted suture was performed for upper ureter. Results: Retroperitoneoscopic ureterolithotomy was successful in all patients, there was neither ureteral stricture nor recurrent calculus, the blood loss ranged from 510 mL, without urine leakage occurred.The mean hospital stay was 7 days, after 3 weeks double J was removed by cystoscopy. With 127 months followup, the hydronephrosis relieved and no recurrence of ureter calculus founded. Conclusion:Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive operation, and worth to generalization.
ObjectiveTo evaluate the value of incision closure device in laparoscopic cholecystolithotomy. MethodsThe clinical data of 130 patients underwent laparoscopic cholecystectomy from Oct. 2014 to Feb. 2015 were retrospectively analyzed. According to the methods of gallbladder suture, 130 cases were divided into two groups, 72 cases underwent traditional manual suture (MS group), and 58 cases underwent incision closure device (ICD group). The operative time, postoperative gastrointestinal function recovery time, bleeding volume, postoperative hospitalization time, hospitalization expenses, complications, and postoperative 6-12 months follow-up of patients in 2 groups were observed.Results One hundred and thirty cases were performed laparoscopic cholecystolithotomy successfully. The operative time and postoperative gastrointestinal function recovery time of ICD group were significantly shorter than those of MS group, the difference was statistically significant (P < 0.05). The hospitalization expenses of the patients in ICD group were significantly higher than those in the MD group (P < 0.05). There were no significant difference between the two groups in the bleeding volume and postoperative hospital stay (P > 0.05). The patients were followed up for 6-12 months, with an average of 8 months, and no complications occurred and stone recurrence. ConclusionIncision closure device can shorten the time of laparoscopic cholecystolithotomy and postoperative recovery of gastrointestinal function, but the cost is higher. Next development, still need decrease the expend and strengthen clinical promotion.
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.
ObjectiveTo explore the impact of different tracts on the effectiveness and safety of percutaneous nephrolithotomy (PCNL) on complete staghorn calculus.MethodsPatients with complete staghorn calculus who underwent single channel PCNL by the same surgeon in West China Hospital of Sichuan University from October 2009 to August 2019 were included. The removing time, the rate of immediate stone removal, the average extubating time, and the incidences of postoperate complications such as fever and bleeding were analyzed statistically.ResultsA total of 379 patients were included. There were 146 cases in the upper tract group, 170 cases in the lower tract group and 63 cases in the middle tract group. Compared with the upper and middle tract groups, the lower tract group had shorter stone removing time [(50.34±18.52) vs. (53.41±22.75) vs. (41.79±17.45) min, P<0.001], shorter average extubating time [(5.53±1.83) vs. (6.17±1.44) vs. (4.96±1.91) d, P=0.007]. The rate of immediate stone removal was higher in the the upper tract group (40.56% vs. 32.79% vs. 34.71% ), but there was no statistical difference among the three groups (P=0.447). There was no significant difference among the three groups in the fever incidence (25.44% vs. 24.24% vs. 26.85%, P=0.938) or bleeding incidence (3.54% vs. 3.03% vs. 4.03%, P=1.000). In addition, there were 8 cases of pleural injury in the upper tract group.ConclusionsCompared with the lower and middle tract, PCNL with upper tract has a higher rate of removing stones for complete staghorn calculus, but there was no significant difference among the three groups. The incidences of bleeding and fever after surgery are similar in the three groups, but the risk of pleural injury may be increased in the upper tract group.
ObjectiveTo explore the value of laparoscopic choledocholithotomy on hepatolithiasis patients with previous bile duct surgery contraindicating hepatectomy. MethodsEighty-six hepatolithiasis patients contraindicating hepatectomy accepted laparoscopic choledocholithotomy during March 2009 and March 2013 in the department of general surgery, AVIC 363 hospital. Among them, 26 cases with previous bile duct surgery(PBS group) and 60 cases without (NPBS group), 15 cases with left intrahepatic bile duct stone, 52 cases with right intrahepatic bile duct stone, and 19 cases with bilateral intrahepatic bile duct stone. Perioperative materials were reviewed between two groups retrospectively. ResultsThe operation time of the PBS group and NPBS group was(161.4±31.5) min and(155.7±28.1) min respectively(P > 0.05). And the intraoperative blood loss of them was(69.2±50.7) mL and(44.1±27.4) mL respectively (P < 0.05). Postoperative complication incidence of PBS group was 53.8%, among them, ascites was found obviously much more in PBS group than that in NPBS group(P < 0.05). The general residual stone incidence of two groups was 15.1%, and the general stone clearance rate was 98.8%. The long term postoperative complication occurrence in PBS group was 23.1%, which was higher significantly than that in NPBS group(P<0.05). ConclusionLaparoscopic choledocholithotomy is a safe, effective thus feasible choice for hepatolithiasis patients with previous bile duct surgery, especially for those without hepatic atrophy, bilateral hepatic bile ducts stone with hepatic bile duct stricture and hepatic bile duct stone with coexisting biliary cirrhosis.
