Bouveret syndrome masquerading as a gastric mass-unmasked with endoscopic luminal laser lithotripsy:A case report

BACKGROUND Bouveret syndrome,also known as gallstone ileus,is a rare form of gastric outlet obstruction accounting for 1%-3%of cases.This condition is most often reported in females.The diagnosis can be challenging and is often missed due to atypical presentations,which occasionally mimic gastric outlet obstruction symptoms such as nausea,vomiting,loss of appetite and hematemesis.The symptoms vary with stone size.Larger stones are managed with a surgical approach,but this carries increased morbidity and mortality.Over the past decade,the endoscopic approach has emerged as an alternative mode of treatment,but it is generally unsuccessful in the management of larger-sized stones.A literature review revealed cases of successful endoscopic treatment requiring multiple sessions for stone sizes measuring up to about 4.5 cm.Here we present a unique case of an elderly patient with Bouveret syndrome with a 5 cm stone mimicking a gastric mass and causing gastric outlet obstruction,who was successfully managed in a single session using a complete endoscopic approach with laser lithotripsy.CASE SUMMARY An 85-year-old female patient presented with 1-month history of intermittent abdominal pain,vomiting,decreased appetite and weight loss.An abdominal computed tomography showed a 4.5 cm×4.7 cm partially calcified mass at the gastric pylorus causing gastric outlet obstruction.Endoscopy showed an ulcerated fistulous opening and a large 5 cm impacted gallstone in the duodenal bulb.Endoscopic nets and baskets were used in an attempt to remove the stone,but this approach was unsuccessful.Given her advanced age,poor physical condition and underlying comorbidities,she was deemed to be high-risk for surgery.Thus,a minimally invasive approach using endoscopic laser lithotripsy was attempted and successfully treated the stone.Post-procedure,the patient experienced complete resolution of her symptoms with no complications and was able to tolerate her diet.She was subsequently discharged home at 48 h,with an uneventful recovery.CONCLUSION In our paper we describe Bouveret syndrome and highlight its management with a novel endoscopic approach of laser lithotripsy in addition to various other endoscopic approaches available to date and its success rates.

Management hepatolithiasis with operative choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy

BACKGROUND: Hepatolithiasis is very common in East Asia. It is benign in nature, but has a high recurrence rate. It is likely to lead to biliary cirrhosis and increase the risk of cholangiocarcinoma. Hence, the treatment of hepatolithiasis is difficult but vital. In this report, we present a novel approach to manage hepatolithiasis using the choledochoscopic Frequency-Doubled Double pulse Nd:YAG (FREDDY) laser lithotripsy combined with or without hepatectomy. METHODS: Between July 2009 and October 2012, 45 patients underwent choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy (laser lithotripsy group). Fortyeight patients underwent a traditional operation (traditional method group) from January 2009 to June 2009. Comparative analysis was made of demographic and clinical characteristics of the two groups. RESULTS: The final stone clearance rate of the laser lithotripsy group was 93.3%, whereas that of the traditional method group was 85.4% (P=0.22). In the laser lithotripsy group, 2 patients experienced hemobilia and 3 patients had acute cholangitis. In the traditional method group, 3 patients had intraoperative hemorrhage, 1 patient had bile leakage, 6 patients had acute cholangitis, and 1 patient died of liver failure. Moreover, the operative time in the traditional method group was significantly longer than that in the laser lithotripsy group (P=0.01). The mean hospital stay of the patients in the traditional method group was longer than that in the laser lithotripsy group (9.8 vs8.2 days, P=0.17). Recurrent intrahepatic bile duct stones were not found during the follow-up period in the two groups. CONCLUSION: Operative choledochoscopic FREDDY laser lithotripsy combined with or without hepatectomy may be an effective and safe treatment for hepatolithiasis.

