Comparative Observation on Nursing Effect of Nursing Intervention and Routine Nursing in Patients with Renal Calculi and Gastric Ulcer and the Impacts on Epidermal Growth Factor

Objective: To explore the comparative observation on nursing effect of nursing intervention and routine nursing in patients with renal calculi and gastric ulcer and the impacts on epidermal growth factor. Methods: A total of 72 patients with renal calculi and gastric ulcer were selected and treated in our hospital from January 2018 to December 2018. They were divided into the observation group and the control group, 36 for each. Comprehensive nursing intervention was implemented in the observation group, whereas routine nursing was implemented in the control group. The level of epidermal growth factor, nursing satisfaction, renal calculi recurrence rate, average hospital stay and postoperative blood loss were compared between the two groups after nursing. Results: There was no significant difference in the level of epidermal growth factor between the two groups before nursing (P > 0.05), while after nursing, the level in the observation group was higher compared with the control group, and the difference between the two groups was significant (P Conclusion: With regard to patients with renal calculi and gastric ulcer, comprehensive nursing intervention can improve nursing satisfaction and quality of patients’ lives, reduce calculi recurrence rate, and increase the level of epidermal growth factor, which has clinical application value.

Contemporary role of multi-tract percutaneous nephrolithotomy in the treatment of complex renal calculi

Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with these large and complex stones.The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance.This systematic review focuses on the need for multi-tract PCNL for complex renal calculi.The literature review was performed using PubMed database using the keywords“multiple tract PCNL”or“multiperc”.We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018,and the search was restricted to available literature in English language only.Ten studies with n>20 were included for the final analysis.We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance,outcomes and complications,especially,procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones.Multiperc is found to be safe,feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure.It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.

Evaluation of Extracorporeal Shockwave Lithotripsy in the Management of Renal and Ureteral Calculi

Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.

An unusual case of renal calculi leading to myocardial infarction and cardiogenic shock

INTRODUCTION The presentation of cardiogenic shock （CS） is usually straightforward, and includes hypotension, absence of hypovolemia, and clinical signs of poor tissue perfusion such as oliguria, cyanosis, cool extremities and altered mentation. The most common etiology of CS is acute myocardial infarction, Here, we report a case of a 42-year-old male who presented with right flank pain, nausea and vomiting initially thought to be nephrolithiasis, which he had a history of but was ultimately diagnosed with CS due to a type II myocardial infarction. This case illustrates the importance of having a broad differential diagnosis especially when a patient＇s vital signs take a drastic turn since this patient initially resembled someone with nephrolithiasis.

Wrist-ankle acupuncture combined with pain nursing for the treatment of urinary calculi with acute pain

BACKGROUND Urological calculi often cause renal colic,which is characterized by paroxysmal or persistent severe pain in the upper abdomen or lumbar region.Development of methods to quickly relieve these pain symptoms has garnered clinical attention.Wrist-ankle acupuncture is a type of floating acupuncture therapy administered at selected points in the carpal and ankle areas,and it has good pain-relieving effects.We used wrist-ankle acupuncture combined with pain nursing for pain intervention in patients with renal calculi to confirm its application and safety.AIM To study the effect of wrist-ankle acupuncture combined with pain nursing in the treatment of urinary calculi with acute pain.METHODS Eighty-two patients with urinary calculi with acute pain as the first symptom followed at our hospital from November 2019 to June 2021 were enrolled in the study and classified into two groups according to the odd and even numbers of the visit sequences,each with 41 cases.The control group received a routine nursing intervention and intramuscular injection of nonsteroidal anti-inflammatory drugs,whereas the observation group received pain management nursing and wrist-ankle acupuncture.Subsequently,the pain-relieving effect was compared between the two groups.RESULTS The score on the visual analog scale(VAS)at 24,48,and 72 h postintervention was decreased in both groups compared with the baseline data;moreover,the observation group scored significantly lower than the control group on the VAS at each time point after the intervention(P<0.05).The clinical efficacy at 24 h postintervention was not significantly different between the two groups(P>0.05).In turn,the pain recurrence rate at 72 h postintervention was lower in the observation group compared with the control group(P<0.05).Finally,the nursing satisfaction rate in the observation group was significantly higher than that observed in the control group(P<0.05).No serious adverse reactions occurred during the treatment and the safety of treatment was high in both groups.CONCLUSION Wrist-ankle acupuncture combined with pain nursing for treating urolithiasis with acute pain effectively alleviated the degree of pain and reduced the recurrence rate,which was worthy of clinical application.

Effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi

Objective:To explore the effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi.Methods: From December 2016 to November 2017, 97 patients with renal calculi were selected and divided into control group (48 cases) and observation group (49 cases), the control group was treated with percutaneous nephrolithotomy. On the basis of the treatment of the control group, the observation group was treated with ureteroscopic lithotripsy. The changes of inflammatory mediators, immune index, thyroxine (TH), urokinase (UK) and renal function were compared between the two groups before and after treatment.Results: After treatment, the levels of prostaglandin E2 (PGE2), substance P (SP), nitric oxide (NO) and lipid peroxide (LPO) in the two groups were significantly higher than those before treatment, and the levels of PGE2, SP, NO and LPO in the control group were significantly higher than those in the observation group;the levels of CD4+, CD4+/CD8+ in the two groups were significantly lower than those before treatment, but the levels of CD8+ were significantly higher than those before treatment, and the levels of CD4+, CD4+/CD8+in the control group were significantly lower than those in the observation group, and the levels of CD8+ were significantly higher than those in the observation group;the levels of TH in the two groups were significantly lower than those before treatment, but the levels of UK were significantly higher than those before treatment, and the levels of TH in the observation group were significantly lower than those in the control group, and the levels of UK were significantly higher than those in the control group;the levels of urea nitrogen (BUN), serum creatinine (Scr), cystatin C (CysC) in the two groups were significantly higher than those before treatment, and the levels of BUN, Scr, CysC in the control group were significantly higher than those in the observation group. Conclusions:The combination of ureteroscope and percutaneous nephroscope can relieve inflammation stress, alleviate immunosuppression, enhance stone clearance and reduce the damage to renal function. It is of clinical significance.

A pilot clinical study of developing an External Assist Targeting Device for rapid and precise renal calyx access during percutaneous nephrolithotomy

Objective:To design a device to increase the accuracy of the targeting process and reduce the radiation exposure to both the patients and the medical staff.Methods:We analyzed the inherent problem and designed the External Assist Targeting Device(EATD)to assist in the alignment of needle targeting on the desired renal calyx under fluoroscopic guidance.The EATD was designed to allow rapid and precise access to calyces at all angles,with a simple two-step puncture protocol developed for puncturing a target renal calyx.We then tested the device in a pilot human trial with four patients.Results:In experiments with phantom models,the time for successful targeting was reduced by 31%using the device.The mean fluoroscopic time was reduced by 40%.In initial human trial,the puncture time was shortened by 66%and the radiation dose was decreased by 65%compared to free-hand technique.No complication was observed during the trial.Conclusion:The EATD was found to be cost effective,portable,simple to set up,and safe to operate for assisting in the percutaneous nephrolithotomy procedures.Our preliminary tests showed high degree of accuracy in gaining precise access to a targeted renal calyx with much shorter time and lesser radiation dose.The EATD also has the potential to be used to access other organs with precision under fluoroscopic guidance.

酮咯酸氨丁三醇与氢溴酸山莨菪碱在输尿管结石导致的急性肾绞痛患者中的应用效果比较

目的 比较酮咯酸氨丁三醇与氢溴酸山莨菪碱在输尿管结石导致的急性肾绞痛患者中的应用效果。方法 回顾性分析2020年1月至2022年1月于北京市海淀医院急诊外科就诊的166例输尿管结石导致的急性肾绞痛患者的临床资料,采用随机数字法将研究对象分为对照组(肌内注射氢溴酸山莨菪碱,81例)和观察组(肌内注射酮咯酸氨丁三醇,85例)。比较分析两组患者用药前以及用药后30 min、1 h、4 h的疼痛程度,用药后30 min的临床疗效,用药期间的不良反应发生情况。结果 与用药前比较,两组患者用药后30 min、1 h、4 h的视觉模拟评分法(VAS)评分均降低,差异均有统计学意义(P<0.05)。用药前,两组患者的VAS评分比较差异无统计学意义(P>0.05);用药后30 min、1 h、4 h,观察组患者的VAS评分均低于对照组,差异均有统计学意义(P<0.05)。用药后30 min,观察组患者的总有效率高于对照组,差异有统计学意义(P<0.05)。观察组患者用药期间的不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论 在输尿管结石导致的急性肾绞痛患者中,与肌内注射氢溴酸山莨菪碱比较,肌内注射酮咯酸氨丁三醇的镇痛效果更好,且不良反应更少。

