ObjectiveTo discuss the safety, feasibility and short-term clinical efficacy of thoracoscopic anterior mediastinal mass resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach.MethodsA total of 44 patients suffering anterior mediastinal tumor enrolled, including 21 patients (10 males and 11 females as a trial group) with an average age of 43.6±11.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach and 23 patients (13 males and 10 females as a control group) with an average age of 45.3±10.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lateral position via transthoracic approach. The clinical efficacy of the two groups was compared.ResultsPostoperative chest drainage time (3.8±1.3 d vs. 5.0±1.8 d, P=0.017), postoperative drainage volume (238.8±66.2 mL vs. 467.2±120.0 mL, P=0.000), postoperative mean visual analogue score at 24 h (2.5±0.9 point vs. 4.9±1.0 point, P=0.000), times of self-pressure analgesic pump (3.7±0.9 vs. 8.4±2.0, P=0.000), duration of postoperative hospital stay (4.7±1.3 d vs. 7.4±3.1 d, P=0.000) and hospitalization cost (34±8 kyaun vs. 44±11 kyuan P=0.001) in the trial group were all better than those in the control group. There was no significant difference between the two groups in surgical duration (59.0±18.1 min vs. 60.4±16.4 min) (P>0.05). During follow-up, no recurrence or metastasis occurred in either group.ConclusionCompared with the lateral position through the transthoracic approach, the lithotomy position through subxiphoid approach of thoracoscopic anterior mediastinal mass resection is safe and feasible, and has certain advantages.
ObjectiveTo explore the perioperative nursing mode for percutaneous nephrolithotomy (PCNL).
MethodsA total of 866 patients with PCNL having undergone lithotripsy between January 2012 and December 2013 in our hospital were included in our study. Before surgery, they received position training, health education and psychological nursing. After surgery, patients received an integral medical wound care and pipeline management, as well as management of infectious shock and intercostal neuralgia. At the same time, we gave them dietary guidance and other health guidance.
ResultsAll the patients were successfully discharged from hospital. Postoperative infection rate was 2.4%, septic shock rate was 0.2%, bleeding rate was 2.2%, urinary leakage rate was 1.5%, the rate of pneumothorax was 0.6%, subcutaneous emphysema rate was 0.3%, and intercostal neuralgia rate was 0.6%. The average hospital stay was (11.2±2.8) days.
ConclusionThe innovative nursing mode and techniques have great significance on the success of PCNL surgery.
Objective To systematically review the effectiveness and safety of flexible ureteroscope lithtripsy (fURL) and percutaneous nephrolithotomy (PCNL) in treating renal calculus. Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CNKI, CBM, VIP, and WanFang Data from January, 1990 to August, 2012 were searched to comprehensively collect the clinical trials that compared fURL and PCNL in treating renal calculus. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Eight non-randomized controlled trials involving 536 patients were included. The results of meta-analysis showed that, PCNL was better than fURL in stone clearance (OR=0.26, 95%CI 0.15 to 0.46), but fURL was better than PCNL in postoperative pyrexia (OR=0.1, 95%CI 0.42 to 3.35), the incidence of blood transfusion (OR=0.17, 95%CI 0.03 to 1.00), and the duration of hospitalization (P=0.45, I2=0%). Conclusion Current evidence has proved that PCNL is better than fURL in decreasing stone clearance, fURL is better than PCNL in complication, the duration of hospitalization, and medical costs.
Objective
To investigate feasibility and curative effect of ultrasound-guided percutaneous transhepatic cholangioscopy in treatment of complicated hepatolithiasis.
Methods
The data of 42 patients with complicated hepatolithiasis from June 2012 to June 2017 in the Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed. All the patients were treated with ultrasound-guided percutaneous transhepatic cholangioscopy, including the first stage of dilation and drainage and the second stage choledochoscopy.
Results
The operations of the 42 patients were successfully performed. No case was converted to the conventional laparotomy. The puncture sites of 10 cases were at the right intrahepatic bile duct, 25 cases were at the left intrahepatic bile duct, and 7 cases were at the bilateral intrahepatic bile duct. The residual stones were removed by two stage choledochoscopy in the 31 patients, 11 patients had the residual stones. After the first stage, there were 4 cases of the bile duct hemorrhage, 8 cases of the cholangitis, 1 case of the pleural effusion and 1 case of the infection, 2 cases of the postoperative drainage tube shedding. After the second stage, there were 3 cases of the cholangitis and 3 cases of the postoperative drainage tube shedding. The stones of the 10/31 patients with stone removal occurred and the diseases of 9/11 patients with stone residual were stable during the following-up of (18.6±7.8) months.
Conclusion
Ultrasound-guided percutaneous transhepatic cholangioscopy including the first stage of dilation and drainage plus the second stage choledochoscopy is safe and effective in treatment of complex intrahepatic bile duct stones, it is an effective supplement to traditional surgery.
Objective
To compare clinical outcomes of percutaneous nephrolithotomy (PCNL) in patients who initially presented with and without urosepsis.
Methods
The study included patients who underwent PCNL for renal and ureter urolithiasis removal from January 2010 to December 2014 in our hospital. A 1∶1 matched-pair analysis was performed to compare outcomes and complications of patients who had obstructive urolithiasis with urosepsis initially (OUU) with patients who had obstructive urolithiasis with no urosepsis initially (NOUU) before PCNL.
