Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture

Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.

Computerized tomography-guided therapeutic percutaneous puncture catheter drainage-combined with somatostatin for severe acute pancreatitis: An analysis of efficacy and safety

BACKGROUND Severe acute pancreatitis(SAP),a condition with rapid onset,critical condition and unsatisfactory prognosis,poses a certain threat to human health,warranting optimization of relevant treatment plans to improve treatment efficacy.AIM To evaluate the efficacy and safety of computerized tomography-guided the-rapeutic percutaneous puncture catheter drainage(CT-TPPCD)combined with somatostatin(SS)in the treatment of SAP.METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected.On the basis of routine treatment,20 patients received SS therapy(control group)and 22 patients were given CT-TPPCD plus SS intervention(research group).The efficacy,safety(pancreatic fistula,intra-abdominal hemorrhage,sepsis,and organ dysfunction syndrome),abdominal bloating and pain relief time,bowel recovery time,hospital stay,inflammatory indicators(C-reactive protein,interleukin-6,and pro-calcitonin),and Acute Physiology and Chronic Health Evaluation(APACHE)II score of both groups were evaluated for comparison.RESULTS Compared with the control group,the research group had a markedly higher total effective rate,faster abdominal bloating and pain relief and bowel recovery,INTRODUCTION Pancreatitis,an inflammatory disease occurring in the pancreatic tissue,is classified as either acute or chronic and is associated with high morbidity and mortality,imposing a socioeconomic burden[1,2].The pathogenesis of this disease involves early protease activation,activation of nuclear factor kappa-B-related inflammatory reactions,and infiltration of immune cells[3].Severe acute pancreatitis(SAP)is a serious condition involving systemic injury and subsequent possible organ failure,accounting for 20%of all acute pancreatitis cases[4].SAP is also characterized by rapid onset,critical illness and unsatisfactory prognosis and is correlated with serious adverse events such as systemic inflammatory response syn-drome and acute lung injury,threatening the health of patients[5,6].Therefore,timely and effective therapeutic inter-ventions are of great significance for improving patient prognosis and ensuring therapeutic effects.Somatostatin(SS),a peptide hormone that can be secreted by endocrine cells and the central nervous system,is in-volved in the regulatory mechanism of glucagon and insulin synthesis in the pancreas[7].It has complex and pleiotropic effects on the gastrointestinal tract,which can inhibit the release of gastrointestinal hormones and negatively modulate the exocrine function of the stomach,pancreas and bile,while exerting a certain influence on the absorption of the di-gestive system[8,9].SS has shown certain clinical effectiveness when applied to SAP patients and can regulate the severity of SAP and immune inflammatory responses,and this regulation is related to its influence on leukocyte apoptosis and adhesion[10,11].Computerized tomography-guided therapeutic percutaneous puncture catheter drainage(CT-TPPCD)is a surgical procedure to collect lesion fluid and pus samples from necrotic lesions and perform puncture and drainage by means of CT image examination and precise positioning[12].In the research of Liu et al[13],CT-TPPCD applied to pa-tients undergoing pancreatic surgery contributes to not only good curative effects but also a low surgical risk.Baudin et al[14]also reported that CT-TPPCD has a clinical success rate of 64.6%in patients with acute infectious necrotizing pan-creatitis,with nonfatal surgery-related complications found in only two cases,suggesting that this procedure is clinically effective and safe in the treatment of the disease.In light of the limited studies on the efficacy and safety of SS plus CT-TPPCD in SAP treatment,this study performed a relevant analysis to improve clinical outcomes in SAP patients.

Ultrasound-guided paravertebral nerve block anesthesia for percutaneous endoscopic laser unroofing treatment of symptomatic simple renal cysts—An innovative ambulatory surgery mode