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。

排石汤对肾结石模型大鼠保护作用及机制研究

[目的]观察排石汤对肾结石模型大鼠肾功能的保护作用,并初步探讨其机制。[方法]采用1%乙二醇和2%氯化铵溶液灌胃建立肾结石大鼠模型,将40只健康雄性SD大鼠随机分为正常组、模型组、枸橼酸钾组和排石汤低、高剂量组,每组8只。给药4周,检测24 h尿量、肾脏系数、血清尿素氮(BUN)、肌酐(Scr)等生化指标,苏木精-伊红(HE)染色检测肾损伤,酶联免疫吸附(ELISA)法检测炎症因子肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-1β(IL-1β),免疫组化法测定转化生长因子-β1(TGF-β1),Western blot法测定丝裂原活化蛋白激酶(p38MAPK)。[结果]与模型组比较,排石汤高、低剂量组24 h尿量明显增加(P<0.01),肾脏系数明显降低(P<0.01),肾损伤程度较轻。与模型组比较,排石汤高、低剂量组BUN和Scr水平明显降低(P<0.01)。与模型组相比,排石汤高、低剂量组TNF-α、IL-6和IL-1β指标显著降低(P<0.01)。与模型组比较,排石汤高、低剂量组TGF-β1/p38 MAPK水平显著低于模型组(P<0.01)。[结论]排石汤能抑制草酸钙结石形成,改善大鼠肾脏功能,降低血中炎症细胞因子水平,抑制TGF-β1/p38 MAPK信号通路,进而发挥肾脏保护作用。

国产一次性电子输尿管软镜联合负压吸引鞘治疗单侧重复肾重复输尿管畸形合并上尿路结石的疗效分析

目的:探讨国产一次性电子输尿管软镜联合负压吸引鞘治疗单侧重复肾重复输尿管畸形合并上尿路结石的有效性及安全性。方法:回顾性分析2018年5月至2023年9月武汉大学人民医院泌尿外科收治的17例单侧重复肾重复输尿管畸形合并上尿路结石的患者资料,该17例患者均采用输尿管软镜联合负压吸引鞘治疗上尿路结石。分析其结石分布、结石大小、手术时间、术中术后并发症、术后住院时间、结石清除率等,并随访患者的术后情况。结果:所有17例患者手术顺利,手术时间27~65 min,平均(43.4±6.7)min,术中术后均未出现输尿管撕裂、穿孔、感染性休克等严重并发症。术后1~3个月复查腹部平片(kidney ureter bladder,KUB)或泌尿系计算机断层扫描(computed tomography,CT),15例患者结石清除,结石清除率15/17(88.24%)。二期手术患者2例,二期手术结石清除率100%。结论:国产一次性电子输尿管软镜联合负压吸引鞘治疗单侧重复肾重复输尿管畸形合并上尿路结石,结石清除率高,手术并发症少,具有良好的有效性及安全性。

可弯曲负压鞘联合一次性输尿管软镜与超微经皮肾镜治疗2~3 cm肾结石的疗效比较

目的 探讨可弯曲负压输尿管软镜鞘(UAS)联合一次性输尿管软镜(FURS)与超微经皮肾镜(SMP)治疗2~3 cm肾结石的治疗效果,为结石患者的治疗选择提供参考。方法 回顾性分析2021年9月—2023年9月于福建中医药大学附属厦门市第三医院行手术治疗的130例2~3 cm肾结石患者的资料,其中采用可弯曲负压UAS联合一次性FURS取石术者68例(UAS联合组),采用SMP者62例(SMP组),比较两组围手术期主要数据指标及术后清石率(SFR)。结果 两组手术均顺利完成,UAS联合组与SMP组术后3 d(88.24%vs.90.32%)及1个月(91.18%vs.93.55%)的总SFR、并发症发生率(5.88%vs.9.67%)比较差异无统计学意义(P>0.05)。对于肾盂肾下盏夹角(IPA)<45°的下盏结石患者,UAS联合组SFR明显低于SMP组(57.14%vs.100%,P<0.05)。UAS联合组较SMP组的手术时间更长[(104.94±8.79)min vs.(77.98±6.60)min,P<0.001]、住院费用更高[(23 112.82±1 152.34)元vs.(21 975.84±1 512.24)元,P<0.001],术后血红蛋白下降值更少[(6.71±2.07)g/L vs.(9.81±4.80)g/L,P<0.001]、术后住院时间更短[(3.28±0.51)d vs.(5.58±0.71)d,P<0.001]。UAS联合组术后6、24、48 h视觉模拟评分(VAS)[(6.38±0.69)、(3.62±0.73)、(3.12±0.33)分]均小于SMP组[(7.87±0.88)、(5.81±0.83)、(3.81±0.60)分],差异有统计学意义(P<0.05)。结论 对于2~3 cm肾结石两种手术方式均具有较高的SFR,SMP具有手术时间短、住院费用低、下盏结石SFR高等优势,而可弯曲负压UAS联合一次性FURS取石术具有出血少、痛苦小、术后住院时间短等优势。术者可以根据患者病情及其意愿,结合自身经验选择合适的手术方式。

