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微通道经皮肾输尿管镜联合气压弹道碎石术在基层医院的应用分析

目的探讨微通道经皮肾输尿管镜联合气压弹道碎石取石术（mini-PCNL）在基层医院的应用疗效和安全性。 方法对2010年3月－2013年3月收治的108例上尿路结石患者采用mini-PCNL予以治疗，并就手术方式、手术时间、结石清除率等情况进行分析表述。 结果107例患者成功在B型超声引导下建立经皮肾穿刺通道，1例肾下盏结石因肾脏大出血改开放手术行肾部分切除术，3例患者术中建立通道后出血较多安置肾造瘘管后行二期手术。手术时间为20～190 min，平均（78.0±40.1）min，结石总清除率78.5%，其中输尿管上段结石单次清除率100.0%、肾结石单次清除率70.1%。术中平均出血量（105.0±45.6）mL，无胸膜、腹腔脏器、结肠损伤；平均住院7～14 d。 结论mini-PCNL治疗上尿路结石具有较高的结石清除率、良好的安全性，同时具有术后恢复快、费用适中等优点，值得在基层医院推广应用。

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。

Comparison of therapeutic effects of endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet laser and traditional mechanical lithotripsy in patients with common bile duct stones

ObjectiveTo compare difference of therapeutic effects between endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet (FREDDY) laser and endoscopic traditional mechanical lithotripsy in treatment of common bile duct stones (CBDs).MethodsThe clinical data of 207 patients with CBDs treated with ERCP and lithotripsy in the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2009 to March 2019 were analyzed retrospectively, of which 71 cases treated by FREDDY (FREDDY group) and 136 cases treated by mechanical lithotripsy (mechanical group). The success rate of stone removal, operation time, postoperative hospitalization time, hospitalization cost, consumables cost, and complications were compared between the two groups.ResultsThere were no significant differences in the general condition and the preoperative clinical data between the two groups (P>0.05). There was no perioperative death in the two groups. There were no significant differences in terms of the postoperative routine laboratory biochemical indexes, consumables cost, hospitalization cost, and rates of the bleeding, postoperative pancreatitis, perforation and biliary tract infection between the two groups (P>0.05). Although the operation time of the FREDDY group was significantly longer than that of the mechanical group (P<0.05), the success rate of stone removal was significantly higher, the postoperative hospitalization time was shorter, the total complications rate and stone residual rate were significantly lower in the FREDDY group as compared with the mechanical group (P<0.05).ConclusionEndoscopic FREDDY laser lithotripsy has a better curative effect and less complications in treatment of large CBDs than mechanical lithotripsy, but operation time needs further to be improved.

Treatment of Acute Renal Failure Induced by Upper Ureteric Obstruction with Ureterorenoscope

目的:探讨急性上尿路梗阻性肾功能衰竭的治疗方法。方法:采用输尿管镜检查,酌情钬激光碎石,放置双J管内引流治疗32例急性上尿路梗阻性肾功能衰竭患者。结果:术后患者血清BUN、SCr均明显下降,尿量不同程度恢复,结石排净率90.6%(29/32)。结论:对于上尿路结石梗阻性急性肾功能衰竭的患者,急诊输尿管镜下钬激光碎石,疗效确切,创伤小,可同时处理双侧输尿管结石。

Pneumatic Ballistic Lithotripsy via Nephroscope in the Treatment of Bladder Stones

【摘要】　目的　探讨肾镜结合气压弹道碎石治疗膀胱结石的临床疗效。　方法　分析2004年9月－2011年3月男性膀胱结石患者87例的临床资料。结石直径1.5~6.7 cm，使用肾镜结合气压弹道碎石术治疗，统计手术时间、手术并发症。随访3个月，观察有无尿道狭窄。　结果　所有患者碎石成功，平均手术时间为37 min，无残留结石，无膀胱穿孔、感染性休克、膀胱大出血等并发症；术后3个月随访，经尿道手术者均未发现尿道狭窄。　结论　肾镜下气压弹道碎石术是治疗膀胱结石安全、有效的方法。【Abstract】　Objective　To explore the clinical efficacy of pneumatic ballistic lithotripsy via nephroscope in treating patients with bladder stones.　Methods　We retrospectively analyzed the clinical data of 87 patients with bladder stones from September 2004 to March 2011. The diameter of the stones were ranged from 1.5 to 6.7 cm. The patients underwent peneumatic ballistic lithotripsy via nephroscope. We recorded the operation time and complications, and observed the incidence of urethrostenosis 3 months after the beginning of the follow-up.　Results　All stones were fragmented and removed successfully. The average operation time was 37 minutes. No residual stone, bladder perforation, infective shock or severe bleeding of the bladder occurred. During the 3-month follow-up, no utethrostenosis occurred.　Conclusion　Pneumatic ballistic lithotripsy via nephroscope is a safe and efficient technique in treating bladder stones.