Objective:This study was designed to evaluate the feasibility,efficacy,and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral nerve block anesthesia.Methods:From December 2015 to September 2017,33 simple renal cyst patients who had surgical indications were enrolled.Under ultrasound guidance,the T10/T11,T11/T12,and T12/L1 paravertebral spaces were identified,and 7-10 mL 0.5%ropivacaine was injected at each segment.Then a puncture needle was placed inside the cyst cavity under ultrasonic monitoring.A guidewire was introduced followed by sequential dilation up to 28/30 Fr.The extra parenchymal portion of the cyst wall was dissociated and incised using a thulium laser,and a pathological examination was performed.Results:Sensory loss to pinprick from T8 to L1 and sensory loss to ice from T6 to L2 were observed in all patients.None of the patients complained of pain during surgery.No serious complications occurred perioperatively.After the surgery,all patients recovered their lower limb muscle strength quickly,got out of bed,resumed oral feeding,and left the hospital within 24 h of admission.The pathologic diagnosis of all cyst walls was a simple renal cyst.The mean follow-up was 35.8 months.At the end of follow-up,the cyst units were reduced in size by more than 50%compared to the preoperative size,and no patient experienced a recurrence.Conclusion:Multi-level paravertebral nerve block for percutaneous ureteroscopy laser unroofing as an ambulatory surgery mode is feasible,safe,and effective for the treatment of simple renal cysts in selected patients.

Efficacy and safety analysis of continued nursing of complications in discharged patients after percutaneous transhepatic biliary drainage

BACKGROUND Percutaneous hepatobiliary drainage(PTCD)is an effective method for the treatment of biliary obstruction and other diseases,but postoperative complications are still one of the important problems faced by patients.Continuous nursing is a comprehensive nursing model that plays an important role in postoperative recovery.The purpose of this study was to investigate the effect of continuous nursing on the incidence of complications in patients after PTCD surgery through meta-analysis and to evaluate its efficacy and safety.AIM To evaluate the effect of extended nursing on the incidence of complications in discharged patients after percutaneous transhepatic biliary drainage(PTBD).METHODS Randomized controlled studies on PTBD postdischarge extended care were identified in the CNKI,Wanfang,VIP,CBM,PubMed,Cochrane Library,Embase,Web of Science,and other databases.The quality of the included studies was evaluated using the Joanna Briggs Institute of Australia literature quality evaluation tool,and a meta-analysis of the included studies was performed with RevMan 5.4 software.RESULTS Finally,9 studies were included,with a total sample size of 854 patients(425 patients in the control group and 429 patients in the intervention group).Meta-analysis revealed that extended care effectively reduced biliary tract infection(RR:0.42,95%CI:0.30-0.57),puncture wound infection(RR:0.19,95%CI:0.06-0.65),catheter protrusion or displacement in discharged patients after PTBD(RR:0.31,95%CI:0.18-0.54),catheter blockage(RR:0.23,95%CI:0.13-0.42),skin infection around the drainage tube(RR:0.30,95%CI:0.12-0.77),and catheter-related readmissions(RR:0.34,95%CI:0.18-0.65)(P<0.05).CONCLUSION Compared with conventional discharge care,extended care can effectively reduce the occurrence of complications such as biliary tract infection,puncture wound infection,catheter prolapse or displacement,catheter blockage,skin infection around the drainage tube,and catheter-related readmission in discharged patients after PTBD.

Percutaneous CT-Guided Drainage of Gastric Leaks Post-Sleeve Gastrectomy

Objectives: The aim of this study was to assess the safety and efficacy of percutaneous CT-guided drainage of gastric leaks post sleeve gastrectomy. Methods: For this single-center retrospective study, we reviewed the clinical data of 78 patients (44 men and 34 women with an average age of 34.6 &plusmn;10.5 years and a body mass index (BMI) of 45 kg/m2 &plusmn;3.2) that underwent percutaneous CT-guided drainage of gastric leaks due to sleeve gastrectomy from September 2011 to September 2018. The outcome measurements were technical and clinical success, complications, and the need for revisional surgery. Results: The technical success rate of drain insertion was 97.5% (76/78 patients). All of the patients (76/76 patients) exhibited early clinical and laboratory improvement, and no emergency surgery was required. However, six patients underwent revisional surgery after 3 - 5 months for non-healing gastric leaks/fistulas. One patient had a major complication of active bleeding due to arterial injury;this was managed by transcatheter coil embolization. All patients underwent endoluminal stent placement and received antimicrobial therapy and nutritional support. Conclusion: Percutaneous CT-guided drainage of gastric leaks after sleeve gastrectomy is a safe, effective, and minimally invasive alternative to surgery. This technique is in line with other conservative measures (endoluminal stent placement, antimicrobial therapy, and nutritional support), which heal most gastric leaks due to sleeve gastrectomy and prevent the need for revisional surgery.