CT三维影像重建技术在肾结石行经皮肾镜取石术中的应用

目的分析CT三维影像重建技术在经皮肾镜取石手术(percutaneous nephrolithotomy,PCNL)中的应用效果。方法选取2022年5月—2023年5月河池市人民医院泌尿外科收治的100例PCNL患者为研究对象,所有患者均接受PCNL治疗,按造影技术不同分为研究组、对照组,每组50例。研究组以CT三维重建技术指导,对照组以静脉肾盂造影指导。比较两组一次性建立通道成功率、结石清除率、并发症(胸膜损伤、大出血、肠道损伤)发生率。结果研究组Ⅰ期结石清除率为92.00%(46/50),高于对照组的76.00%(38/50),差异有统计学意义(χ^(2)=4.762,P<0.05)。研究组一次性建立通道成功率高于对照组,差异有统计学意义(P<0.05)。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CT三维影像重建提高了Ⅰ期结石清除率,同时一次性建立通道成功率高,手术并发症发生率低。

广金钱草或聚花过路黄替代金钱草的利胆排石液对大鼠肾结石防治效果的影响

目的:研究利胆排石液中金钱草替换为广金钱草或聚花过路黄后对大鼠肾结石防治效果的影响。方法:参照《中国药典》利胆排石片的制备方法制备利胆排石液(LDPS)、广金钱草替代金钱草的利胆排石液(LDPS-G)、聚花过路黄替代金钱草的利胆排石液(LDPS-J)3个药物。连续4周以乙二醇联合氯化铵灌胃,制备肾结石模型大鼠。药物组大鼠以1.5g/kg的剂量灌胃,自腹主动脉采血,剖取双肾,观察外形并秤肾质量,计算肾系数,肾组织匀浆。酶标法检测血清、肾组织中的钙离子浓度,变色酸比色法测血清、肾组织中的草酸浓度,肾病理切片观察草酸钙结晶的形成情况等。结果:与空白组比较模型组肾系数显著提高,与模型组比较,各药物组肾系数无显著性差异(P>0.05),与空白组比较模型组大鼠肾组织中钙离子、草酸浓度显著增高(P<0.01)而血清中钙离子、草酸浓度显著降低,除LDPS组外的其他药物组大鼠血清中钙离子、草酸浓度均显著降低(P<0.05),肾组织中钙离子、草酸浓度显著增高(P<0.01)。与模型组比较各药物组大鼠肾组织中钙离子、草酸浓度差异无统计学意义,血清中钙离子浓度除LDPS组增高显著(P<0.05)外其他无统计学意义,血清中草酸浓度除LDPS-J组无统计学意义外其他各组升高显著(P<0.05),与LDPS组比较LDPS-G、LDPS-J组大鼠肾组织、血清中钙离子、草酸浓度差异均无统计学意义。HE染色结果表明,与空白组比较模型组与药物组肾组织切片可见明显草酸钙结晶簇集或散在,与模型组比较LDPS组大鼠肾组织结晶明显减少而LDPS-G、LDPS-J组大鼠肾组织结晶差异无统计学意义。结论:乙二醇联合氯化铵制备肾结石模型大鼠的方法可行,LDPS对防止草酸钙结晶在大鼠肾内的形成、聚集有一定的作用,利胆排石液方中金钱草用广金钱草或聚花过路黄替代后对肾结石模型大鼠的防治效果降低。

