目的探讨在B超引导下经皮穿刺胆道造瘘气压弹道碎石取石术治疗肝内外胆管结石患者的疗效,并对影响术后结石复发的因素进行分析。方法 2014年1月～2016年6月我院收治的106例肝内外胆管结石患者,其中57例接受经皮穿刺胆道造瘘气压弹道碎...目的探讨在B超引导下经皮穿刺胆道造瘘气压弹道碎石取石术治疗肝内外胆管结石患者的疗效,并对影响术后结石复发的因素进行分析。方法 2014年1月～2016年6月我院收治的106例肝内外胆管结石患者,其中57例接受经皮穿刺胆道造瘘气压弹道碎石取石术,另49例接受腹腔镜胆道探查取石术。术后随访2年,采用Logistic回归分析影响术后结石复发的相关因素。结果胆道造瘘气压弹道碎石取石术治疗患者住院时间、住院费用、术中出血量和手术时间分别为(5.2±1.7) d、(7321.5±528.3)元、(20.4±4.8) m L和(62.5±14.8) min,显著短于或少于腔镜治疗组【分别为(8.7±2.2)d、(10426.4±1032.5)元、(25.7±5.1) m L和(71.7±15.3) min,P<0.05】;胆道造瘘气压弹道碎石取石术治疗患者结石完全清除率为84.2%,显著高于腔镜治疗组(67.3%,P<0.05);胆道造瘘气压弹道碎石取石术治疗患者结石复发率为1.8%,显著低于对照组(20.4%,P<0.05);Logistic回归分析显示,结石数目、结石直径和手术方式为影响肝内外胆管结石患者术后结石复发的危险因素。结论采用经皮穿刺胆道造瘘气压弹道碎石取石术治疗肝内外胆管结石经济、安全、有效,值得临床进一步验证。展开更多
Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively,in order to make a more effective and safer preventive and therapeutic strategy.M...Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively,in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015,5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study.These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory results,while they had no infection in their blood and urine preoperatively.Without delay,5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours.The body temperature was recovered to normal in 2 or 3 days,and the blood and urine test results were not abnormal in 7 days.At last,5patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy.Especially for patients who had not presented infection preoperatively,careful preparation preoperatively,corrective manipulation,low pressure irrigation,drainage and controlling time during operation,and early diagnosis,appropriate treatment postoperatively are the key to cure and prevent urosepsis.展开更多
文摘目的探讨在B超引导下经皮穿刺胆道造瘘气压弹道碎石取石术治疗肝内外胆管结石患者的疗效,并对影响术后结石复发的因素进行分析。方法 2014年1月～2016年6月我院收治的106例肝内外胆管结石患者,其中57例接受经皮穿刺胆道造瘘气压弹道碎石取石术,另49例接受腹腔镜胆道探查取石术。术后随访2年,采用Logistic回归分析影响术后结石复发的相关因素。结果胆道造瘘气压弹道碎石取石术治疗患者住院时间、住院费用、术中出血量和手术时间分别为(5.2±1.7) d、(7321.5±528.3)元、(20.4±4.8) m L和(62.5±14.8) min,显著短于或少于腔镜治疗组【分别为(8.7±2.2)d、(10426.4±1032.5)元、(25.7±5.1) m L和(71.7±15.3) min,P<0.05】;胆道造瘘气压弹道碎石取石术治疗患者结石完全清除率为84.2%,显著高于腔镜治疗组(67.3%,P<0.05);胆道造瘘气压弹道碎石取石术治疗患者结石复发率为1.8%,显著低于对照组(20.4%,P<0.05);Logistic回归分析显示,结石数目、结石直径和手术方式为影响肝内外胆管结石患者术后结石复发的危险因素。结论采用经皮穿刺胆道造瘘气压弹道碎石取石术治疗肝内外胆管结石经济、安全、有效,值得临床进一步验证。
基金Supported by the Chow Tai Fook Medical Research Special Fund(202836019-04)
文摘Objective To analyze the risk factors causing postoperative urosepsis in ureter endoscopic lithotripsy without infection preoperatively,in order to make a more effective and safer preventive and therapeutic strategy.Methods From January 2010 to January 2015,5 ureteral calculus patients undergoing ureter endoscopic lithotripsy with holmium laser were retrospectively enrolled in this clinical study.These patients suffered urosepsis postoperatively confirmed by the clinical presentations and laboratory results,while they had no infection in their blood and urine preoperatively.Without delay,5 patients were treated by anti-inflammation and anti-shock.Results The vasopressor drug was stopped gradually after 12-36 hours.The body temperature was recovered to normal in 2 or 3 days,and the blood and urine test results were not abnormal in 7 days.At last,5patients were all cured.Conclusions Stone and operation themselves are potential factors to cause urosepsis after ureter endoscopic lithotripsy.Especially for patients who had not presented infection preoperatively,careful preparation preoperatively,corrective manipulation,low pressure irrigation,drainage and controlling time during operation,and early diagnosis,appropriate treatment postoperatively are the key to cure and prevent urosepsis.
