Objective: To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requirin...Objective: To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other.Methods: We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022.Results: Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles.Conclusion: PCN appears to be the intervention better tolerated, with less impact on the patient’s perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.展开更多
Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, peri...Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, perinephric and bladder diseases （n=79）. The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4–20 min. 12F–16F single tract was established in nephrohydrop patients and 16F–20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2–12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) is preferred for managing biliary obstruction in patients with bilio-enteric anastomotic strictures(BEAS) and calculi. In patients whose duodenal anatomy...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) is preferred for managing biliary obstruction in patients with bilio-enteric anastomotic strictures(BEAS) and calculi. In patients whose duodenal anatomy is altered following upper gastrointestinal(UGI) tract surgery, ERCP is technically challenging because the biliary tree becomes difficult to access by per-oral endoscopy.Advanced endoscopic therapies like balloon-enteroscopy or rendevous-ERCP may be considered but are not always feasible. Biliary sepsis and comorbidities may also make these patients poor candidates for surgical management of their biliary obstruction.CASE SUMMARY We present two 70-year-old caucasian patients admitted as emergencies with obstructive cholangitis. Both patients had BEAS associated with calculi that were predominantly extrahepatic in Patient 1 and intrahepatic in Patient 2. Both patients were unsuitable for conventional ERCP due to surgically-altered UGl anatomy. Emergency biliary drainage was by percutaneous transhepatic cholangiography(PTC) in both cases and after 6-weeks' maturation, PTC tracts were dilated to perform percutaneous transhepatic cholangioscopy and lithotripsy(PTCSL) for duct clearance. BEAS were firstly dilated fluoroscopically,and then biliary stones were flushed into the small bowel or basket-retrieved under visualization provided by the percutaneously-inserted video cholangioscope. Lithotripsy was used to fragment impacted calculi, also under visualization by video cholangioscopy. Satisfactory duct clearance was achieved in Patient 1 after one PTCSL procedure, but Patient 2 required a further procedure to clear persisting intrahepatic calculi. Ultimately both patients had successful stone clearance confirmed by check cholangiograms.CONCLUSION PTCSL offers a pragmatic, feasible and safe method for biliary tract clearance when neither ERCP nor surgical exploration is suitable.展开更多
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 s...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.展开更多
The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no ...The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.展开更多