Ureteroscopic Holmium:YAG Laser Lithotripsy for Managing Ureteral Calculi (A Report of 168 Cases)

Summary: The effectiveness and safety of ureteroscopic holmium:YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium:YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6 % in the upper ureteral calculi, 93.9 % in the middle ureteral calculi and 94.4 % in the lower ureteral calculi, respectively. The complication rate was 4.8 % (8 cases). It was suggested that ureteroscopic holmium:YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Successful endoscopic treatment of a large impacted gallstone in the duodenum using laser lithotripsy,Bouveret’s syndrome:A case report

BACKGROUND Bouveret´s syndrome is defined as a gastric outlet obstruction after passage of a gallstone through a fistula into the duodenum.Due to its rarity,the diagnosis of Bouveret’s syndrome is often delayed and causes a high morbidity and mortality rate.CASE SUMMARY A 93-year-old female presented with worsening pain in the right upper abdomen and vomiting.A gastroscopy revealed fluid retention caused by a massive obstructive stone in the bulbus.Endoscopic laser lithotripsy of the impacted stone was planned after multidisciplinary consultation.A Dornier Medilas H Solvo lithotripsy 350μm laser fiber(10 Hz,2 Joules)was used to disintegrate the stone into smaller pieces.The patient recovered completely.CONCLUSION A mechanical obstruction due to a gallstone that has entered the gastrointestinal tract is a complication that appears in 0.3%-0.5%of patients who have cholelithiasis.Stones larger than 2 cm can become impacted in the digestive tract,which occurs mostly in the terminal ileum.In approximately 1%-3%of cases,the stones cause obstruction in the duodenum.This phenomenon is called Bouveret’s syndrome.As this condition is mostly observed in elderly individuals with multiple comorbidities,treatment by an open surgical approach is unsuitable.Endoscopic removal is the preferred technique.The benefit of using laser lithotripsy is the precise targeting of energy onto the stone with minimal tissue injury.Endoscopic laser lithotripsy is a safe and feasible treatment option for Bouveret’s syndrome.

A method for reducing thermal injury during the ureteroscopic holmium laser lithotripsy

Objective:Many studies have demonstrated the heat effect from the holmium laser lithotripsy can cause persistent thermal injury to the ureter.The purpose of this study was to elucidate the use of a modified ureteral catheter with appropriate firing and irrigation to reduce the thermal injury to the“ureter”during the ureteroscopic holmium laser lithotripsy in vitro.Methods:An in vitro lithotripsy was performed using a modified catheter(5 Fr)as the entrance for the irrigation and the holmium laser fiber while using the remaining space in the ureteroscopic channel as an outlet.Different laser power settings(10 W,20 W,and 30 W)with various firing times(3 s,5 s,and 10 s)and rates of irrigation(15 mL/min,20 mL/min,and 30 mL/min)were applied in the experiment.Temperature changes in the“ureter”were recorded with a thermometer during and after the lithotripsy.Results:During the lithotripsy,the local highest mean temperature was 60.3℃ and the lowest mean temperature was 26.7℃.When the power was set to 10 w,the temperature was maintained below 43℃ regardless of laser firing time or irrigation flow.Regardless of the power or firing time selected,the temperature was below 43℃ at the rate of 30 mL/min.There was a significant difference in temperature decrease when continuous 3 s drainage after continuous firing(3 s,5 s,or 10 s)compared to with not drainage(p<0.05)except for two conditions of 0.5 J×20 Hz,30 mL/min,firing 5 s,and 1.0 J×10 Hz,30 mL/min,firing 5 s.Conclusion:Our modified catheter with timely drainage reducing hot irrigation may significantly reduce the local thermal injury effect,especially along with the special interrupted-time firing setting during the simulated holmium laser procedure.

Ureteroscopic Management of Ureteral Calculi: Pneumatic versus Holmium: YAG Laser Lithotripsy