Effectiveness and Safety of Ureteroscopy Surgery in Treatment of Upper Ureteral Calculi: A Meta-Analysis

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.

体外冲击波碎石联合枸橼酸氢钾钠颗粒治疗输尿管上段尿酸结石

目的 探讨枸橼酸氢钾钠联合体外冲击波治疗输尿管上段尿酸结石的临床疗效。 方法 2007年1月-2009年5月收治输尿管尿酸结石患者89例， 枸橼酸氢钾钠联合体外冲击波碎石治疗输尿管上段尿酸结石48例，并与复方金钱草颗粒联合体外冲击波碎石治疗的患者41例进行对比。 结果 试验组排出结石41例，有效率85.4%，对照组排出结石24例，有效率58.5%；排出结石时间试验组（12±3）d，对照组（20±5）d。 结论 输尿管上段尿酸结石体外冲击波碎石治疗后口服友来特可以提高治愈率，并可以减少输尿管石街的形成。

微通道经皮肾镜激光碎石术后全身炎症反应综合征致弥散性血管内凝血一例

小儿体外冲击波碎石的护理

目的　总结小儿体外冲击波碎石围手术期护理方法。 方法　2009年3月－2011年6月对56例行体外冲击波碎石的泌尿结石患儿，术前完善各项筛查、抗感染工作，术后严密监测生命体征，予促石排泄指导，对相关并发症及时处置，并做好出院指导等护理工作。 结果　56例患儿均顺利完成体外冲击波碎石手术。其中1例排石效果不理想于次日行手术切开取石，1例术后14 d复查结石仍未排净行第2次排石术，其余54例患儿均一次性碎石成功。术后3个月门诊随访，56例均无结石形成。 结论　术前完善的检查及抗感染处置，术后排石的观察与指导，及并发症的预防护理是结石患儿体外碎石治愈成功的关键。

Application of ERCP and extracorpareal shock wave lithotripsy in the treatment of chronic pancreatitis with pancreatic duct stones

Objective To explore the value of endoscopic retrograde cholangiopancreatograph (ERCP) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of pancreatic duct stones. Methods A retrospective collection of 28 patients with chronic pancreatitis and pancreatic duct stones admitted to the Department of Gastroenterology from January 2010 to August 2021 was performed. According to the treatment of patients, they were divided into ERCP direct stone extraction group and ESWL combined ERCP stone extraction group. We compared the treatment effects of the two groups of patients, including the success rate of stone extraction, postoperative complications of ERCP, postoperative symptom improvement, and so on. Results Among the 28 patients, 19 cases underwent ERCP direct stone extraction, and 9 cases underwent ESWL combined with ERCP stone extraction. In the ERCP direct stone extraction group, 7 cases (36.84%) were completely extracted, 1 case was partially extracted (5.26%), and 11 cases (57.89%) failed to extract and only placed stents and drained; 5 cases (26.32%) had elevated white blood cells at 6 hours postoperatively, C-reactive protein increased in 4 cases (21.05%), 3 cases (15.79%) were diagnosed as ERCP-related pancreatitis, and 2 cases (10.53%) were diagnosed as hyperamylaseemia. The abdominal pain symptoms were completely relieved in 14 cases (73.68%) during a follow-up period of 3 to 6 months. The body mass of 17 cases (89.47%) increased in the 6 months after stone extraction. ESWL combined with ERCP had complete stone extraction in 5 cases (55.56%), partial stone extraction in 3 cases (33.33%), and failure in stone extraction and only stent drainage in 1 case (11.11%). One case (11.11%) had elevated white blood cells at 6 hours postoperatively, and 1 case (11.11%) had elevated C-reactive protein . One case (11.11%) was diagnosed with ERCP-related pancreatitis. One case (11.11%) got abdominal pain and transient hematuria during ESWL, which resolved spontaneously 3 days later. After 3 to 6 months of follow-up, 9 patients (100%) had complete relief of abdominal pain symptoms, and the body mass of 9 patients (100%) increased in the 6 months after stone extraction. The stone clearance rate of the ESWL combined with ERCP stone extraction group was higher than that of the ERCP direct stone extraction group (P=0.033), but there was no statistically significant difference between the two groups in terms of ERCP-related complications, relief of abdominal pain, and weight gain (P>0.05). Conclusion ESWL combined with ERCP in the treatment of chronic pancreatitis complicated with pancreatic duct stone extraction is more effective than ERCP direct stone extraction.