Objective: To investigate the effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi. M...Objective: To investigate the effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi. Methods: A total of 97 cases of renal calculi patients were chosen as the research objects, based on the random data table, they were divided into the control group (n=49) and the observation group (n=48), patients in the control group underwent percutaneous nephrolithotomy (PCNL) treatment, while the observation group patients were treated with flexible ureteroscope lithotripsy (FURL), before and after 1 d ,the levels of inflammatory factors [interleukin-10 (IL-10), C reactive protein (CRP), white blood cell (WBC)], stress hormone [cortisol (COR), adrenocorticotropic hormone (ACTH), norepinephrine (NE)] and oxidative stress [malondialdehyde (MDA), superoxide dismutase (SOD) ] of the two groups were compared. Results: There were no significant differences in IL-10, CRP, WBC, COR, ACTH, NE, MDA and SOD levels between the two groups preoperative;Compared with the preoperative level in the group, the 1 d post-operation levels of IL-10, CRP, WBC, COR, ACTH, NE and MDA in the two groups were significantly increased, and the level of the observation group was significantly lower than that in the control group;The levels of SOD in the two groups 1 d post-operation were significantly lower than those in the same group preoperative, and the control group (85.65±9.95) U/mL was significantly lower than that of the control group (94.71±7.63) U/mL. Conclusion: Compared with percutaneous nephrolithotomy, flexible ureteroscopic lithotripsy for renal calculi is less stressful and more favorable for postoperative recovery, has an important clinical value.展开更多
BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional mul...BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.展开更多
Objectives: To compare the outcomes of Percutaneous Nephrolithotomy (PCNL) with or without nephrostomy tube. Materials & Methods: This prospective comparative study intended to compare the outcomes between PCNL wi...Objectives: To compare the outcomes of Percutaneous Nephrolithotomy (PCNL) with or without nephrostomy tube. Materials & Methods: This prospective comparative study intended to compare the outcomes between PCNL without nephrostomy tube and PCNL with nephrostomy tube. A total of 50 cases of renal stone disease planned for PCNL in Dhaka Medical College Hospital from July 2015 to June 2017, were included in this study according to the statistical calculation. Cases were randomly allocated to group A (PCNL without nephrostomy tube) and group B (PCNL with nephrostomy tube). Each group consisted of 25 patients. The outcome variables were post operative pain, requirement of analgesic, leakage of urine and post operative hospital stay. Data were analyzed and compared by statistical tests. Results: No significant differences were found regarding age (p = 0.95), sex (p = 0.55) and operation time (p = 0.36) between two groups. Post operative pain (p p p p Conclusions: Percutaneous nephrolithotomy without nephrostomy tube is better than percutaneous nephrolithotomy with nephrostomy tube in selective cases. It significantly reduces post operativepain, analgesic requirement and postoperative hospital stay. So percutaneous nephrolithotomy without nephrostomy tube is safe and effective.展开更多
1临床资料患者男,76岁,因“发作性胸痛半年余,加重1周”入院。查体:脉搏74次/min,血压138/73 mm Hg(1 mm Hg=0.133 k Pa),口唇无发绀,肝颈静脉反流征阴性,双肺呼吸音清。心界正常,心率74次/min,律齐,无杂音。心电图检查示V1-5导联ST-T...1临床资料患者男,76岁,因“发作性胸痛半年余,加重1周”入院。查体:脉搏74次/min,血压138/73 mm Hg(1 mm Hg=0.133 k Pa),口唇无发绀,肝颈静脉反流征阴性,双肺呼吸音清。心界正常,心率74次/min,律齐,无杂音。心电图检查示V1-5导联ST-T变化。心肌肌钙蛋白(cardiac troponin,cTn)I 2.46μg/L,诊断为急性非ST段抬高型心肌梗死。冠状动脉造影显示罪犯病变前降支近中段弥漫性重度钙化狭窄,最重处95%狭窄(图1(1)),心肌梗死溶栓治疗(TIMI)血流分级3级。展开更多