Background: Among various intracorporeal lithotripters, pneumatic lithotripter has become the widely used tool for the treatment of urinary stones. Recently the holmium: YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of urinary calculi. Purpose: Compare the effectiveness and complications of treatment for ureteric stones between holmium laser lithotripsy and pneumatic lithotripsy. Material and Methods: Comparison of 100 patients presented with ureteric stones, group one (50) of whom were treated with pneumatic lithotripsy and group two (50) with holmium laser was done and the effectiveness and complications of both were analyzed. Results: There was no difference in patient age, sex, stone size and location of stones between the two groups. The immediate stone free rates were 88% in the holmium: YAG group and 66% in the pneumatic lithotripsy group (p < 0.05). The four weeks stone free rates were 98% and 94% respectively (p = 0.07). The mean ± SD operative time in the holmium: YAG group (40 ± 26 min) was shorter than those with pneumatic lithotripsy group (60 ± 40 min). Postoperative stay in hospital was less than 24 hours in holmium: YAG group (70.4%) and shorter than those for pneumatic group (29.6%) (p < 0.002). Post treatment complications such as ureteral perforation were encountered in only two patients who underwent pneumatic lithotripsy. Other complications, such as mucosal injury, ureteral perforation and postoperative fever;there was no statistically significant difference between the two groups. While light hematuria was found more frequently in the pneumatic group (14%) in comparison to laser group (12%) (p = 0.02). On the other hand, the overall complication rates between the two groups was statistically significant (8%) laser group vs. (32%) pneumatic group (p = 0.003). Conclusions: Holmium: YAG laser lithotripsy was associated with shorter operation time and postoperative hospitalization period. These data suggest that holmium: YAG lithotripsy was safe and more effective than Pneumatic lithotripsy in the aspect of immediate stone free rate. We believe that holmium: YAG is an excellent treatment modality for managing ureteral calculi.

Systematic evaluation of a holmium:yttrium-aluminum-garnet laser lithotripsy device with variable pulse peak power and pulse duration

Objective:The Holmium:yttrium-aluminum-garnet(Ho:YAG)laser is the standard lithotrite for ureteroscopy.This paper is to evaluate a Ho:YAG laser with a novel effect function in vitro,which allows a real-time variation of pulse duration and pulse peak power.Methods:Two types of phantom calculi with four degrees of hardness were made for fragmentation and retropulsion experiments.Fragmentation was analysed at 5(0.5 J/10 Hz),10(1 J/10 Hz),and 20(2 J/10 Hz)W in non-floating phantom calculi,retropulsion in an ureteral model at 10(1 J/10 Hz)and 20(2 J/10 Hz)W using floating phantom calculi.The effect function was set to 25%,50%,75%,and 100%of the maximum possible effect function at each power setting.Primary outcomes:fragmentation(mm^3),the distance of retropulsion(cm);
5 measurements for each trial.Results:An increase of the effect feature(25%vs.100%),i.e.,an increase of pulse peak power and decrease of pulse duration,improved Ho:YAG laser fragmentation.This effect was remarkable in soft stone composition,while there was a trend for improved fragmentation with an increase of the effect feature in hard stone composition.Retropulsion increased with increasing effect function,independently of stone composition.The major limitations of the study are the use of artificial stones and the in vitro setup.Conclusion:Changes in pulse duration and pulse peak power may lead to improved stone fragmentation,most prominently in soft stones,but also lead to increased retropulsion.This new effect function may enhance Ho:YAG laser fragmentation when maximum power output is limited or retropulsion is excluded.

Thulium fiber laser lithotripsy:Is it living up to the hype?

Objective:The holmium:yttrium-aluminium-garnet laser(Ho:YAG)has been the gold standard for laser lithotripsy over the last three decades.After demonstrating good in vitro efficacy,the thulium fiber laser(TFL)has been recently released in the market and the initial clinical results are encouraging.This article aims to review the main technology differences between the Ho:YAG laser and the TFL,discuss the initial clinical results with the TFL as well as the optimal settings for TFL lithotripsy.Methods:We reviewed the literature focusing on the technological aspects of the Ho:YAG laser and TFL as well as the results of in vitro and in vivo studies comparing both technologies.Results:In vitro studies show a technical superiority of TFL compared to the Ho:YAG laser and encouraging results have been demonstrated in clinical practice.However,as TFL is a new technology,limited studies are currently available,and the optimal settings for lithotripsy are not yet established.Conclusion:TFL has the potential to be an alternative to the Ho:YAG laser,but more reports are still needed to determine the optimal laser for lithotripsy of urinary tract stones when considering all parameters including effectiveness,safety,and costs.

