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.

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.

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.

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.

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.

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.

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.

输尿管镜钬激光碎石术治疗糖尿病肾盏结石的效果及对术后尿路炎症的影响

目的探讨输尿管镜钬激光碎石术治疗糖尿病肾盏结石的效果及对术后尿路炎症的影响。方法选取2021-01-01至2023-03-31武警北京总队医院收治的行输尿管镜钬激光碎石术治疗的肾盏结石患者124例,根据是否合并糖尿病分为A组62例(合并糖尿病)和B组62例(不合并糖尿病)。观察两组治疗指标及治疗前后血清、尿液中的炎症因子表达情况。结果两组手术时间[(75.6±8.7)min vs.(73.8±12.8)min]和结石清除率(80.6%vs.82.3%)比较,差异无统计学意义;B组住院时间(4.1±0.8)d,术中出血量(12.4±3.9)ml,显著低于A组[(6.6±1.2)d、(15.2±5.8)ml],差异有统计学意义(P<0.05)。两组手术后12 h血清IL-1β、IL-6和CRP表达量显著高于手术前,且B组明显低于A组,差异有统计学意义(P<0.05)。两组手术后12 h尿液中IL-1β、IL-6和CRP表达量显著高于手术前,且B组显著低于A组,差异具有统计学意义(P<0.05)。结论合并有糖尿病的肾盏结石患者行输尿管镜钬激光碎石术后要积极抗炎治疗,避免影响手术结果。

改进型超声引导下针状可视肾镜(Needle perc)钬激光碎石术治疗肾下盏结石的临床评价:与输尿管软镜对比

目的比较改进型超声引导下针状可视肾镜(Needle perc)钬激光碎石术和输尿管软镜下钬激光碎石术治疗1~2 cm肾下盏结石的效果,为临床治疗方式的选择提供参考。方法回顾性分析2022年1月—2023年5月郑州市第一人民医院收治的60例肾内单发下盏结石(最大径1~2 cm)患者的临床资料,比较行输尿管软镜钬激光碎石术的30例患者(软镜组)和改进型超声引导下Needle perc钬激光碎石术的30例患者(Needle perc组)的临床资料。结果Needle perc组较软镜组的整体住院时间[(3.00±1.25)d vs.(4.00±1.25)d]、手术时间[(44.63±5.42)min vs.(48.50±7.24)min]和住院花费[(15518±441)元vs.(16872±903)元]均较少(P<0.05)。Needle perc组术后清石率高于软镜组[93.3%(28/30)vs.50.7%(15/30),P<0.001]。术后降钙素原(PCT)上升幅度低于软镜组[(0.02±0.01)vs.(0.12±0.18),P=0.007],而并发症发生率低于软镜组[3.3%(1/30)vs.26.7%(8/30),P=0.030]。结论对于1~2 cm的肾下盏单发结石,改进型超声引导下Needle perc钬激光碎石术清石率较高、并发症发生率低,安全且有效。

可控负压吸引下输尿管软镜钬激光碎石术治疗肾结石合并尿路感染的疗效分析

目的 分析肾结石且伴有尿路感染患者应用可控负压吸引下输尿管软镜钬激光碎石术治疗的临床效果。方法 80例肾结石合并尿路感染患者,将样本经随机法分为实验组和对照组,每组40例。对照组患者接受常压输尿管软镜钬激光碎石术治疗,实验组患者接受可控负压吸引下输尿管软镜钬激光碎石术治疗。比较两组患者术后住院时间、术后血尿时间、手术时间、术后结石清除率及术后感染发生情况。结果 实验组患者的术后住院时间(2.55±1.45)d、术后血尿时间(1.13±0.56)d、手术时间(42.30±4.24)min明显短于对照组的(4.00±2.35)d、(2.20±0.65)d、(63.03±6.33)min(P<0.05)。实验组患者的术后感染发生率为12.5%(5/40),相比于对照组的40.0%(16/40)低(P<0.05),手术更安全、可靠。实验组患者的术后结石清除率97.5%(39/40)显著高于对照组的82.5%(33/40)(P<0.05),术后残石率更低。结论 可控负压吸引下输尿管软镜钬激光碎石术应用于肾结石合并尿路感染治疗中,能够有效缩短住院时间及手术时间,提高术后结石清除率,降低患者术后发热发生率,安全有效。

mPCNL与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

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。

SpyGlass^(TM)DS直视下激光碎石治疗胆总管巨大结石伴急性胆管炎1例的护理体会

本文总结1例胆总管巨大结石伴急性胆管炎患者行SpyGlass^(TM)DS直视下激光碎石取石的围手术期护理经验,护理重点包括术前准备、术中配合、术后护理及中医护理方案,旨在帮助患者缓解术后不适症状,促进康复。