目的本研究旨在评价Ⅰ期经皮肾镜取石术(PCNL)和Ⅰ期经皮肾穿刺造瘘术(PCN)、Ⅱ期PCNL治疗结石性脓肾患者的临床疗效,以确定此类患者最佳手术方案的选择。方法全面检索PubMed、Cochrane Library、Web of Science和EMBASE数据库以及中国...目的本研究旨在评价Ⅰ期经皮肾镜取石术(PCNL)和Ⅰ期经皮肾穿刺造瘘术(PCN)、Ⅱ期PCNL治疗结石性脓肾患者的临床疗效,以确定此类患者最佳手术方案的选择。方法全面检索PubMed、Cochrane Library、Web of Science和EMBASE数据库以及中国知网、万方、维普数据库,于2012年1月—2022年10月发表的有关于结石性脓肾研究的文章,并根据纳入和排除标准选择文献。在检索数据并评价文献质量后,采用Review Manager software(RevMan 5.4.3,Cochrane协作网,Oxford,UK)进行Meta分析。结果本文从105项研究中选择了11项共688例患者。其中347例接受Ⅰ期PCNL治疗,341例患者接受Ⅰ期PCN及Ⅱ期PCNL治疗(以下简称Ⅱ期PCNL)。Meta分析结果显示:Ⅰ期PCNL和Ⅱ期PCNL在结石清除率(P=0.95)、手术时间(P=0.48)、术后感染性休克(P=0.36)、肾周积液感染(P=0.27)方面差异无统计学意义;Ⅰ期和Ⅱ期PCNL在术后发热(P=0.03)、留置肾造瘘管时间(P<0.01)、住院费用(P<0.01)、住院时间(P<0.01)、术后住院时间(P=0.02)方面差异有统计学意义。对于结石性脓肾患者的治疗,以上2种方案在结石清除率、手术时间、术后发生肾周积液感染及感染性休克的发生方面类似。虽然Ⅰ期PCNL术后发热的患者更多,但是住院费用更低,留置肾造瘘管时间、总住院时间、术后住院时间更短。结论Ⅰ期PCNL治疗肾及输尿管上段结石合并脓肾是经济、安全、有效的,在临床实践中具备一定的推广价值。展开更多
The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modal...The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modality.The data for this review were collected after a thorough PubMed search in core clinical journals in English language.The key words included“PCNL”and“PNL”in combination with“indications”,“techniques”,“review”and“miniaturized PCNL”.Publications relevant to the subject were retrieved and critically reviewed.Current European and American Urology Association Nephrolithiasis Guidelines were included as well.The indications for standard PCNL have been changed through the past decade.Despite evolution of the procedure,innovations and the development of new technical approaches,the indications for miniaturized PCNL have not been standardized yet.There is a need for well-constructed randomized trials to explore the indications,complications and results for each evolving approach.A continuous reduction of tract size is not the only revolution of the last years.There is constant ongoing interest in developing new efficient miniature instruments,intracorporeal lithotripters and sophisticated tract creation methods.We can summarize that,PCNL represents a valuable well-known tool in the field of endourology.We should be open minded to future changes in surgical approaches and technological improvements.展开更多
目的探讨微通道经皮肾镜取石术(mPCNL)与输尿管软镜钬激光碎石术(FURL)联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响。方法将104例完全性铸型肾结石患者随机分为对照组与研究组,每组52例。对照组行mPCNL治疗,研...目的探讨微通道经皮肾镜取石术(mPCNL)与输尿管软镜钬激光碎石术(FURL)联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响。方法将104例完全性铸型肾结石患者随机分为对照组与研究组,每组52例。对照组行mPCNL治疗,研究组行mPCNL与FURL联合治疗。比较2组患者手术一般情况、结石清除率及并发症发生情况;观察2组术前术后肾功能[尿素氮(BUN)、肌酐(SCr)]、氧化应激[皮质醇(Cor)、丙二醛(MDA)、谷胱过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)]、炎症因子[白介素(IL)-6、C反应蛋白(CRP)、降钙素原(PCT)]指标的变化情况。结果与对照组相比,研究组手术时间、住院时间及结石清除率显著增加(P<0.05)。2组术前术后BUN、Scr水平比较差异无统计学意义(P>0.05)。与术前相比,2组术后24、48 h Cor、MDA水平显著升高(P<0.05),GSH-Px、SOD水平显著降低(P<0.05);与对照组术后各时点比较,研究组Cor、MDA水平显著降低(P<0.05),GSH-Px、SOD水平显著升高(P<0.05)。2组术后2 h IL-6水平均较术前显著升高(P<0.05),术后12 h IL-6水平与术前比较差异无统计学意义(P>0.05);研究组术后2 h IL-6水平显著低于对照组(P<0.05)。与术前相比,2组术后2、12 h PCT水平均显著升高(P<0.05);但研究组术后各时点PCT水平显著低于对照组(P<0.05)。与术前相比,2组术后24、48 h CRP水平显著升高;但研究组术后各时点CRP水平显著低于对照组(P<0.05)。结论mPCNL联合FURL治疗完全性铸型肾结石疗效确切,虽然延长了手术时间,但结石清除率显著增加,且不增加患者肾功能及机体应激与炎症反应程度,有利于术后恢复。展开更多
文摘Objective: To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other.Methods: We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022.Results: Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles.Conclusion: PCN appears to be the intervention better tolerated, with less impact on the patient’s perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.
