目的 系統(tǒng)評價經(jīng)輸尿管軟鏡取石術(shù)與經(jīng)皮腎鏡取石術(shù)治療腎結(jié)石的有效性和安全性。方法 計算機(jī)檢索MEDLINE、EMbase、The Cochrane Library、CNKI、CBM、VIP及WanFang Data(1990.1~2012.8),全面收集有關(guān)經(jīng)輸尿管軟鏡取石術(shù)和經(jīng)皮腎鏡取石術(shù)比較治療腎結(jié)石的臨床試驗。由兩位研究者獨(dú)立進(jìn)行文獻(xiàn)篩選、資料提取和評價納入研究的方法學(xué)質(zhì)量后,采用RevMan 5.1軟件進(jìn)行Meta分析。結(jié)果 納入8篇研究,均為非隨機(jī)對照試驗,共計536例患者。Meta分析結(jié)果顯示:經(jīng)輸尿管軟鏡取石術(shù)的結(jié)石清除率低于經(jīng)皮腎鏡取石術(shù)[OR=0.26,95%CI(0.15,0.46)],而在術(shù)后發(fā)熱[OR=0.1,95%CI(0.42,3.35)]、是否輸血[OR=0.17,95%CI(0.03,1.00)]、住院時間[MD= –1.25,95%CI(–1.54,–0.96)]方面則優(yōu)于經(jīng)皮腎鏡取石術(shù)。結(jié)論 現(xiàn)有證據(jù)顯示,在結(jié)石清除率方面,經(jīng)輸尿管軟鏡取石術(shù)低于經(jīng)皮腎鏡取石術(shù),而在并發(fā)癥、住院時間、醫(yī)療費(fèi)用方面,經(jīng)輸尿管軟鏡取石術(shù)則優(yōu)于經(jīng)皮腎鏡取石術(shù)。
目的 探討腹腔鏡膽總管切開取石術(shù)的優(yōu)勢,總結(jié)手術(shù)操作經(jīng)驗及常見并發(fā)癥的預(yù)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(jié)石患者行腹腔鏡膽總管探查取石術(shù)的手術(shù)方法、操作要點(diǎn)及并發(fā)癥的處理。結(jié)果 腹腔鏡手術(shù)成功 105例, 中轉(zhuǎn)開腹3例; 手術(shù)時間(120±20) min,出血量(25±5) ml,住院時間(9±1) d; 術(shù)后發(fā)生膽道出血3例,漏膽7 例,殘余結(jié)石6 例; 全組無死亡病例。結(jié)論 腹腔鏡膽總管切開取石術(shù)具有創(chuàng)傷小、痛苦輕、恢復(fù)快、對腹腔臟器干擾小、住院時間短等優(yōu)點(diǎn),值得臨床推廣。
目的 探討纖維膽道鏡在肝膽管結(jié)石手術(shù)術(shù)中及術(shù)后的操作技巧,提高肝膽管結(jié)石的臨床治愈率。方法 總結(jié)分析180例肝膽管結(jié)石病例,在纖維膽道鏡下觀察,使用取石籃取石、鉗咬、抓取、沖洗,行術(shù)中、術(shù)后經(jīng)T管竇道取出結(jié)石。結(jié)果 本組180例中158例行術(shù)中取石,結(jié)石取凈率為94.3%(149/158); 余22例系術(shù)后再次經(jīng)T管竇道取石,結(jié)石取凈率為86.4%(19/22)。術(shù)中、術(shù)后取凈結(jié)石共168例,結(jié)石取凈率93.3%(168/180)。結(jié)論 纖維膽道鏡能有效治療肝膽管結(jié)石,降低術(shù)中、術(shù)后殘余結(jié)石發(fā)生率,提高治愈率。
目的 評價選擇性保膽取石術(shù)后口服?;切苋パ跄懰犷A(yù)防膽囊結(jié)石復(fù)發(fā)的臨床價值。方法 將成都軍區(qū)總醫(yī)院2004年至2008年符合微創(chuàng)保膽取石術(shù)條件的80例膽囊結(jié)石患者按隨機(jī)序列表分為兩組,每組各40例。兩組患者均經(jīng)微創(chuàng)保膽取石術(shù)后保留功能良好的膽囊,治療組患者術(shù)后口服?;切苋パ跄懰?年,對照組患者除不用服藥外,其余護(hù)理、飲食等與治療組相同。術(shù)后2年復(fù)查膽囊壁厚度及膽囊收縮功能,統(tǒng)計膽結(jié)石癥狀和膽囊結(jié)石復(fù)發(fā)率。結(jié)果 兩組患者保膽取石術(shù)均獲成功。術(shù)后2年治療組和對照組膽囊壁厚度差值、膽囊收縮功能差值的差異均有統(tǒng)計學(xué)意義(Plt;0.05),術(shù)后2年治療組結(jié)石復(fù)發(fā)明顯減少(Plt;0.05)。結(jié)論 保膽取石術(shù)后患者口服?;切苋パ跄懰釋δ懩医Y(jié)石的復(fù)發(fā)有預(yù)防作用。
目的 探討孤立腎腎結(jié)石經(jīng)皮腎鏡取石(PCNL)術(shù)并發(fā)感染性休克的護(hù)理。 方法 回顧性分析2010年3月-2012年10月5例孤立腎腎結(jié)石患者行PCNL術(shù)后并發(fā)感染性休克的臨床資料,對患者術(shù)后出現(xiàn)的休克及時補(bǔ)足血容量,使用有效的抗生素,早期足量應(yīng)用激素、血管活性藥物,同時加強(qiáng)心理疏導(dǎo)、健康教育等護(hù)理措施。 結(jié)果 5例患者體溫均在3 d內(nèi)降至正常;血管活性藥物平均使用時間為1.8 d (2~4 d);1例因血氧飽和度<80%,血壓<85/50 mm Hg(1 mm Hg=0.133 kPa)轉(zhuǎn)往重癥監(jiān)護(hù)病房行呼吸機(jī)輔助呼吸2 d后呼吸循環(huán)功能改善;另1例同時出現(xiàn)少尿無尿,及時行血液透析,第4天尿量逐漸恢復(fù);5例患者均痊愈出院。 結(jié)論 感染性休克是PCNL術(shù)后最危險的并發(fā)癥之一,對其采取積極預(yù)防、及早發(fā)現(xiàn)、及時有效的治療和護(hù)理等措施,可有效促進(jìn)患者康復(fù)。