微创经皮肾镜取石术在输尿管上段结石合并感染中的效果

目的观察微创经皮肾镜取石术治疗输尿管上段结石合并感染的效果。方法本次研究对象为福建省福清市医院2021年1月—2023年5月接受诊治的60例输尿管上段结石合并感染患者,由随机数字表法选取划分为试验组、对照组,各30例。此次研究中的试验组受试者实施微创经皮肾镜取石术治疗措施,对照组则实施经尿道输尿管镜碎石术。结束干预之后,比对试验对象之间的治疗总有效率、并发症发生率、结石清除率和肾功能水平。结果治疗后,试验组的治疗总有效率高于对照组,差异有统计学意义(P<0.05);试验组并发症发生率比对照组更低,差异有统计学意义(P<0.05);试验组结石清除率比对照组更高,差异有统计学意义(P<0.05);在肾功能水平方面,试验组的血尿素氮(blood urea nitrogen,BUN)比对照组更低,血肌酐(serum creatinine,Scr)比对照组更低,差异有统计学意义(P<0.05)。结论在试验组的治疗过程中,给予输尿管上段结石合并感染患者微创经皮肾镜取石术治疗干预,其实施后的效果相对较好。患者的症状在治疗干预后,得以显著改善,其出现并发症的情况相对较少,其自身的结石清除率也得以提升,肾功能也随之改善,值得被临床应用推广。

智能控压输尿管软镜取石术治疗多囊肾合并结石的临床分析

目的:探讨智能控压输尿管软镜取石术治疗多囊肾(polycystic kidney disease,PKD)合并结石的临床疗效。方法:回顾性分析2022年6月至2023年9月暨南大学附属第一医院收治的3例PKD合并结石患者的临床资料,分析智能控压输尿管软镜取石术的治疗效果。结果:3例患者均为男性,平均年龄(51.00±6.08)岁,结石平均表面积(4.75±4.53)cm 2,2例患者结石位于左侧、1例位于右侧,3例患者均有不同程度患侧肾积水。3例患者手术均顺利完成,平均手术时间(195.30±65.61)min,术中、术后均无发热和活动性出血,所有患者术后均未出现脓毒血症、脏器损伤、灌注液吸收综合征等并发症,无输血治疗,术后第1天复查血常规、生化,平均血红蛋白下降(9.73±13.35)g/L,术后平均血肌酐值为(265.10±194.28)μmol/L。结论:智能控压输尿管软镜取石术治疗PKD合并结石是安全、有效的。

ERAS理念下护理用于肾结石伴肾积水患者围手术期的价值

目的探讨加速康复外科(ERAS)理念下护理用于肾结石伴肾积水患者围手术期的价值。方法选择2021年10月至2023年10月我院收治的肾结石伴肾积水患者94例为研究对象,按照随机数表法分成研究组与对照组,各47例。对照组给予常规护理,研究组给予ERAS理念下护理。记录两组围手术期指标、视觉模拟评分(VAS)、不良情绪[焦虑自评量表(SAS)及抑郁自评量表(SDS)]、睡眠情况[阿森斯失眠量表(AIS)、匹兹堡睡眠质量指数(PSQI)]及生活质量。结果研究组排气时间、排便时间、饮水时间、下床时间早于对照组,住院时间短于对照组(P<0.05)。术后12 h、24 h、36 h、48 h,研究组VAS评分低于对照组(P<0.05),且两组VAS评分组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。术前12 h,研究组SAS、SDS评分低于对照组(P<0.05)。干预后,两组AIS、PSQI评分均较干预前下降(P<0.05),且研究组评分更低(P<0.05)。干预后,两组生活质量各维度评分均较干预前上升(P<0.05),且研究组更高(P<0.05)。结论ERAS理念下护理能够促进肾结石伴肾积水患者术后恢复,减轻其术后疼痛及术前不良情绪,同时改善术后睡眠及生活质量,减轻术后并发症发生。

柔性可弯曲输尿管导引鞘在软镜碎石处理复杂肾结石手术中的应用效果

目的探讨柔性可弯曲输尿管导引鞘在软镜碎石处理复杂肾结石手术中的应用效果。方法选取2022年1月至2023年2月赣南医学院第三附属医院收治的40例复杂肾结石患者作为研究对象,按随机数字表法分为对照组与观察组,每组20例。所有患者均行输尿管软镜钬激光碎石术,对照组术中采用非可弯曲输尿管导引鞘,观察组术中采用柔性可弯曲输尿管导引鞘。比较两组结石清除率、手术相关指标、疼痛程度、生命质量及并发症发生率。结果观察组术后即刻结石清除率高于对照组,差异有统计学意义(P<0.05);两组术后1个月结石清除率比较差异无统计学意义。观察组手术时间、住院时间均短于对照组,术中出血量少于对照组,尿素氮差值低于对照组(P<0.05)。术后3d,两组VAS评分均低于术前,且观察组低于对照组(P<0.05)。术后1个月,两组精力、社会功能、情感职能、精神健康、生理机能、生理职能、躯体疼痛、一般健康状况评分均高于术前,且观察组高于对照组(P<0.05)。两组并发症发生率比较差异无统计学意义。结论柔性可弯曲输尿管导引鞘在软镜碎石处理复杂肾结石手术中效果显著,可提高结石清除率,缩短手术时间,缓解患者术后疼痛,对患者肾功能影响较小,可加快术后恢复,改善其生命质量,且无严重并发症,值得临床推广应用。