文摘Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy （PNL） was performed in patients with various renal, perinephric and bladder diseases （n=79）. The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4–20 min. 12F–16F single tract was established in nephrohydrop patients and 16F–20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2–12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) is preferred for managing biliary obstruction in patients with bilio-enteric anastomotic strictures(BEAS) and calculi. In patients whose duodenal anatomy is altered following upper gastrointestinal(UGI) tract surgery, ERCP is technically challenging because the biliary tree becomes difficult to access by per-oral endoscopy.Advanced endoscopic therapies like balloon-enteroscopy or rendevous-ERCP may be considered but are not always feasible. Biliary sepsis and comorbidities may also make these patients poor candidates for surgical management of their biliary obstruction.CASE SUMMARY We present two 70-year-old caucasian patients admitted as emergencies with obstructive cholangitis. Both patients had BEAS associated with calculi that were predominantly extrahepatic in Patient 1 and intrahepatic in Patient 2. Both patients were unsuitable for conventional ERCP due to surgically-altered UGl anatomy. Emergency biliary drainage was by percutaneous transhepatic cholangiography(PTC) in both cases and after 6-weeks' maturation, PTC tracts were dilated to perform percutaneous transhepatic cholangioscopy and lithotripsy(PTCSL) for duct clearance. BEAS were firstly dilated fluoroscopically,and then biliary stones were flushed into the small bowel or basket-retrieved under visualization provided by the percutaneously-inserted video cholangioscope. Lithotripsy was used to fragment impacted calculi, also under visualization by video cholangioscopy. Satisfactory duct clearance was achieved in Patient 1 after one PTCSL procedure, but Patient 2 required a further procedure to clear persisting intrahepatic calculi. Ultimately both patients had successful stone clearance confirmed by check cholangiograms.CONCLUSION PTCSL offers a pragmatic, feasible and safe method for biliary tract clearance when neither ERCP nor surgical exploration is suitable.
文摘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.
文摘The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.
文摘Objective: To investigate the effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi. Methods: A total of 97 cases of renal calculi patients were chosen as the research objects, based on the random data table, they were divided into the control group (n=49) and the observation group (n=48), patients in the control group underwent percutaneous nephrolithotomy (PCNL) treatment, while the observation group patients were treated with flexible ureteroscope lithotripsy (FURL), before and after 1 d ,the levels of inflammatory factors [interleukin-10 (IL-10), C reactive protein (CRP), white blood cell (WBC)], stress hormone [cortisol (COR), adrenocorticotropic hormone (ACTH), norepinephrine (NE)] and oxidative stress [malondialdehyde (MDA), superoxide dismutase (SOD) ] of the two groups were compared. Results: There were no significant differences in IL-10, CRP, WBC, COR, ACTH, NE, MDA and SOD levels between the two groups preoperative;Compared with the preoperative level in the group, the 1 d post-operation levels of IL-10, CRP, WBC, COR, ACTH, NE and MDA in the two groups were significantly increased, and the level of the observation group was significantly lower than that in the control group;The levels of SOD in the two groups 1 d post-operation were significantly lower than those in the same group preoperative, and the control group (85.65±9.95) U/mL was significantly lower than that of the control group (94.71±7.63) U/mL. Conclusion: Compared with percutaneous nephrolithotomy, flexible ureteroscopic lithotripsy for renal calculi is less stressful and more favorable for postoperative recovery, has an important clinical value.
基金Supported by The Key Medical Specialty Nurturing Program of Foshan During The 14th Five-Year Plan Period,No.FSPY145205The Medical Research Project of Foshan Health Bureau,No.20230814A010024+1 种基金The Guangzhou Science and Technology Plan Project,No.202102010251the Guangdong Science and Technology Program,No.2017ZC0222.
文摘BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
文摘Objectives: To compare the outcomes of Percutaneous Nephrolithotomy (PCNL) with or without nephrostomy tube. Materials & Methods: This prospective comparative study intended to compare the outcomes between PCNL without nephrostomy tube and PCNL with nephrostomy tube. A total of 50 cases of renal stone disease planned for PCNL in Dhaka Medical College Hospital from July 2015 to June 2017, were included in this study according to the statistical calculation. Cases were randomly allocated to group A (PCNL without nephrostomy tube) and group B (PCNL with nephrostomy tube). Each group consisted of 25 patients. The outcome variables were post operative pain, requirement of analgesic, leakage of urine and post operative hospital stay. Data were analyzed and compared by statistical tests. Results: No significant differences were found regarding age (p = 0.95), sex (p = 0.55) and operation time (p = 0.36) between two groups. Post operative pain (p p p p Conclusions: Percutaneous nephrolithotomy without nephrostomy tube is better than percutaneous nephrolithotomy with nephrostomy tube in selective cases. It significantly reduces post operativepain, analgesic requirement and postoperative hospital stay. So percutaneous nephrolithotomy without nephrostomy tube is safe and effective.