吸引式输尿管支架与常规输尿管支架治疗泌尿系结石的疗效及安全性比较

目的比较吸引式输尿管支架和常规输尿管支架在泌尿系结石患者治疗中的疗效及安全性,以评估吸引式输尿管支架的临床应用价值。方法回顾性分析黄石市中心医院2022年12月—2023年5月收治的196例行输尿管硬镜或软镜钬激光碎石术的泌尿系结石患者,术中使用吸引式输尿管支架(吸引式输尿管支架组)100例,常规输尿管支架(常规组)96例。比较两组患者术前一般资料,拔管时的视觉模拟评分(VAS)、拔管时间、拔管成功率,以及拔管后有无肉眼血尿、腰腹部疼痛和泌尿系感染等指标。结果在拔管过程中,吸引式输尿管支架组较常规组的VAS评分低[(2.94±1.24)分vs.(5.78±1.50)分],拔管时间短[(4.28±0.51)min vs.(13.51±1.81)min],差异有统计学意义(P<0.01)。在拔管后,吸引式输尿管支架组较常规组并发症发生率更低(P<0.05)。结论在泌尿系结石治疗中,采用吸引式输尿管支架相较于常规输尿管支架具有操作简便、患者舒适性高、并发症少、拔管时间短和医疗费用少等优势。

输尿管置管联合钬激光碎石治疗输尿管中下段结石合并前列腺增生的效果及对性功能的影响

目的研究输尿管置管联合钬激光碎石治疗输尿管中下段结石合并前列腺增生的效果及对性功能的影响。方法300例输尿管中下段结石合并前列腺增生患者,根据具体手术方式不同分为试验组(152例)和对照组(148例)。对照组给予钬激光碎石治疗,试验组给予输尿管置管联合钬激光碎石治疗。比较两组围术期情况、国际勃起功能指数5(IIEF-5)评分、射精功能评分表(CIPE)评分、肾功能、临床改善情况及不良反应发生情况。结果试验组失血量(82.34±28.56)ml少于对照组的(103.47±33.58)ml,手术时间(60.66±32.27)min、血尿时间(2.45±0.14)d及住院时间(8.51±0.77)d均短于对照组的(72.55±33.26)min、(3.56±1.10)d、(13.60±1.35)d(P<0.05)。术后,两组IIEF-5、CIPE评分均较术前升高,且试验组IIEF-5评分(9.06±2.41)分、CIPE评分(28.04±3.31)分高于对照组的(8.04±2.25)、(25.16±3.24)分(P<0.05)。术后,两组血清肌酐(SCR)、尿白蛋白(ALB)、血尿素氮(BUN)水平均较术前降低,且试验组血清SCR(68.12±7.14)μmol/L、尿ALB(88.12±23.61)mg/L、BUN(4.19±0.78)mmol/L低于对照组的(75.25±7.32)μmol/L、(106.28±24.62)mg/L、(4.89±0.83)mmol/L(P<0.05)。试验组腰痛、膀胱刺激及尿路梗阻改善时间分别为(9.71±1.28)、(7.51±1.01)、(8.72±1.31)d,均显著短于对照组的(11.31±1.30)、(8.89±1.21)、(10.20±1.50)d(P<0.05)。治疗期间,两组不良反应发生率比较无差异(P>0.05)。结论在输尿管中下段结石合并前列腺增生患者中应用输尿管置管联合钬激光碎石效果显著,可有效改善患者性功能水平。