目的 總結(jié)超選擇性腎動脈栓塞治療經(jīng)皮腎鏡取石術(shù)后嚴(yán)重出血的臨床經(jīng)驗。 方法 回顧分析2009年10月-2012年11月行經(jīng)皮腎鏡取石術(shù)后發(fā)生嚴(yán)重出血的6例(2.74%)患者的臨床資料和對其進(jìn)行超選擇性腎動脈栓塞術(shù)的血管造影表現(xiàn)和栓塞療效。 結(jié)果 患者平均年齡67歲,經(jīng)皮腎鏡取石術(shù)后急性出血1例,遲發(fā)出血5例,均有體外沖擊波碎石史或糖尿病、高血壓病史。腎動脈造影顯示損傷動脈為腎后下段動脈、腎下段動脈分支,表現(xiàn)為假性動脈瘤5例,動靜脈瘺1例。使用彈簧圈或聚乙烯醇顆粒超選擇性栓塞,栓塞后出血無一例復(fù)發(fā)。隨訪6個月,5例腎功能未見下降,1例受損。 結(jié)論 經(jīng)皮腎鏡術(shù)后嚴(yán)重出血與術(shù)中動脈損傷有關(guān),采用超選擇性腎動脈栓塞術(shù)能夠達(dá)到迅速止血、盡可能保全患腎功能、有效挽救生命的診療效果。
【摘要】 目的 探討微創(chuàng)經(jīng)皮腎鏡下鈥激光碎石術(shù)治療上尿路結(jié)石的方法及療效?!》椒ā?007年9月-2010年10月在B型超聲引導(dǎo)下應(yīng)用微創(chuàng)經(jīng)皮腎鏡下鈥激光碎石術(shù)治療上尿路結(jié)石138例,其中腎鹿角形結(jié)石64例,單發(fā)腎盂、腎盞結(jié)石38例,雙腎結(jié)石8例,輸尿管上段結(jié)石28例,孤立腎結(jié)石2例。 結(jié)果 136例取石成功,其中95例一期取石成功(包括雙通道取石5例),41例二期取石,2例因經(jīng)皮腎穿失敗改行開放手術(shù)取石。27例術(shù)后體外震波碎石治療。平均結(jié)石清除率78.9%(109/138)。平均手術(shù)時間112 min,平均住院時間10 d,腎造瘺管平均留置時間4 d,雙J管平均留置時間4周。5例因術(shù)中出血較多需輸血。11例術(shù)后1周內(nèi)出血較多,其中3例需要輸血。12例出現(xiàn)尿外滲。7例術(shù)后出現(xiàn)高熱(gt;39 ℃)。隨訪: 98例伴有腎積水,時間3~6個月,平均4個月,24例積水消失,68例積水減輕,6例無改善也無加重;22例殘余結(jié)石隨訪4~9個月,平均6個月,6例結(jié)石增大,16例結(jié)石無變化;87例隨訪12個月無殘余結(jié)石,7例結(jié)石復(fù)發(fā)。 結(jié)論 微創(chuàng)經(jīng)皮腎鏡下鈥激光碎石術(shù)治療上尿路結(jié)石創(chuàng)傷小,恢復(fù)快,并發(fā)癥少,療效滿意。【Abstract】 Objective To discuss the method and the curative effect of minimally invasive percataneous nephrolithotomy (mini PCNL) with holmium laser in treating upper urinary tract calculi. Methods From September 2007 to October 2010, 138 patients with upper urinary tract calculi were treated with mini PCNL with holmium laser under the conduction by type-B ultrasonography. Of the 138 cases, 64 patients had staghorn calculi, 38 had single renal pelvis or renal calyx stones, eight had bilateral renal calculi, 28 had upper-ureteral calculi, and two had solitary kidney calculi. Results Successful stone removal was achieved in 136 cases, among which there were 95 cases of stage-one nephrolithotomy (double tracts were used in five cases) and 41 cases of sfage-two neploolithotomy. Two cases were changed to open operation due to failures of percutaneous nephrolithotory. Extracorporeal shock-wave lithotomy was used in 27 cases after operation. The average stone removal rate was 78.9% (109/138). The average operation time was 112 minutes. The average hospital stay was 10 days. The average nephrostomy tube stay was four days. The average double J tube stay was four weeks. Five patients needed