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Transurethral Lithotripsy Combined with Transurethral Resection of the Prostate in Treating Benign Prostatic Hyperplasia and Bladder Calculi

【摘要】　目的　探讨良性前列腺增生（benign prostatic hyperplasia，BPH）伴膀胱结石的有效腔内治疗方法。〖HTH〗方法　2003年6月-2009年12月，使用F26号电切镜外鞘作为撑开器，气压弹道和（或）钬激光粉碎膀胱结石，经尿道前列腺电切术 （transurethral resection of the prostate，TURP） 治疗BPH伴膀胱结石86例。患者年龄58～83岁，平均68.6岁；病程2～8年，平均5.2年。术前患者国际前列腺症状评分（international prostate symptom score，IPSS）为（24.6±3.9）分，生活质量（5.7±0.6）分；前列腺重量（46.5±6.8） g，剩余尿量（185±58） mL，最大尿流率（5.7±2.3） mL/s。　结果　86例均一次手术成功。碎石时间为16~58 min，平均38 min；前列腺电切时间40~100 min，平均65 min。术中无并发症发生。术后 5~8 d拔除尿管，平均6.5 d。术后4 例出现前尿道狭窄，经治疗后痊愈。54例获随访，随访时间2~6个月，平均3个月。术后2个月，54例最大尿流率升至（18.5±4.1） mL/s，剩余尿量下降至（16±22） mL，IPSS评分下降至（7.8±1.6）分，生活质量（2.5±0.3）分，与术前比较差异均有统计学意义（Plt;0.01）。　结论　经尿道碎石术和TURP一次性治疗BPH伴膀胱结石安全、有效、经济。【Abstract】　Objective　To explore an effective endourologic treatment method for benign prostatic hyperplasia (BPH) with bladder calculi. 　Methods　From June 2003 to December 2009, ballistic or holmium laser lithotripsy by outer sheath resectoscope and transurethral resection of the prostate (TURP) were performed on 86 patients with BPH and bladder calculi. The patients aged 58 to 83 years old, averaging at 68.6 years. Duration of their disease course ranged from 2 to 8 years, averaging 5.2 years. Before surgery, the international prostate symptom score (IPSS) was 24.6±3.9; the score of quality of life (QOL) was 5.7±0.6; prostatic weight was (46.5±6.8) g; residual urine (RU) volume was (185±58) mL; and the peak urine flow rate (Qmax) was (5.7±2.3) mL/s.　Results　The operations were completed successfully in all cases with a mean lithotripsy time of 38 min (16-58 minutes) and a mean TURP time of 65 min (40-100 minutes). No complications occurred during the operation. Urethral catheter was withdrawn 5-8 days after operation, with a mean period of 6.5 days. Four patients had anterior urethral stricture after operation, but recovered through treatment. Fifty-four patients were followed up for 2 to 6 months with an average follow-up time of 3 months. Two months after the operations, IPSS decreased to 7.8±1.6; Qmax increased to (18.5±4.1) mL/s; RU decreased to (16±22) mL and QOL was 2.5±0.3. Compared with preoperative conditions, the differences were all statistically significant (P＜0. 01).　Conclusion　Transurethral lithotripsy combined with TURP is an effective, safe and economical treatment for benign prostatic hyperplasia with bladder calculi.

医护合作-快速康复模式在经输尿管镜钬激光碎石术中的应用及效果评价

目的 探讨医护合作-快速康复模式在经输尿管镜钬激光碎石手术中的临床应用及效果的评价。 方法 将 2015 年 10 月—2016 年 3 月入住的 166 例输尿管结石患者随机分为对照组和试验组各 83 例，对照组按传统方法进行住院治疗及围手术期护理，试验组按照医护合作-快速康复模式进行诊治及护理，包括门诊评估、术前检查的完善、麻醉评估、流程办理、家庭护理的注意事项、围手术期的饮食活动指导和疼痛管理、健康保健等。比较两组患者的住院时间、住院费用、术后并发症、术后首次进食时间和满意度的差异。 结果 试验组患者住院时间[（22.46±0.89）h]少于对照组[（76.46±0.75）h]，住院费用[（8 275.21±789.45）元]低于对照组[（12 859.11±1 047.54）元]，并发症发生率[10.8%（9/83）]低于对照组[41.0%（34/83）]，患者满意度[（99.87±5.12）%]高于对照组[90.66±5.95）%]，差异均有统计学意义（P<0.05）。 结论 医护合作-快速康复模式应用于输尿管镜钬激光碎石手术，能充分利用医疗资源，促进医患关系协调，缩短患者的住院日，减少患者的住院费用，降低术后并发症的发生，促进术后康复，早日恢复患者的正常生活。

Pneumatic Lithotripsy Combined with TURP in the Treatment of Bladder Calculi with Benign Prostate Hyperplasia

目的:探讨微创治疗BPH并发膀胱结石的方法。方法:应用气压弹道碎石术联合TURP治疗BPH并发膀胱结石26例。结果:24例一次成功,1例一期碎石,二期行TURP;1例中转开放手术。结论:气压弹道碎石术联合TURP治疗BPH并发膀胱结石创伤小,恢复快,安全高效。

A Meta-analysis of Percutaneous Nephrolithotomy versus Ureterolithotripsy in the Treatment of Impacted Proximal Ureteral Stones >1 cm

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.