Results
A total of 172 patients were included involving 122 (71%) males and 50 (29%) females with a mean age of 46.2 years (range 32 to 65 years). There were no significant differences between two groups in age, gender, BMI, complications, the size of the stones, stone's number and stone location (P>0.05). OUU groups had the similar stone-free rates (86.0%vs. 84.8%, P=0.829) as the NOUU group. OUU group had higher overall complications rate, longer duration of nephrostomy tube (NT), longer hospital length of stay (LOS), longer courses of postoperative antibiotics and higher grade of antibiotics after PCNL (all P<0.05). Higher fever developed postoperatively (11.6%vs. 3.5%, P=0.043), higher asymptomatic bacteriuria (11.6% vs. 3.5%, P=0.043) and symptomatic urinary tract infections (10.5% vs. 2.3%, P=0.029) were also found in OUU groups. There was no significant difference between two groups in sepsis (2.3% vs. 1.2%, P=0.560).
Conclusion
PCNL after decompression for urolithiasis-related urosepsis has similar success but higher complication rates than obstructive urolithiasis with no urosepsis initially.
ObjectiveTo assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) versus ureteroscopic lithotripsy (URL) in the treatment of impacted proximal ureteral stones>1 cm.
MethodsWe electronically searched PubMed, Cochrane library, Embase, WanFang, Chinese National Knowledge Infrastructure and VIP database (by the end of July 2015) to collect randomized controlled trials involving PCNL vs. URL for the treatment of impacted proximal ureteral stones> 1 cm. The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software.
ResultsSix randomized controlled trials were finally obtained after screening. A total of 487 patients were included for a Meta-analysis. The results showed that, as compared with the control group (URL), the patients in the trial group (PCNL) had the following features: ① There was a remarkable improvement of stone clearance rate [RR=1.20, 95% CI (1.09, 1.33), P=0.000 3].② There was no statistical difference in postoperative fever rates, urinary tract perforation rates [RR=1.73, 95%CI (0.43, 7.00), P=0.45; RR=1.02, 95%CI (0.11, 9.37), P=0.99], but the incidence of hematuria was higher [RR=1.99, 95%CI (1.09, 3.62), P=0.03], and the mean operative duration was longer [WMD=30.03 minutes, 95%CI (10.04, 50.02) minuntes, P=0.003].③ The mean hospitalization stay was delayed by an average of 3.73 days [WMD=3.73 days, 95%CI (3.02, 4.44) days, P<0.000 01].
ConclusionPCNL is better than URL in the stone clearance rate, while patients in the PCNL group have to stay in the hospital much longer, and should bear longer mean operative duration.
ObjectiveTo discuss the reason and treatment strategy of gallbladder muddy stones after cholecysto-lithotomy.
MethodsThe clinical data of 62 patients with gallbladder muddy stones after cholecystolithotomy who were treated in our hospital from December 2008 to December 2014 was analyzed retrospectively.
ResultsThere were 43 patients without any symptom and 19 patients with acute cholecystitis in 62 patients. Four patients were diagnosed with septation gallbladder, 6 patients with long and tortuous cystic duct, 3 patients with calculus of cystic duct, 4 patients with common bile duct stones, 39 patients with periampullary diverticula, 18 patients with pancreaticobiliary maljunction, 6 patients with duodenal papilla stenosis, 29 patients with duodenal papillitis, and 3 patients with duodenal papilla adenocarcinoma. Two patients were treated with laparoscopic cholecystectomy (LC), 1 patient with endoscopic sphincterotomy (EST) /endoscopic balloon dilation (EPBD) and LC, 1 patient with percutaneous transhepafic gallbladder drainage (PTGD) and open cholec-ystectomy, 14 patients with PTGD and EST/EPBD, 1 patient with PTGD and hepatocholangioplasty with the use of gallbladder (HG), 34 patients with EST/EPBD, 3 patients with EST/EPBD and endoscopic biliay metal stent drainage (EBMSD), 5 patients with HG, and 1 patient with EST/EPBD and HG. The gallbladder muddy stones disappeared after operations in 55 patients with gallbladder reserved, and gallbladder ejection fraction increased from (42±12) % to (59±16) %. Of the 62 patients, 53 patients were followed up for 6 months to 6 years (the median time was 3.6-year). During the follow-up period, 3 patients were diagnosed with gallbladder stones, 2 patients with common bile duct stones, and 2 patients with intrahepatic and extrahepatic bile duct stones.
ConclusionBile efferent tract obstruction is the important reason for the formation of gallbladder stones. HG, EST, and balloon expansion are the efficient methods to resolve the bile efferent tract obstruction.
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.
ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation.MethodsThe clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness.ResultsBoth groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction (P<0.05). Incision infection occurred in 1 case (3.03%) of the trial group and 3 cases (6.67%) of the control group after operation. The difference in the incidence of infection was significant (χ2=0.139, P=0.045). The incisions of other patients healed by first intention. X-ray film reexamination showed that the fractures of the two groups healed. The fracture healing time of the trial group was (5.30±1.33) months, while that of the control group was (5.98±1.80) months, with no significant difference (t=?1.815, P=0.073). There was no significant difference in VAS score, Harris scores of knee joint and ankle joint between the two groups before operation and at 3, 6, and 12 months after operation (P>0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant (P<0.05).ConclusionApplication of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.
