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經皮經肝膽道鏡碎石取石術治療膽腸吻合術后肝膽管結石病

目的探討經皮經肝膽道鏡碎石取石術（PTCSL）必要時聯合球囊擴張治療膽腸吻合術后肝膽管結石病的可行性及安全性。方法重慶醫科大學附屬第二醫院 2015 年 12 月至 2020 年 12 月期間共有 54 例膽腸吻合術后肝膽管結石病患者接受 PTCSL 必要時聯合球囊擴張治療（符合納入標準）。回顧性收集患者的一般資料、手術情況、術后情況以及術后隨訪資料。結果54 例患者中有 52 例（96.3%）行 PTCSL 治療成功，2 例因為膽腸吻合口完全閉塞而失敗。術中出血量的中位數為 55 mL（15～520 mL）；取凈結石 48 例（88.9%），結石殘留 6 例（11.1%）。術后并發癥發生率為 27.8%（15/54），無圍手術期死亡患者。取凈結石的 48 例患者獲隨訪，中位隨訪時間 33 個月（2～60 個月），有 10 例結石復發，復發率為 20.8%（10/48）。結論PTCSL 必要時聯合球囊擴張治療膽腸吻合術后肝膽管結石病具有良好的安全性和可行性，但是術后需要注意預防結石復發。

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.

Pneumatic Ballistic Lithotripsy via Nephroscope in the Treatment of Bladder Stones

【摘要】　目的　探討腎鏡結合氣壓彈道碎石治療膀胱結石的臨床療效。　方法　分析2004年9月－2011年3月男性膀胱結石患者87例的臨床資料。結石直徑1.5~6.7 cm，使用腎鏡結合氣壓彈道碎石術治療，統計手術時間、手術并發癥。隨訪3個月，觀察有無尿道狹窄。　結果　所有患者碎石成功，平均手術時間為37 min，無殘留結石，無膀胱穿孔、感染性休克、膀胱大出血等并發癥；術后3個月隨訪，經尿道手術者均未發現尿道狹窄。　結論　腎鏡下氣壓彈道碎石術是治療膀胱結石安全、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.

微通道經皮腎輸尿管鏡聯合氣壓彈道碎石術在基層醫院的應用分析

目的探討微通道經皮腎輸尿管鏡聯合氣壓彈道碎石取石術（mini-PCNL）在基層醫院的應用療效和安全性。 方法對2010年3月－2013年3月收治的108例上尿路結石患者采用mini-PCNL予以治療，并就手術方式、手術時間、結石清除率等情況進行分析表述。 結果107例患者成功在B型超聲引導下建立經皮腎穿刺通道，1例腎下盞結石因腎臟大出血改開放手術行腎部分切除術，3例患者術中建立通道后出血較多安置腎造瘺管后行二期手術。手術時間為20～190 min，平均（78.0±40.1）min，結石總清除率78.5%，其中輸尿管上段結石單次清除率100.0%、腎結石單次清除率70.1%。術中平均出血量（105.0±45.6）mL，無胸膜、腹腔臟器、結腸損傷；平均住院7～14 d。 結論mini-PCNL治療上尿路結石具有較高的結石清除率、良好的安全性，同時具有術后恢復快、費用適中等優點，值得在基層醫院推廣應用。

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.

微通道經皮腎鏡激光碎石術后全身炎癥反應綜合征致彌散性血管內凝血一例

Ureteroscope Pneumatic Lithotripsy for Calculi in Distal Common Bile Duct (Report of 19 Cases)

目的　探討輸尿管鏡氣壓彈道碎石治療膽總管下段嵌頓性結石的方法及療效。方法　傳統方法取石失敗病例改用輸尿管鏡置入膽總管直視見到膽總管下段嵌頓性結石，氣壓彈道碎石，鹽水沖洗出或鉗夾出結石，并探查下段是否通暢。結果　清除結石時間5~10 min，成功率100%（19/19），術后2~4周拔T管，無切口感染、無膽道感染、無殘留結石。結論　輸尿管鏡氣壓彈道碎石治療膽總管下段嵌頓性結石，高效、安全，值得臨床推廣應用。

