Objective:To compare the treatment effects of minimally invasive percutaneous nephrolithotomy and open surgery on kidney stones.Methods:From November 2018 to November 2019,80 patients with kidney stones who were treat...Objective:To compare the treatment effects of minimally invasive percutaneous nephrolithotomy and open surgery on kidney stones.Methods:From November 2018 to November 2019,80 patients with kidney stones who were treated in our hospital were selected and divided into two groups according to the random number table method.Each group contained 40 patients.The patients in control group were treated with open surgery while the patients in observation group were treated with minimally invasive percutaneous nephrolithotomy.The surgical indicators,rate of stone removal,and adverse events were compared between the two groups.Results:There was no statistically significant difference in surgical time between the two groups(P>0.05).Compared with the control group,the observation group had less intraoperative blood loss and shorter hospital stay,and the differences were statistically significant(P<0.05).The stone clearance rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).Compared with the control group,the incidence of postoperative adverse effects was lower in the observation group,and the difference was statistically significant(P<0.05).Conclusion:Minimally invasive percutaneous nephrolithotomy for kidney stones is effective in reducing the intraoperative blood loss,shortening the length of hospital stay,improving the rate of stone clearance and reducing the occurrence of adverse effects.Therefore,this treatment method should be promoted for clinical use.展开更多
BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the ga...BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIM To compare the feasibility,safety and effectiveness of pure natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy(LC)for symptomatic gallstones.METHODS We adopted propensity score matching(1:1)to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones.We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020;517 patients met the matching criteria(NOTES,110;LC,407),yielding 86 pairs.RESULTS The technical success rate for the NOTES group was 98.9%vs 100%for the LC group.The median procedure time was 119 min[interquartile ranges(IQRs),95-175]with NOTES vs 60 min(IQRs,48-90)with LC(P<0.001).The frequency of post-operative pain was similar between NOTES and LC:4.7%(4/85)vs 5.8%(5/95)(P=0.740).The median duration of post-procedure fasting with NOTES was 1 d(IQRs,1-2)vs 2 d with LC(IQRs,1-3)(P<0.001).The median post-operative hospital stay for NOTES was 4 d(IQRs,3-6)vs 4 d for LC(IQRs,3-5),(P=0.092).During follow-up,diarrhea was significantly less with NOTES(5.8%)compared to LC(18.6%)(P=0.011).Gallstones and cholecystitis recurrence within a median of 12 mo(range:6-40 mo)following NOTES was 10.5%and 3.5%,respectively.Concerns regarding the presence of abdominal wall scars were present in 17.4%(n=15/86)of patients following LC(mainly women).CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy.This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder.Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.展开更多
目的探讨微创胆囊癌意向性根治术的安全性及有效性。方法回顾性分析2022年1月至2023年8月于西安交通大学第一附属医院肝胆外科因胆囊癌行意向性根治术的126例患者的临床病理资料,其中男性38例(30.2%),女性88例(69.8%);年龄40~88(63.3...目的探讨微创胆囊癌意向性根治术的安全性及有效性。方法回顾性分析2022年1月至2023年8月于西安交通大学第一附属医院肝胆外科因胆囊癌行意向性根治术的126例患者的临床病理资料,其中男性38例(30.2%),女性88例(69.8%);年龄40~88(63.3±8.8)岁;开腹组92例(73.0%),微创组34例(27.0%),其中微创组含5例行机器人辅助手术者。通过比较倾向性评分匹配(1:1匹配)前后两组患者临床病理资料的差异,分析开腹和微创组的手术耗时、术中出血量、术中输血量、淋巴结清扫数目、术后恢复、并发症发生、住院时间及住院费用。结果倾向性评分匹配后开腹和微创组基线资料比较,差异均无统计学意义(P>0.05)。微创组手术耗时长于开腹组(314.3±116.5 min vs.234.3±65.2 min,P=0.001),但两组患者在术中出血量、输注红细胞、输注血浆、是否阻断肝门、肝门阻断次数、肝门阻断时间、淋巴结清扫数目、阳性淋巴结数目、手术切缘比较,差异均无统计学意义(P>0.05);两组术后并发症发生情况及并发症C-D分级≥Ⅲ级者比较,差异无统计学意义(P>0.05);微创组患者术后首次进食时间及拔除引流管时间均短于开腹组(P<0.05);微创组术后住院时间短于开腹组(7.0 d vs.8.0 d,P=0.014),而住院总时间、总费用比较,差异无统计学意义(P>0.05)。结论微创胆囊癌根治术具有良好的手术安全性和有效性,可有助于患者快速恢复,具有一定的临床应用价值。展开更多
目的:总结腹腔镜联合术中胆道镜经胆囊管胆道探查取石术(laparoscopic transcystic common bileduct exploration,LTCBDE)治疗胆囊结石合并胆总管结石的临床经验。方法:回顾性分析我院2006年12月至2010年12月间546例采用LTCBDE治疗胆囊...目的:总结腹腔镜联合术中胆道镜经胆囊管胆道探查取石术(laparoscopic transcystic common bileduct exploration,LTCBDE)治疗胆囊结石合并胆总管结石的临床经验。方法:回顾性分析我院2006年12月至2010年12月间546例采用LTCBDE治疗胆囊结石合并胆总管结石的临床资料和疗效。结果:成功完成LTCBDE 519例。成功率95.1%(519/546),全组平均手术时间(83.2±36.5)min,术后平均住院时间(2.1±2.1)d。全组并发症发生率1.5%(8/546)。结论:LTCBDE应成为治疗继发性胆总管结石的首选方案。展开更多
文摘Objective:To compare the treatment effects of minimally invasive percutaneous nephrolithotomy and open surgery on kidney stones.Methods:From November 2018 to November 2019,80 patients with kidney stones who were treated in our hospital were selected and divided into two groups according to the random number table method.Each group contained 40 patients.The patients in control group were treated with open surgery while the patients in observation group were treated with minimally invasive percutaneous nephrolithotomy.The surgical indicators,rate of stone removal,and adverse events were compared between the two groups.Results:There was no statistically significant difference in surgical time between the two groups(P>0.05).Compared with the control group,the observation group had less intraoperative blood loss and shorter hospital stay,and the differences were statistically significant(P<0.05).The stone clearance rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).Compared with the control group,the incidence of postoperative adverse effects was lower in the observation group,and the difference was statistically significant(P<0.05).Conclusion:Minimally invasive percutaneous nephrolithotomy for kidney stones is effective in reducing the intraoperative blood loss,shortening the length of hospital stay,improving the rate of stone clearance and reducing the occurrence of adverse effects.Therefore,this treatment method should be promoted for clinical use.