Mid-Infrared Pulsed Laser Lithotripsy with a Tunable Laser Using Difference-Frequency Generation

A novel technique of lithotripsy was investigated with a mid-infrared tunable pulsed laser using difference-frequency generation (DFG). Human gallstone samples obtained from 24 patients were analyzed with their infrared absorption spectra. It was found that the principal components of the gallstones were different for the different patients and that the gallstone samples used in this research could be classified into four groups, i.e., mixed stones, calcium bilirubinate stones, cholesterol stones, and calcium carbonate stones. In addition, some gallstone samples had different compositions within the single stone. The mid-infrared laser tunable within a wavelength range of 5.5 - 10 μm was irradiated to the cholesterol stones at two different wavelengths of 6.83 and 6.03 μm, where the cholesterol stones had relatively strong and weak absorption peaks, respectively. As the result, the cholesterol stones were more efficiently ablated at the wavelength of 6.83 μm with the strong absorption peak. Therefore, it is suggested that the gallstones could be efficiently ablated by tuning the wavelength of the laser to the strong absorption peak of the gallstones. The higher efficiency of the ablation using the characteristic absorption peaks should lead to the safer treatment without damage to the surrounding normal tissues. In order to identify the composition of the gallstones in the patients, endoscopic and spectroscopic diagnosis using the DFG laser and an optical fiber probe made with two hollow optical fibers and a diamond attenuation total reflection prism should be useful. The absorption spectrum of the gallstones in the patients could be measured by measuring the energy of the DFG laser transmitted through the optical fiber probe and by scanning the wavelength of the DFG laser.

Appropriate kidney stone size for ureteroscopic lithotripsy:When to switch to a percutaneous approach

Flexible ureteroscopy(f URS) has become a more effective and safer treatment for whole upper urinary tract stones. Percutaneous nephrolithotomy(PNL) is currently the first-line recommended treatment for large kidney stones ≥ 20 mm and it has an excellent stone-free rate for large kidney stones. However, its invasiveness is not negligible considering its major complication rates. Staged f URS is a practical treatmentfor such large kidney stones because f URS has a minimal blood transfusion risk, short hospitalization and few restrictions on daily routines. However, as the stone size becomes larger, the stone-free rate decreases, and the number of operations required increases. Therefore, in our opinion, staged f URS is a practical option for kidney stones 20 to 40 mm. Miniaturized PNL combined with f URS should be considered to be a preferred option for stones larger than 40 mm. Moreover, URS is an effective treatment for multiple upper urinary tract stones. Especially for patients with a stone burden < 20 mm, URS is a favorable option that promises a high stone-free rate after a single session either unilaterally or bilaterally. However, for patients with a stone burden ≥ 20 mm, a staged operation should be considered to achieve stone-free status.

Ureteroscopic lithotripsy using holmium laser for 187 patients with proximal ureteral stones

Background Improving the success rate of ureteroscopic lithotripsy for proximal ureteral stones is the hot issue in this field. Here we reported our experience on the treatment of proximal ureteral stones.Methods From 2005 to 2010, 187 consecutive patients with proximal ureteral stones who underwent ureteroscopic lithotripsy were enrolled. The initial 52 patients treated by semi-rigid ureteroscope alone were classified as group 1. The subsequent 135 patients treated by semi-rigid ureteroscope with the aid of stone basket and flexible ureteroscope were classified as group 2.Results In group 1, the overall stone-free rate was 67.3%. By a single procedure of ureteroscopic lithotripsy using a semi-rigid instrument, patients with ureteral stones below the 4th lumbar vertebra level achieved 91.7% stone-free rate, which was only 50% in patients with stones above the 4th lumbar vertebra level. Conversion to open surgery occurred in two patients since ureteral perforation was observed. In group 2, the stone-free rate achieved 93.2% with the aid of an N-Trap basket, which was significantly higher than that of patients without the aid of the basket （51.6%）. Flexible ureteroscope was subsequently used in patients with fragment migration, thus making the overall success rate in group 2 increases to 97.0%.Conclusions Ureteroscopic lithotripsy is a safe and efficacious treatment for proximal ureteral stones. A single procedure of ureteroscopic lithotripsy using semi-rigid ureteroscope could achieve a satisfactory stone-free rate in patients with proximal ureteral stones below the 4th lumbar vertebra level. However, patients with ureteral stones above the 4th lumbar vertebra level experienced higher stone-migration rate, which would decrease the success rate. Fortunately, the stone-free state could possibly be achieved with the aid of an N-trap basket and flexible ureteroscope.