文摘1临床资料患者男,76岁,因“发作性胸痛半年余,加重1周”入院。查体:脉搏74次/min,血压138/73 mm Hg(1 mm Hg=0.133 k Pa),口唇无发绀,肝颈静脉反流征阴性,双肺呼吸音清。心界正常,心率74次/min,律齐,无杂音。心电图检查示V1-5导联ST-T变化。心肌肌钙蛋白(cardiac troponin,cTn)I 2.46μg/L,诊断为急性非ST段抬高型心肌梗死。冠状动脉造影显示罪犯病变前降支近中段弥漫性重度钙化狭窄,最重处95%狭窄(图1(1)),心肌梗死溶栓治疗(TIMI)血流分级3级。
文摘The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modality.The data for this review were collected after a thorough PubMed search in core clinical journals in English language.The key words included“PCNL”and“PNL”in combination with“indications”,“techniques”,“review”and“miniaturized PCNL”.Publications relevant to the subject were retrieved and critically reviewed.Current European and American Urology Association Nephrolithiasis Guidelines were included as well.The indications for standard PCNL have been changed through the past decade.Despite evolution of the procedure,innovations and the development of new technical approaches,the indications for miniaturized PCNL have not been standardized yet.There is a need for well-constructed randomized trials to explore the indications,complications and results for each evolving approach.A continuous reduction of tract size is not the only revolution of the last years.There is constant ongoing interest in developing new efficient miniature instruments,intracorporeal lithotripters and sophisticated tract creation methods.We can summarize that,PCNL represents a valuable well-known tool in the field of endourology.We should be open minded to future changes in surgical approaches and technological improvements.
文摘目的探讨微通道经皮肾镜取石术(mPCNL)与输尿管软镜钬激光碎石术(FURL)联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响。方法将104例完全性铸型肾结石患者随机分为对照组与研究组,每组52例。对照组行mPCNL治疗,研究组行mPCNL与FURL联合治疗。比较2组患者手术一般情况、结石清除率及并发症发生情况;观察2组术前术后肾功能[尿素氮(BUN)、肌酐(SCr)]、氧化应激[皮质醇(Cor)、丙二醛(MDA)、谷胱过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)]、炎症因子[白介素(IL)-6、C反应蛋白(CRP)、降钙素原(PCT)]指标的变化情况。结果与对照组相比,研究组手术时间、住院时间及结石清除率显著增加(P<0.05)。2组术前术后BUN、Scr水平比较差异无统计学意义(P>0.05)。与术前相比,2组术后24、48 h Cor、MDA水平显著升高(P<0.05),GSH-Px、SOD水平显著降低(P<0.05);与对照组术后各时点比较,研究组Cor、MDA水平显著降低(P<0.05),GSH-Px、SOD水平显著升高(P<0.05)。2组术后2 h IL-6水平均较术前显著升高(P<0.05),术后12 h IL-6水平与术前比较差异无统计学意义(P>0.05);研究组术后2 h IL-6水平显著低于对照组(P<0.05)。与术前相比,2组术后2、12 h PCT水平均显著升高(P<0.05);但研究组术后各时点PCT水平显著低于对照组(P<0.05)。与术前相比,2组术后24、48 h CRP水平显著升高;但研究组术后各时点CRP水平显著低于对照组(P<0.05)。结论mPCNL联合FURL治疗完全性铸型肾结石疗效确切,虽然延长了手术时间,但结石清除率显著增加,且不增加患者肾功能及机体应激与炎症反应程度,有利于术后恢复。