预测微通道经皮肾镜碎石取石术治疗鹿角形肾结石术后严重出血的贝叶斯网络模型的建立与验证

目的探讨微通道经皮肾镜碎石取石术(M-PCNL)治疗鹿角形肾结石术后严重出血的危险因素,以此构建预测术后严重出血的贝叶斯网络模型。方法回顾性分析2020年1月—2022年1月于新乡医学院第一附属医院由同等资历术者行M-PCNL的160例鹿角形肾结石患者,采用计算机产生的随机数法以3∶1的比例将患者分为建模组(120例)和验证组(40例),将建模组患者按照术后出血情况分为严重出血组(38例)和非严重出血组(82例),比较两组患者一般资料,分析患者术后严重出血的独立危险因素,采用R软件构建贝叶斯网络模型,Netica软件进行贝叶斯网络模型推理预测;采用受试者工作特征(ROC)曲线对模型进行评价。结果对建模组进行多因素logistic回归分析,初步筛选出肾功能不全(OR:2.845,95%CI:1.563~6.515)、结石最大径≥2 cm(OR:2.063,95%CI:1.824~4.555)、手术时间≥90 min(OR:3.632,95%CI:2.365~7.114)、一期手术(OR:2.321,95%CI:1.874~6.332)、多通道取石(OR:1.842,95%CI:1.366~3.687)是影响患者术后严重出血的独立危险因素(P<0.05)。结合多因素logistic回归分析的结果,以肾功能不全、结石最大径、通道数目、手术时间、手术分期和术后严重出血建立贝叶斯网络模型。利用建模组和验证组对贝叶斯网络模型进行内、外部评价。建模组的AUC为0.879(95%CI:0.804~0.931,P<0.001),灵敏度、特异度分别为87.68%和89.63%;验证组的AUC为0.875(95%CI:0.818~0.908,P<0.001),灵敏度、特异度分别为87.55%和89.40%。模型区分度良好。结论肾功能不全、结石最大径≥2 cm、手术时间≥90 min、一期手术、多通道取石是影响患者M-PCNL后严重出血的危险因素。采用贝叶斯网络构建的鹿角形肾结石术后严重出血的预测模型具有较好的预测能力,并且能够更加直观地描述疾病与各因素间复杂的网络风险机制。

40~80 Hz钬激光微通道经皮肾镜与输尿管软镜手术治疗肾结石患者的疗效比较

目的比较微通道经皮肾镜碎石取石术(mPCNL)和输尿管软镜碎石术(RIRS)两种方式下利用高频率钬激光治疗2~3 cm肾结石的临床疗效。方法回顾性分析嘉兴市第一医院泌尿外科2020年10月—2022年10月收治的105例单发2~3 cm肾结石患者的临床资料,其中52例采用RIRS利用40~80 Hz钬激光碎石(RIRS组),53例采用mPCNL利用40~80 Hz钬激光碎石(mPCNL组)。比较两组的结石一期清除率、手术时间、24 h内血红蛋白(Hb)下降量、术后24 h内炎症指标、术后并发症发生率、住院时间、住院费用。结果两组患者术前基本资料、一期清除率、术后24 h内炎症指标及术后并发症发生率,差异无统计学意义(P>0.05)。RIRS组较mPCNL组术后24 h内Hb下降量更少[(6.35±2.00)g/L vs.(12.25±5.72)g/L,P=0.001],住院时间较短[(5.13±0.82)d vs.(7.92±1.59)d,P<0.001],住院费用更少[(15221.52±796.46)元vs.(19514.51±909.98)元,P<0.001],而手术时间更长[(58.17±7.67)min vs.(49.60±4.52)min,P<0.001]。结论在钬激光频率为40~80 Hz情况下行mPCNL和RIRS治疗2~3 cm肾结石均安全有效,且一期清石率相近,而RIRS虽较mPCNL的手术时间长,但具有手术创伤更小、术后恢复更快、住院时间更短的优点,在2~3 cm肾结石的治疗中可能更具优势和前景。