内镜逆行胰胆管造影术中使用胰胆直视成像系统联合激光碎石治疗胆总管复杂结石的分析

目的探讨经内镜逆行胰胆管造影术中使用胰胆直视成像系统联合激光碎石治疗胆总管复杂结石的治疗效果,及与传统内镜逆行胰胆管造影术的临床疗效获益对比分析。方法回顾性分析2022年1月1日至2023年5月31日南京医科大学第四附属医院内镜中心及南京医科大学第二附属医院内镜中心接受ERCP手术治疗的胆总管复杂结石症患者。分为成像辅助组(胰胆直视成像系统辅助ERCP术,n=24)和对照组(常规ERCP术,n=26)。比较2组手术指标、康复指标、术后并发症发生率、疼痛程度评分标准、焦虑自评量表等临床疗效获益和医疗成本上的差异。结果成像辅助组平均手术时间、平均总住院时间显著低于对照组,且第一次手术成功率显著高于对照组(P<0.05)。成像辅助组切口出血、胆管炎和消化道损伤的发生率显著低于对照组(P<0.05),仅中度疼痛的发生比例低于对照组(P<0.05)。结论胰胆直视成像系统辅助下ERCP术能够给患者带来更好的临床疗效,符合快速康复和精准微创治疗的理念要求。

输尿管软镜与硬镜钬激光碎石术治疗输尿管上段结石对肾功能的保护效果

目的比较输尿管软镜与硬镜钬激光碎石术治疗输尿管上段结石对肾功能的保护效果。方法选取2020年3月至2022年4月江西中医药高等专科学校附属医院收治的64例输尿管上段结石患者作为研究对象,按照手术方式的不同分为实验组与对照组,每组32例。实验组行输尿管软镜钬激光碎石术治疗,对照组行输尿管硬镜钬激光碎石术治疗,比较两组围手术期指标(手术时间、术中出血量和术后住院时间)、手术疗效、肾功能指标、氧化应激反应指标和并发症发生率。结果实验组手术时间、术后住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。实验组手术成功率高于对照组,但组间比较差异无统计学意义;实验组术后第1、30天结石清除率均高于对照组,差异有统计学意义(P<0.05)。术后,两组血清胱抑素C(CysC)水平均低于术前,血清肌酐(Cr)水平高于术前,且实验组血清CysC、Cr水平均低于对照组,差异有统计学意(P<0.05)。术后,两组血清皮质醇(Cor)水平均高于术前,血清谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)水平均低于术前,且实验组血清Cor、GSH-Px、SOD水平均低于对照组,差异有统计学意义(P<0.05)。实验组并发症发生率低于对照组(6.26%vs.34.38%),差异有统计学意义(P<0.05)。结论与输尿管硬镜钬激光碎石术相比,输尿管软镜钬激光碎石术治疗输尿管上段结石效果显著,手术成功率及结石清除率均较高,可减少氧化应激反应及并发症的发生,保护肾功能,安全性较高。

血糖控制情况对糖尿病合并肾结石患者钬激光碎石术治疗效果的影响分析

目的探究血糖控制情况对糖尿病合并肾结石患者钬激光碎石术治疗效果的影响。方法回顾性选取晋江市医院(上海市第六人民医院福建医院)于2023年1—11月收治的100例糖尿病合并肾结石患者的临床资料,根据不同血糖水平分为对照组(随机血糖>10 mmol/L,糖化血红蛋白>7%)、研究组(随机血糖≤10 mmol/L,糖化血红蛋白≤7%),每组50例。两组均行钬激光碎石术治疗。对比两组术后1 h、1 d、2 d血糖水平与术前的波动值;比较两组皮质醇(Cortisol,Cor)、醛固酮(Aldosterone,ALD)及去甲肾上腺素(Norepinephrine,NE)水平;对比两组手术时间、住院总时间和并发症发生率。结果研究组术后1 h、1 d、2 d血糖波动值均低于对照组,差异有统计学意义(P均<0.001)。术后1 d,研究组Cor水平为(223.78±18.35)nmol/L,ALD水平为(25.58±2.69)ng/L,NE水平为(85.26±5.71)μg/L,均低于对照组,差异有统计学意义(t=7.349、9.202、8.974,P均<0.001)。研究组住院时间短于对照组,差异有统计学意义(P<0.001)。研究组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论糖尿病合并肾结石行钬激光碎石术患者在术前将血糖控制良好,可降低应激反应与并发症风险,从而缩短住院时间。