Thermal effect of holmium laser lithotripsy under ureteroscopy

To the Editor: Ureteral calculus is a common urological disease. In recent years, one of the main treatment methods is ureteroscopy with holmium laser lithotripsy. However, with the extensive application of holmium laser lithotripsy, the increasing incidence of postoperative ureteral stricture or even occlusion has attracted the attention of clinicians to its etiology. The issue of the intraoperative holmium laser thermal effect has also gradually gained attention. The holmium laser is a long-wavelength pulsed laser, which crushes calculi by an optomechanical/photoacoustic mechanism as well as a photothermal mechanism, and it is mainly based on the photothermal mechanism.[1] Currently, multiple in vitro studies worldwide have confirmed that the holmium laser did increase the water temperature in the working area. However, these studies only simulated the lithotripsy process of the holmium laser in vitro, which did not completely reflect the thermal effect of the holmium laser during an actual operation. Accordingly, this study monitored the temperature changes of the lavage fluid in the operative field during the actual holmium laser lithotripsy process under an ureteroscope, with the aim of providing more information for the etiology study of ureteral stricture after ureteroscopy with holmium laser lithotripsy.

Flexible ureteroscopic treatment of kidney stones: How do the new laser systems change our concepts?

Objective: Flexible ureteroscopy (fURS) has become a widely accepted and effective technique for treating kidney stones. With the development of new laser systems, the fURS approach has evolved significantly. This literature review aims to examine the current state of knowledge on fURS treatment of kidney stones, with a particular focus on the impact of the latest laser technologies on clinical outcomes and patient safety.Methods: We conducted a search of the PubMed/PMC, Web of Science Core Collection, Scopus, Embase (Ovid), and Cochrane Databases for all randomized controlled trial articles on laser lithotripsy in September 2023 without time restriction.Results: We found a total of 22 relevant pieces of literature. Holmium laser has been used for intracavitary laser lithotripsy for nearly 30 years and has become the golden standard for the treatment of urinary stones. However, the existing holmium laser cannot completely powder the stone, and the retropulsion of the stone after the laser emission and the thermal damage to the tissue have caused many problems for clinicians. The introduction of thulium fiber laser and Moses technology brings highly efficient dusting lithotripsy effect through laser innovation, limiting pulse energy and broadening pulse frequency.Conclusion: While the holmium:yttrium-aluminum-garnet laser remains the primary choice for endoscopic laser lithotripsy, recent technological advancements hint at a potential new gold standard. Parameter range, retropulsion effect, laser fiber adaptability, and overall system performance demand comprehensive attention. The ablation efficacy of high-pulse-frequency devices relies on precise targeting, which may pose practical challenges.

Clinical usefulness of transpapillary removal of common bile duct stones by frequency doubled double pulse Nd:YAG laser

AIM: To study the efficacy and the safety of laser lithotripsy without direct visual control by using a balloon catheter in patients with bile duct stones that could not be extracted by standard technique. METHODS: The seventeen patients (7 male and 10 female; mean age 67.8 years) with difficult common bile duct (CBD) stones were not amenable for conventional endoscopic maneuvers such as sphincterotomy and mechanical lithotripsy were included in this study. Laser wavelengths of 532 nm and 1064 nm as a double pulse were applied with pulse energy of 120 mJ. The laser fiber was advanced under fluoroscopic control through the ERCP balloon catheter. Laser lithotripsy was continued until the fragment size seemed to be less than 10 mm. Endoscopic extraction of the stones and fragments was performed with the use of the Dormia basket and balloon catheter. RESULTS: Bile duct clearance was achieved in 15 of 17 patients (88%). The mean number of treatment sessions was 1.7 ± 0.6. Endoscopic stone removal could not be achieved in 2 patients (7%). Adverse effects were noted in three patients (hemobilia, pancreatitis, and cholangitis). CONCLUSION: The Frequency Doubled Double Pulse Nd:YAG (FREDDY) laser may be an effective and safe technique in treatment of difficult bile duct stones.