blood transfusion in operations due to a large amount of blood loss. Eleven patients suffered from massive hemorrhage one week after operation and blood transfusion was performed in three patients. Urine exosmosis happened in 12 cases. And there were seven cases of high fever (gt;39 ℃) after operation. Follow-up was done for 98 patients accompanied by hydronephrosis for a time period ranged from three to six months averaging at four months. Hydronephrosis disappeared in 24 patients, alleviated in 68 cases, and did not change in six cases. Twenty-two cases of residual calculi were followed up for a period ranged from four to nine months averaging at six months. Enlarged calculi occurred in six cases and no change happened to the calculi in 16 cases. Eighty-seven patients without residual calculi were followed up for 12 months, and there were seven cases of reoccurrence. Conclusion Treatment of upper urinary tract calculi with minimally invasive percutaneous nephrolithotomy with holmium laser is a simple and safe method with little injury, quick recovery, few complications and satisfactory results.
目的:探討微創(chuàng)經(jīng)皮腎穿刺取石術(shù)(MPCNL)治療腎結(jié)石的療效。方法:采用MPCNL治療41例腎結(jié)石患者,其中腎石30例(結(jié)石直徑gt;2.0 cm),輸尿管上段結(jié)石11例(結(jié)石直徑1.0~2.0 cm);單側(cè)結(jié)石37例,雙側(cè)結(jié)石4例。結(jié)果:41例手術(shù)均獲成功。手術(shù)時間45~120 min,平均52.7 min,無一例改開放手術(shù)。本組腎結(jié)石病例單次結(jié)石清除26例(86.7%),4例殘余結(jié)石行二期手術(shù)取凈;輸尿管上段單次結(jié)石清除率100%。結(jié)論:MPCNL 是一種有效的治療腎結(jié)石的方法,并具有創(chuàng)傷小、取石率高、恢復(fù)快等優(yōu)點(diǎn)。
目的:探討腹腔鏡膽囊切除術(shù)(LC)與內(nèi)鏡十二指腸乳頭括約肌切開術(shù)(EST)聯(lián)合應(yīng)用治療膽囊結(jié)石合并膽總管結(jié)石的臨床效果。方法:回顧性分析我院開展的LC聯(lián)合EST治療膽囊結(jié)石合并膽總管結(jié)石76例,其中56例先行EST后行LC,20例先行LC后行ERCP/EST。結(jié)果:本組全部治愈,先行EST組56例,3例并發(fā)胰腺炎,3例出血,2例再發(fā)膽總管結(jié)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(jié)石自行掉入腸道,1例出現(xiàn)膽道感染,1例胰腺炎,無出血及穿孔。結(jié)論:內(nèi)鏡治療膽囊結(jié)石繼發(fā)膽總管結(jié)石具有創(chuàng)傷小、效果好、并發(fā)癥少、恢復(fù)快的的特點(diǎn);先作EST可解除膽道梗阻、減輕炎癥,并為LC創(chuàng)造條件,選擇性先行LC后可減輕創(chuàng)傷,甚至不必做EST。
摘要:目的:探討后腹腔鏡輸尿管切開取石術(shù)治療嵌頓性輸尿管結(jié)石的臨床價值和技術(shù)要點(diǎn)。 方法:2006年12月至 2009年3月,對58例嵌頓性輸尿管中上段結(jié)石采用后腹腔鏡輸尿管切開取石術(shù),術(shù)中取石后于鏡下直接置入雙J管,間段縫合輸尿管切口。 結(jié)果:58例手術(shù)均獲成功,無中轉(zhuǎn)開放手術(shù),結(jié)石清除率100%。術(shù)后創(chuàng)腔引流液量少,3~5d拔除引流管,1周出院,術(shù)后3周膀胱鏡下拔除雙J管。隨訪1~27個月,B超復(fù)查顯示腎積水明顯好轉(zhuǎn)或消失,無結(jié)石復(fù)發(fā)。 結(jié)論:后腹腔鏡輸尿管切開取石術(shù)治療嵌頓性輸尿管結(jié)石具有創(chuàng)傷小\療效好、術(shù)后恢復(fù)快等特點(diǎn),明顯優(yōu)于開放手術(shù)及其它手術(shù),值得推廣應(yīng)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.