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.
Objective To evaluate the clinical value of ureteroscope in cholelithiasis treated by laparoscopic surgery. Methods The clinical data of 36 patients admitted because of hepatolithus with ureteroscope combination in laparoscopic surgery from February 2007 to September 2009 in Guidong People’s Hospital of Guangxi were analyzed retrospectively. Results In 33 cases, stones were removed once by ureteroscope in laparoscopic surgery with residual stones (in 3 cases residual stone were removed secondarily through T tube) and the other 3 cases were transferred to laparotomy forcedly due to bleeding of biliary duct and vessels of porta hepatis and tearing of bile duct. During operation, blood loss was 30-280 (94.51±54.70) ml; operation time was 110-260 (147.22±48.45) min; recovery time of bowel movement was 1-3 (2.03±0.76) d; postoperative hospitalization time was 6-13 (7.12±1.65) d (some discharged with T tube); the time of patients of T tubes pulled out was 28-45 (38.92±6.52) d. Bile leakage happened in 1 case and infection of biliary tract in 1 case, no complications such as biliary stricture or bile duct bleeding were found after operation. Conclusions Treatment of intrahepatic bile duct or a single extra-hepatic sand-like stones with ureteroscopy usage in laparoscopic surgery is feasible and less invasive. It is a minimally invasive treatment for intra- or extra-hepatic stones due to rapidly postoperative rehabilitation.
ObjectiveTo evaluate the risk factors for postoperative indwelling catheter following enhanced recovery after primary unilateral total knee arthroplasty (TKA) under general anesthesia.MethodsPatients who underwent primary unilateral TKA under general anesthesia between January 2017 and August 2018 were enrolled in the study. Among them, 205 patients who met the selection criteria were included in the study, and the clinical data were collected, including gender, age, body mass index, preoperative range of motion, Hospital for Special Surgery (HSS) score, American Society of Anesthesiologists (ASA) score, disease type, comorbidity, hemoglobin, hematocrit, blood volume, length of operation and operation time, whether to keep drainage after surgery, intraoperative blood loss, total blood loss, and preoperative, intraoperative, postoperative fluid infusions, and total fluid infusion on the day of surgery, urine volume on the day of surgery. Univariate analysis and logistic regression analysis were used to screen the risk factors for postoperative indwelling catheter. Length of stay and incidences of complications (intermuscular vein thrombosis, deep vein thrombosis, pulmonary embolism, incision swelling and exudation, electrolyte disorder, nausea and vomiting, and urinary tract infection) were compared between the patients with or without indwelling catheter.ResultsIndwelling catheter occurred in 41 (20%) of 205 patients. Single factor analysis showed that the influence factors were age, gender, keeping drainage after surgery, total fluid infusion and urine volume on the day of surgery (P<0.05). The multiple factors analysis showed that the males and more urine volume on the day of surgery were the significant risk factors for indwelling catheter after primary TKA (P<0.05). In addition, postoperative length of stay was shorter and the incidence of urinary tract infection was lower in non-indwelling catheter group than in indwelling catheter group, showing significant differences (P<0.05).ConclusionThe male patients with more urine on the day of surgery have higher risk for indwelling catheter after primary unilateral TKA under general anesthesia with an enhanced recovery program.
ObjectiveTo analyze the related risk factors for catheter-associated urinary tract infection in the Intensive Care Unit (ICU), and make corresponding nursing countermeasures.
MethodsBy target monitoring of catheter-associated urinary tract infection in 184 patients in the ICU from 2011 to 2012, infection risk factors were analyzed. The measures of nursing interventions had been taken since January 2012, and the effects before and after the intervention were contrasted and evaluated.
ResultsBefore the intervention, 951 out of 1 229 patients in 2011 had indwelling catheter, and catheter-associated urinary tract infection occurred in 127 patients with an infection rate of 13.35%. After the intervention, 841 out of 1 437 in 2012 had indwelling catheter, and catheter-associated urinary tract infection occurred in 57 patients with an infection rate of 6.78%.
ConclusionTaking effective intervention measures can effectively reduce the ICU catheter-associated urinary tract infection and it also ensures the safety of medical care.
Objective
To investigate cost-effectiveness of no indwelling urinary catheter in pulmonary lobectomy patients and to confirm the advances of no indwelling urinary catheter.
Methods
We recruited 148 lung cancer patients who were scheduled for pulmonary lobectomy under general anesthesia in West China Hospital from July through December 2015. These patients were divided into two groups including an indwelling urinary catheter group (74 patients, 45 males and 29 females, at age of 52.55±19.87 years) and a no indwelling urinary catheter group (74 patients, 42 males and 32 females, at age of 54.03±16.66 years). Indexes of cost-effectiveness of the two groups were compared.
Results
There was no statistical difference between the two groups in duration of indwelling catheter (1.56±0.0.65 d versus 1.68±0.91 d, P=0.077). Material expense(4 811.48 yuan versus 296.74 yuan, P=0.045), cost of nursing care (7 413.32 yuan versus 457.32 yuan, P=0.013), and total expense (12 224.8 yuan versus 754.06 yuan, P=0.000) in the indwelling catheter group were higher than those in the no indwelling catheter group. Material expense per patient (65.02±5.62 yuan/patient-time versus 4.01±0.00 yuan/patient-time, P=0.000), cost of nursing care per patient (100.18±7.19 yuan/patient-time versus 6.18±1.22 yuan/patient-time, P=0.000), and total cost per patient (165.20±12.81 yuan/patienttime versus 10.19±1.22 yuan/patient-time, P=0.000) in the indwelling catheter group were higher than those in the no indwelling catheter group.
Conclusion
Both costs and labor of nurse can be cut down for appropriate lung cancer patients undergoing lobectomy without routine indwelling urinary catheter.