腹腔镜下经胆道镜钬激光碎石治疗难治性胆管结石

目的探讨腹腔镜下经胆道镜钬激光碎石治疗难治性胆管结石的可行性和疗效。 方法回顾性分析我院2009年6月至2014年12月期间18例腹腔镜下经胆道镜钬激光碎石治疗难治性胆管结石（无法在内镜下乳头括约肌切开取石术取出者）的临床资料。 结果成功手术18例，手术时间60～200 min，平均130 min。一次性取净结石16例，2例女性患者分别有四川、安徽生活居住史，术后造影在左、右肝管内再次发现絮状结石，予熊去氧胆酸口服，随访至今，其中1例结石消失，另外1例仍有结石表现。术后均无胆管出血、胆瘘、胆管狭窄等并发症发生。 结论对于难治性的胆管结石，腹腔镜下经胆道镜钬激光碎石治疗是一种安全、有效的方法。

经尿道前列腺电切及膀胱结石碎石术中膀胱内气体爆炸一例

Exploration of New Perioperative Nursing Mode for Percutaneous Nephrolithotomy

ObjectiveTo explore the perioperative nursing mode for percutaneous nephrolithotomy (PCNL). MethodsA total of 866 patients with PCNL having undergone lithotripsy between January 2012 and December 2013 in our hospital were included in our study. Before surgery, they received position training, health education and psychological nursing. After surgery, patients received an integral medical wound care and pipeline management, as well as management of infectious shock and intercostal neuralgia. At the same time, we gave them dietary guidance and other health guidance. ResultsAll the patients were successfully discharged from hospital. Postoperative infection rate was 2.4%, septic shock rate was 0.2%, bleeding rate was 2.2%, urinary leakage rate was 1.5%, the rate of pneumothorax was 0.6%, subcutaneous emphysema rate was 0.3%, and intercostal neuralgia rate was 0.6%. The average hospital stay was (11.2±2.8) days. ConclusionThe innovative nursing mode and techniques have great significance on the success of PCNL surgery.

经电切镜外鞘输尿管镜气压弹道碎石术治疗下尿路结石

【摘要】　目的　总结经电切镜外鞘输尿管镜气压弹道碎石术治疗下尿路结石的疗效。　方法　2009年10月－2010年4月，采用经电切镜外鞘输尿管镜直达结石部位，采用气压弹道碎石术治疗下尿路结石20例。其中男15例，女5例；年龄35~80岁，平均54岁。膀胱结石18例，后尿道（尿道膜部）结石2例，结石直径0.5~2.0 cm，均为单发。病程6 h~2年，平均15 d。　结果　20例均一次性成功碎石，碎石成功率100%。碎石时间15~45 min，平均27 min；术后住院时间2~6 d，平均3.7 d。术后无大出血、水中毒、感染等术后早期并发症。13例患者获随访，随访时间1~3个月，平均1.2个月。所有患者均未出现结石复发、尿道狭窄等并发症。　结论　经电切镜外鞘输尿管镜下气压弹道碎石术治疗下尿路结石疗效确切、微创，是一种治疗下尿路结石的安全方法。

Application of ultrasound-guided percutaneous transhepatic cholangioscopy in treatment of complicated hepatolithiasis

Objective To investigate feasibility and curative effect of ultrasound-guided percutaneous transhepatic cholangioscopy in treatment of complicated hepatolithiasis. Methods The data of 42 patients with complicated hepatolithiasis from June 2012 to June 2017 in the Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed. All the patients were treated with ultrasound-guided percutaneous transhepatic cholangioscopy, including the first stage of dilation and drainage and the second stage choledochoscopy. Results The operations of the 42 patients were successfully performed. No case was converted to the conventional laparotomy. The puncture sites of 10 cases were at the right intrahepatic bile duct, 25 cases were at the left intrahepatic bile duct, and 7 cases were at the bilateral intrahepatic bile duct. The residual stones were removed by two stage choledochoscopy in the 31 patients, 11 patients had the residual stones. After the first stage, there were 4 cases of the bile duct hemorrhage, 8 cases of the cholangitis, 1 case of the pleural effusion and 1 case of the infection, 2 cases of the postoperative drainage tube shedding. After the second stage, there were 3 cases of the cholangitis and 3 cases of the postoperative drainage tube shedding. The stones of the 10/31 patients with stone removal occurred and the diseases of 9/11 patients with stone residual were stable during the following-up of (18.6±7.8) months. Conclusion Ultrasound-guided percutaneous transhepatic cholangioscopy including the first stage of dilation and drainage plus the second stage choledochoscopy is safe and effective in treatment of complex intrahepatic bile duct stones, it is an effective supplement to traditional surgery.

Endoscopic reverse biliary tract stent placement via choledochus in treatment of situs inversus totalis complicated with choledocholithiasis

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.