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。
ObjectiveTo observe the effect of thermal damage in the fresh isolated kidneys of New Zealand white rabbits caused by domestic holmiumlaser. MethodsIn the operation room (constant temperature 22℃, humidity 60%), Guangdong electric (POTENT) domestic holmium laser equipment was chosen. The fresh isolated kidney of New Zealand white rabbit was put into a disposable sterilized syringe with 50 mL normal saline, then the holmium laser optical fiber (550 μm) was put into it, and the temperature of normal saline was measured by a mercury thermometer. The parameters of holmium laser were setted as frequency 20 Hz, energy 2 J, stimulating time 15 seconds, intermittent time 5 seconds, which was repeated. The temperature was measured 2, 5 and 7 minutes after stimulation. Then the kidney was dissected, phtographed, haematoxylin-eosin stained, and pathologically examined.ResultsAt the 2nd minute of stimulation, the temperature of normal saline in the syringe increased from 22℃ to 38℃; the cortex and medulla of rabbit kidney were ruddy, and the cortex, medulla and ureter were almost normal in pathological section. At the 5-minute point, the temperature increased to 57℃, and the cortex turned to be white, while the medulla remained ruddy, but the demarcation between the cortex and medulla was not very clear. At the 7th minute, the temperature was 78℃, and the cortex and medulla were both white and solidification with no clear demarcation. Pathological examination showed severe degeneration and necrosis of glomerulus and renal tubule.ConclusionCommon power of domestic holmium laser would produce increasing thermal damage, which may cause tissue damage in the human body when the temperature increases above 50℃.
ObjectiveTo evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for renal stones of longer than 2 cm in diameter. MethodsFrom August 2012 to July 2014, 15 selected patients with renal calculi of longer than 2 cm in diameter underwent flexible ureteroscopic lithotripsy with holmium laser by the same surgeon. Preoperative indwelling ureteral stent was performed for 1-2 weeks, and super smooth guidewire was inserted after checking and dilation of the ureter was performed with F8.0/9.8 rigid ureterosope. Flexible ureteroscope sheath was inserted through guidewire. Ureterosope was followed by flexible ureteroscope sheath. Larger stone fragments were removed by basket. ResultsThe success rate of ureteroscopic insertion was 100% and no severe intraoperative complications occurred. The operation time ranged from 50 to 125 minutes averaging 75. No ureteral perforations or pyonephrosis or acute renal insufficiency occurred. Four patients had high fever after operation and improved after positive anti-infection treatment. After 2 days, the stone-free rate was 73.3% (11/15) by reviewing KUB. The follow-up of 4 weeks showed the stone-free rate was 86.7% (13/15). One case of stone fragments retained in the middle and lower ureter and the fragments were taken out by ureteroscopic lithotripsy. The other case of renal residual calculi was operated by flexible ureteroscope holmium laser lithotripsy in two stage. ConclusionFlexible ureteroscopic lithotripsy is a favorable option for patients with renal stones of longer than 2 cm in diameter, especially for recurrent renal calculi.