基金Supported by Outstanding Foreign Scientist Studio Project of Henan Province,No.GZS2020006.
文摘BACKGROUND Cholecystectomy is the preferred treatment option for symptomatic gallstones.However,another option is gallbladder-preserving cholecystolithotomy which preserves the normal physiological functions of the gallbladder in patients desiring to avoid surgical resection.AIM To compare the feasibility,safety and effectiveness of pure natural orifice transluminal endoscopic surgery(NOTES)gallbladder-preserving cholecystolithotomy vs laparoscopic cholecystectomy(LC)for symptomatic gallstones.METHODS We adopted propensity score matching(1:1)to compare trans-rectal NOTES cholecystolithotomy and LC patients with symptomatic gallstones.We reviewed 2511 patients with symptomatic gallstones from December 2017 to December 2020;517 patients met the matching criteria(NOTES,110;LC,407),yielding 86 pairs.RESULTS The technical success rate for the NOTES group was 98.9%vs 100%for the LC group.The median procedure time was 119 min[interquartile ranges(IQRs),95-175]with NOTES vs 60 min(IQRs,48-90)with LC(P<0.001).The frequency of post-operative pain was similar between NOTES and LC:4.7%(4/85)vs 5.8%(5/95)(P=0.740).The median duration of post-procedure fasting with NOTES was 1 d(IQRs,1-2)vs 2 d with LC(IQRs,1-3)(P<0.001).The median post-operative hospital stay for NOTES was 4 d(IQRs,3-6)vs 4 d for LC(IQRs,3-5),(P=0.092).During follow-up,diarrhea was significantly less with NOTES(5.8%)compared to LC(18.6%)(P=0.011).Gallstones and cholecystitis recurrence within a median of 12 mo(range:6-40 mo)following NOTES was 10.5%and 3.5%,respectively.Concerns regarding the presence of abdominal wall scars were present in 17.4%(n=15/86)of patients following LC(mainly women).CONCLUSION NOTES provides a feasible new alternative scar-free treatment for patients who are unwilling or unable to undergo cholecystectomy.This minimally invasive organ-sparing procedure both removes the gallstones and preserves the physiological function of the gallbladder.Reducing gallstone recurrence is essential to achieving widespread clinical adoption of NOTES.
文摘目的探讨微创胆囊癌意向性根治术的安全性及有效性。方法回顾性分析2022年1月至2023年8月于西安交通大学第一附属医院肝胆外科因胆囊癌行意向性根治术的126例患者的临床病理资料,其中男性38例(30.2%),女性88例(69.8%);年龄40~88(63.3±8.8)岁;开腹组92例(73.0%),微创组34例(27.0%),其中微创组含5例行机器人辅助手术者。通过比较倾向性评分匹配(1:1匹配)前后两组患者临床病理资料的差异,分析开腹和微创组的手术耗时、术中出血量、术中输血量、淋巴结清扫数目、术后恢复、并发症发生、住院时间及住院费用。结果倾向性评分匹配后开腹和微创组基线资料比较,差异均无统计学意义(P>0.05)。微创组手术耗时长于开腹组(314.3±116.5 min vs.234.3±65.2 min,P=0.001),但两组患者在术中出血量、输注红细胞、输注血浆、是否阻断肝门、肝门阻断次数、肝门阻断时间、淋巴结清扫数目、阳性淋巴结数目、手术切缘比较,差异均无统计学意义(P>0.05);两组术后并发症发生情况及并发症C-D分级≥Ⅲ级者比较,差异无统计学意义(P>0.05);微创组患者术后首次进食时间及拔除引流管时间均短于开腹组(P<0.05);微创组术后住院时间短于开腹组(7.0 d vs.8.0 d,P=0.014),而住院总时间、总费用比较,差异无统计学意义(P>0.05)。结论微创胆囊癌根治术具有良好的手术安全性和有效性,可有助于患者快速恢复,具有一定的临床应用价值。