系统性护理对输尿管镜碎石术患者的影响

目的本研究旨在探讨系统性护理对输尿管镜碎石术患者的影响。方法选取2023年7月—2024年2月在医院接受输尿管镜碎石术治疗的160例患者作为研究对象,按照组间基线资料均衡可比的原则分为对照组和观察组,每组80例。对照组患者实施常规护理,观察组患者在对照组的基础上实施系统性护理,并分析两组患者的住院时间、腰痛症状消失时间、碎石完全排出时间、VAS评分、护理质量(心理干预、业务水平、护理态度、健康宣教)以及护理满意程度。结果观察组患者住院时间、腰痛症状消失时间、碎石完全排出时间均短于对照组,差异有统计学意义(P<0.05)。观察组患者干预后VAS评分低于对照组,差异有统计学意义(P<0.05);观察组患者护理质量(心理干预、业务水平、护理态度、健康宣教)评分均高于对照组,差异有统计学意义(P<0.05);观察组患者护理满意程度高于对照组,差异有统计学意义(P<0.05)。结论系统性护理在输尿管镜碎石术患者中不仅可以有效缓解疼痛、提高治疗效果,还能够提升护理质量和患者满意程度,有较好的护理效果。

Measurements of Laser Induced Bubble Behavior in Elastic Tube and Temperature around Bubble in TUL Treatment

Transurethral ureteral lithotripsy (TUL) is a treatment that breaks stones by irradiating a pulsed laser through an optical fiber. Heat and impulsive force of the laser may affect nearby tissues during treatment. A bubble induced by the pulsed laser plays an important role in laser lithotripsy. It is important to understand effects of the bubble on the surroundings by simulating treatment in a narrow space such as in a ureter. In this study, we observe behaviors of the bubble in the narrow space inside a soft material simulating under in vivo condition. The bubble formed under various laser irradiation conditions exhibits characteristic behavior, and the surrounding elastic wall is compressed and bulged when the bubble grows and collapses. In the case of bubble formed near the elastic wall, the bubble contacts with the elastic wall during growth, and severe large deformation of the elastic wall is observed at bubble collapse. According to the temperature measurement, a temperature rise of 25℃ - 30℃ occurs in the area where the bubbles are in contact. From the above, by presenting the deformation of the elastic wall and temperature increase, we can show useful information to improve the safety for treatment at narrow space.

输尿管软镜钬激光碎石术后尿路感染患者血清sTREM-1、RBP4、HBD-3水平变化及检测意义

目的:探讨输尿管软镜钬激光碎石术(FURL)后尿路感染(UTI)患者血清可溶性髓样细胞触发受体-1(sTREM-1)、视黄醇结合蛋白4(RBP4)、人β-防御素-3(HBD-3)水平变化及检测意义。方法:选取行FURL患者183例,根据患者术后是否发生UTI分为UTI组(98例)和非UTI组(85例)。比较两组临床资料及血清sTREM-1、RBP4、HBD-3水平。采用多因素Logistic回归分析患者FURL术后发生UTI的影响因素。分析血清sTREM-1、RBP4、HBD-3对患者FURL术后发生UTI的预测价值。结果:UTI组有泌尿道手术史、导尿管留置时间≥7 d、抗菌药物种类>3种患者比例高于非UTI组(均P<0.05)。UTI组血清sTREM-1、RBP4、HBD-3水平高于非UTI组(均P<0.05)。泌尿道手术史、导尿管留置时间、抗菌药物种类及血清sTREM-1、RBP4、HBD-3是患者FURL术后发生UTI的影响因素(均P<0.05)。血清sTREM-1、RBP4、HBD-3水平与患者泌尿道手术史、导尿管留置时间及抗菌药物种类呈正相关(均P<0.05)。血清sTREM-1、RBP4、HBD-3联合预测患者FURL术后发生UTI的曲线下面积(AUC)为0.894,高于三者独立预测的AUC(均P<0.05)。结论:FURL术后UTI患者血清sTREM-1、RBP4、HBD-3水平升高,三者联合对FURL术后发生UTI具有较高的预测价值。