Objective To access the efficacy and safety of Holmium laser prostatectomy technique compared to TURP. Methods We searched MEDLINE (1996 to 2004), EMBASE (1984 to 2004), The Cochrane Library (Issue 4, 2004), CNKI, VIP, CMCC and CBMdisc; and handsearched the relevant Chinese journals. Randomized controlled trials (RCT) were included. The quality of trials was evaluated and meta-analysis was performed. Non-randomized controlled trials were also included to evaluate the safety and efficacy. Results We found 4 randomized controlled trials. A total of 480 participants were in the trials ranging from 60 to 200. There was no statistical difference between the two techniques at 12 or 48 months follow-up in terms of quality of life (QOL) improvement（WMD=-0.19, 95%CI -0.81 to 0.44, Z=0.59, P=0.56; WMD=-0.30, 95%CI -0.90 to 0.30, Z=0.98, P=0.33); Qmax improvement（WMD=1.63 ml/s, 95%CI -0.32 to 3.59, Z=1.64, P=0.10; WMD=3.80 ml/s, 95%CI -1.36 to 8.96,Z=1.44, P=0.15); I-PSS or AUA (WMD=-0.06, 95%CI -1.01 to 0.89, Z=0.12, P=0.91; WMD=-1.40, 95%CI -3.91 to 1.11, Z=1.09, P=0.27) and the urethral stricture complication rate (RR=0.75, 95%CI 0.35 to 1.60, Z=0.74, P=0.46). However hospital stay was significantly shorter in the Holmium laser prostatectomy groups (total WMD=-24.89, 95%CI -28.56 to -21.21, Z=13.27, P＜0.000 01). We can not draw consistent conclusions in terms of blood loss according to the present data. One study indicated Holmium laser prostatectomy technique was more cost-effective than TURP. Conclusions In short period Holmium laser prostatectomy is as safe as TURP in terms of hospital stay, urethral stricture and blood loss complication. This new technique is as effiective as TURP in terms of I-PSS (AUA), Qmax and QOL. More RCTs and more long term follow-up is necessary.
ObjectiveTo investigate the clinical efficacy and safety of lithotripsy under flexible ureteroscope using 200 μm holmium laser for medullary sponge kidney stones. MethodsWe identified and retrospectively reviewed 10 patients who underwent flexible ureteroscopic lithotripsy for medullary sponge kidney calculi between January 2013 and July 2014. The remission of clinical symptoms and incidence of perioperative complications were observed. ResultsThe staged surgery was performed on 10 bilateral cases with one session for each kidney. The operative time of our cohort was 130-180 minutes. The postoperative average hemoglobin was not significantly reduced (110.6 g/L) as compared with preoperative average hemoglobin (116.8 g/L) (P>0.05). Two patients had fever after operation and temperatures became normal by anti-infection. The renal function and plain film of kidney-ureter-bladokr (KUB) and CT scan were rechecked for all cases on three months after operation. The kidney function in 3 cases of chronic renal failure was ameliorated to varying degrees. The postoperative average of serum creatinine (196.2 μmol/L) was reduced as compared with the preoperative average serum creatinine (385.7 μmol/L) (P<0.05). Six patients reported spontaneous discharge of residuary stones during three months after surgery. KUB and CT scan proved significant reduction of the loads of stones for all cases after operation. ConclusionFlexible ureteroscope with 200 μm holmium laser lithotripsy is a safe and effective treatment for medullary sponge kidney stones based on its effect on amelioration of symptom and renal function.
ObjectiveTo evaluate the therapeutic efficacy of flexible ureteroscopic holmium laser combined with lithotripsy in treating renal calculi. MethodsWe retrospectively analyzed the data of 78 patients from August 2012 to February 2014 who underwent flexible ureteroscopic holmium laser lithotripsy in our hospital. Among them, calculi were located at the upper or middle calyx in 41 patients, at the lower calyx in 27, at the renal pelvis in 6, and at multiple calyxes in 4. The diameter of the stones ranged from 0.8 to 2.0 cm with a mean of 1.4 cm. The stones were fragmentized by using 200 μm holmium laser fiber. A follow-up by renal CT scan was done 4 weeks after the procedure to evaluate the rate of the stone clearance. ResultsThe calculi were detected in 76 patients (97.4%, 76/78). The success rate in one-session procedure was 94.9% (74/78). After 4 weeks, the total stone-free rate was 97.4% (74/76). The mean operative time was 30 minutes (20-55 minutes). The mean hospital stay of the patients was 3 days (2-6 days). Two cases were found to have lower back pain combined with fever and cured by anti-inflammatory treatment. Naked eye hematuria disappeared in our cases after operation for 1 to 2 days. Seventy-four cases were followed up from 4 to 16 months with a median time of 8 months and no recurrence was detected. ConclusionThe flexible ureteroscopic holmium laser lithotripsy is a safe and effective mini-invasive therapy for patients with renal calculi, with a high discovery rate of stones, high success rate, high evacuation rate, few severe complications, short hospital stay and sustainable treatment.