ObjectiveTo assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) versus ureteroscopic lithotripsy (URL) in the treatment of impacted proximal ureteral stones>1 cm. MethodsWe electronically searched PubMed, Cochrane library, Embase, WanFang, Chinese National Knowledge Infrastructure and VIP database (by the end of July 2015) to collect randomized controlled trials involving PCNL vs. URL for the treatment of impacted proximal ureteral stones> 1 cm. The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software. ResultsSix randomized controlled trials were finally obtained after screening. A total of 487 patients were included for a Meta-analysis. The results showed that, as compared with the control group (URL), the patients in the trial group (PCNL) had the following features: ① There was a remarkable improvement of stone clearance rate [RR=1.20, 95% CI (1.09, 1.33), P=0.000 3].② There was no statistical difference in postoperative fever rates, urinary tract perforation rates [RR=1.73, 95%CI (0.43, 7.00), P=0.45; RR=1.02, 95%CI (0.11, 9.37), P=0.99], but the incidence of hematuria was higher [RR=1.99, 95%CI (1.09, 3.62), P=0.03], and the mean operative duration was longer [WMD=30.03 minutes, 95%CI (10.04, 50.02) minuntes, P=0.003].③ The mean hospitalization stay was delayed by an average of 3.73 days [WMD=3.73 days, 95%CI (3.02, 4.44) days, P<0.000 01]. ConclusionPCNL is better than URL in the stone clearance rate, while patients in the PCNL group have to stay in the hospital much longer, and should bear longer mean operative duration.
ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo systematically review the effectiveness and safety of transurethral ureteroscopy lithotripsy in the treatment of upper ureteral calculi. MethodsWe electronically searched The Cochrane Library (Issue 3, 2013), PubMed (1966 to 2013.8), EMbase (1990 to 2013.8), CNKI (1949 to 2013.9), CBM (1978 to 2013.9), VIP (1989 to 2013.8) and WanFang Data (1990 to 2013.8) for the randomized controlled studies (RCTs) related to retroperitoneoscopy ureterolithotomy versus transurethral ureteroscopy lithotripsy for upper ureteral calculi. Two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 410 patients (transurethral ureteroscopy lithotripsy:747 cases; etroperitoneal laparoscopic ureterolithotomy:663 cases) were included. The results of meta-analysis showed that, transurethral ureteroscopy lithotripsy was lower than retroperitoneoscopy ureterolithotomy in success rates of surgery (OR=0.26, 95%CI 0.14 to 0.51), 3-day stone clearance rates (OR=0.06, 95%CI 0.03 to 0.11), and 1-month stone clearance rates (OR=0.21, 95%CI 0.08 to 0.53), while it showed superiority in operation time (MD=-22.35, 95%CI-35.29 to-9.41) and postoperative hospital stay (MD=-1.84, 95%CI-3.44 to-0.24). ConclusionCurrent evidence shows that, in the treatment of upper ureteral calculi, transurethral ureteroscopy lithotripsy causes less operation time and postoperative hospital stay, but it had no advantage in success rates of surgery, 3-day stone clearance rates, and 1-month stone clearance rates.
ObjectiveTo explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation.MethodsThe clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness.ResultsBoth groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction (P<0.05). Incision infection occurred in 1 case (3.03%) of the trial group and 3 cases (6.67%) of the control group after operation. The difference in the incidence of infection was significant (χ2=0.139, P=0.045). The incisions of other patients healed by first intention. X-ray film reexamination showed that the fractures of the two groups healed. The fracture healing time of the trial group was (5.30±1.33) months, while that of the control group was (5.98±1.80) months, with no significant difference (t=?1.815, P=0.073). There was no significant difference in VAS score, Harris scores of knee joint and ankle joint between the two groups before operation and at 3, 6, and 12 months after operation (P>0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant (P<0.05).ConclusionApplication of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.