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

【摘要】　目的　探討良性前列腺增生（benign prostatic hyperplasia，BPH）伴膀胱結石的有效腔內治療方法。〖HTH〗方法　2003年6月-2009年12月，使用F26號電切鏡外鞘作為撐開器，氣壓彈道和（或）鈥激光粉碎膀胱結石，經尿道前列腺電切術 （transurethral resection of the prostate，TURP） 治療BPH伴膀胱結石86例。患者年齡58～83歲，平均68.6歲；病程2～8年，平均5.2年。術前患者國際前列腺癥狀評分（international prostate symptom score，IPSS）為（24.6±3.9）分，生活質量（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。　結果　86例均一次手術成功。碎石時間為16~58 min，平均38 min；前列腺電切時間40~100 min，平均65 min。術中無并發癥發生。術后 5~8 d拔除尿管，平均6.5 d。術后4 例出現前尿道狹窄，經治療后痊愈。54例獲隨訪，隨訪時間2~6個月，平均3個月。術后2個月，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評分下降至（7.8±1.6）分，生活質量（2.5±0.3）分，與術前比較差異均有統計學意義（Plt;0.01）。　結論　經尿道碎石術和TURP一次性治療BPH伴膀胱結石安全、有效、經濟。【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.

Clinical Exploration of Shockwave Lithotripsy under Laparoscope Combined with Choledochoscope for the Treatment of Hepatobiliary Calculi

目的　探討腹腔鏡下膽道鏡聯合微爆破碎石術儀治療肝膽管結石的安全性及治療效果。 方法　回顧分析2008年7月－2012年6月183例膽道結石患者，行腹腔鏡下膽道鏡聯合微爆破碎石儀治療或單純經內鏡Oddi括約肌切開取石治療的臨床資料。87例患者在術中均應用微爆破碎石儀碎石（微爆破組），96例患者行單純經內鏡Oddi括約肌切開術或經內鏡乳頭切開術碎石（對照組）。 結果　微爆破組碎石成功率100%，結石取凈率85.06%（74/87），微爆破組的碎石時間、平均住院時間、平均住院總費用、并發癥發生率均明顯低于對照組（P＜0.05）。 結論　腹腔鏡下膽道鏡聯合微爆破碎石術在治療肝膽管結石病方面，具有微創、安全、經濟有效的優點，能降低結石殘留率及取石次數，值得臨床推廣。

Value of percutaneous transhepatic choledochoscopic lithotripsy in treatment of recurrent type Ⅱa hepatolithiasis

ObjectiveTo investigate the feasibility and safety of percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent type Ⅱa hepatolithiasis.MethodsAll of 293 patients with recurrent type Ⅱa hepatolithiasis admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2010 to December 2017 were collected retrospectively, 82 of whom were treated with the PTCSL (PTCSL group), 211 of whom were treated with traditional open surgery (open group). The patients were matched according to the ratio of 1∶1 by using the method of propensity score matching, then the patients were compared after matching.ResultsA total of 59 pairs were successfully matched, that was, there were 59 patients in the PTCSL group and open group, respectively. Compared with the open group, the PTCSL group had the similar conditions such as the gender, age, preoperative Child-Pugh classification, and times of previous biliary operations, etc. (P>0.050). There was no perioperative death in both groups. There were no significant differences between the two groups in the success rate, operation time, times of operations, time of T tube removal after operation, stone residual rate, and stone recurrence rate (P>0.050). Although the hospital costs of the PTCSL group was higher than that of the open group (P<0.050), the PTCSL group had various advantages, such as less intraoperative bleeding, smaller incisional scar, shorter hospital stay and postoperative ventilation time, and lower rate of total postoperative complications (P<0.050).ConclusionsAfter learning curve, PTCSL has many advantages over traditional open surgery in treatment of recurrent type Ⅱa hepatolithiasis. PTCSL is a minimally invasive surgery, which is safe and effective.