输尿管镜下钬激光碎石术治疗输尿管结石的效果

目的:分析输尿管镜下钬激光碎石术治疗输尿管结石的效果。方法:选取2021年1月—2024年1月张家港市第三人民医院收治的80例输尿管结石患者为研究对象,采用双色球法随机分为观察组和对照组,各40例。观察组应用输尿管镜下钬激光碎石术治疗,对照组采用体外冲击波碎石治疗。对比两组取石效果、并发症发生率、手术时间、住院时间。结果:观察组一次性碎石率、结石排净率均高于对照组(P<0.05)。观察组并发症总发生率低于对照组(P=0.023)。观察组手术时间长于对照组,住院时间短于对照组(P<0.001)。结论:输尿管镜钬激光碎石术对输尿管结石的碎石、排石效果较好,并发症发生率低,术后恢复快,但手术时间较长。

基于医护一体化的预见性护理在泌尿系统结石手术患者中的应用效果

目的:观察基于医护一体化的预见性护理在泌尿系统结石手术患者中的应用效果。方法:选取2021年3月至2022年5月于该院实施输尿管软镜碎石术的92例泌尿系统结石患者进行前瞻性研究,按照随机数字表法将其分为对照组(n=46)和研究组(n=46)。对照组采用常规护理,研究组采用基于医护一体化的预见性护理,比较两组围术期指标(肠鸣音恢复时间、下床活动时间、导尿管拔除时间和住院时间)水平,护理前后疼痛程度[视觉模拟评分法(VAS)]、负性情绪[焦虑自评量表(SAS)和抑郁自评量表(SDS)]评分,以及术后并发症发生率。结果:研究组肠鸣音恢复时间、下床活动时间、导尿管拔除时间和住院时间均短于对照组,差异有统计学意义(P<0.05);护理后,研究组VAS评分低于对照组,差异有统计学意义(P<0.05);护理后,研究组SAS、SDS评分均低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为6.52%(3/46),低于对照组的23.91%(11/46),差异有统计学意义(P<0.05)。结论:基于医护一体化的预见性护理应用于泌尿系统结石手术患者可改善围术期指标水平,降低疼痛程度评分、负性情绪评分和并发症发生率,效果优于常规护理。

三金排石汤联合输尿管镜钬激光碎石术治疗肾输尿管结石的临床研究

目的:探究三金排石汤联合输尿管镜钬激光碎石术用于肾输尿管结石患者治疗的临床价值。方法:选取2023年1月—2024年1月本院收治的肾输尿管结石患者102例,按照信封随机法分为三金组和常规组两组,每组各51例。三金组予以三金排石汤联合输尿管镜钬激光碎石术(UHLL)治疗,常规组予以UHLL治疗。比较两组肾输尿管结石患者术后恢复状态、治疗前后中医证候积分(主症:腰酸胀痛、小便淋沥不畅、尿色深红;次症:冷汗、恶心呕吐)、清石率及血肌酐含量、疼痛差异[视觉疼痛量表(VAS)]和并发症情况。结果:治疗后,三金组中医证候积分的主症和次症积分均低于常规组(P <0.05)。两组术后首次排气时间均无明显差异(P>0.05)。三金组下床活动时间、血尿改善时间和住院时间均短于常规组(P <0.05)。三金组清石率为(96.52±2.13)%,明显高于常规组的(90.47±3.56)%(P <0.05)。治疗后,三金组血肌酐水平为(95.67±4.28)μmol/L,明显低于常规组的(108.91±5.17)μmol/L,差异有统计学意义(P <0.05)。术后24 h、1周和治疗结束时,三金组VAS得分均低于常规组(P <0.05)。三金组患者并发症总发生率为1.96%,低于常规组的13.73%(P <0.05)。结论:三金排石汤联合输尿管镜钬激光碎石术能有效促进肾输尿管结石患者术后恢复,提高清石率,改善肾功能,缓解疼痛并降低并发症风险,有临床应用价值。