Effectiveness and Therapeutic Impact of CT-Guided Percutaneous Drainage for Deep Neck Abscesses

Objective: The purpose of this study is to evaluate the effectiveness and safety of CT-guided percutaneous drainage (CPD) in the management of deep neck abscesses. Factors associated with successful treatment in patients with DNA will be identified. Methods: We retrospectively studied 29 patients who presented to the department of otolaryngology with deep neck abscesses between April 2011 and April 2015. These 29 patients were managed with CPD after antibiotic therapy or needle aspiration failed. Data on patient demographics, location of infection, existing comorbidity, duration of hospitalization, treatment received, and complications were reviewed. Results: The average age of 29 patients, including 18 men and 11 women, was 56 years old. Abscess was found in parapharyngeal space (n = 16), submandibular space (n = 7), retropharyngeal space (n = 5) and pretracheal space (n = 1). The maximum transverse diameter of abscess ranged from 4.8 cm to 8.0 cm (mean 6.03 cm). Positive cultures were found in 24 cases and the most common pathogen found was Streptococcus viridans. Average hospital stay was 6.7 days. Deep neck abscesses were completely removed without residual in all patients. No one had complications and no one died during and after CPD. Conclusion: CPD is a safe and highly effective procedure for treating patients with deep neck abscesses who do not respond to antibiotics therapy. This technique can also provide reliable evidence on pathogens responsible for deep neck abscesses and help otolaryngologists choose effective treatment to achieve better clinical success rate. We recommend that most deep neck abscesses should be managed initially by CPD before resorting to open surgery.

Evaluation of the stress response and immune response after percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe cholecystitis

Objective: To study the stress response and immune response after percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe cholecystitis. Methods: A total of 86 patients with severe acute cholecystitis who received surgical treatment in Yulin Second Hospital between April 2013 and April 2017 were selected as the research subjects and randomly divided into two groups, observation group of patients received percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery, control group of patients received emergency laparoscopic surgery, and serum was collected the same day and 3 d after operation to determine the inflammation indexes, stress response indexes and immune response indexes. Results: The same day after operation and 3 d after operation, serum HMGB-1, IL-2, IL-6, hs-CRP, ET-1, ACTH, Cor and MDA levels as well as peripheral blood CD8+ levels of observation group were significantly lower than those of control group while serum SOD, IgG, IgM and IgA levels as well as peripheral blood CD3+ and CD4+ levels were significantly higher than those of control group. Conclusion: Percutaneous transhepatic gallbladder puncture combined with laparoscopic surgery for acute severe cholecystitis can improve the postoperative inflammatory response, stress response and immune response.

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.

Current insights on haemorrhagic complications in percutaneous nephrolithotomy

Objective:Percutaneous nephrolithotomy(PCNL)is the standard procedure for the management of large and complex renal stones.Blood loss during PCNL may occur during puncture,tract dilatation,and stone fragmentation.Therefore,despite recent advances in PCNL,haemorrhagic complication still occurs.This study aims to enlighten on various aspects of haemorrhagic complication in PCNL,mainly focusing on risk factors and management of this dreadful complication.Methods:Literature search for the study was carried out using advanced search engines like PubMed,Cochrane,and Google Scholar,combining keyword“percutaneous lithotomy”with other keywords like“bleeding”,“haemorrhage”,“complications”,“stone scoring systems”,“mini-PCNL vs.standard”,“dilatation techniques”,“supine vs.prone”,“USG-guided”,“endoscopic combined intra-renal surgery”,“papillary vs.non-papillary puncture”,“bilateral”,and“angioembolization”.The articles published between January 1995 and September 2020 were included for the review.Results:A total of 3670 articles published from January 1995 to September 2020 were screened for the review.Although not consistent,multiple studies have described various preoperative and intraoperative risk factors related to significant bleeding in PCNL.Identification of these risk factors help urologists to anticipate and promptly manage haemorrhagic complications associated with the procedure.A conservative approach suffices to control bleeding in most cases;nevertheless,bleeding can be life-threatening and few still need surgical intervention in the form of angiographic embolisation or open surgical exploration.Conclusion:As hemorrhagic complication in PCNL is associated with considerable morbidity and mortality,prudent intraoperative decision and postoperative care are necessary for its timely prevention,detection,and management.

Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures

Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.

Percutaneous management of atrium and lung perforation: A case report

BACKGROUND Cardiac perforation by a transvenous lead is an uncommon but serious complication. Delayed perforation, defined as migration and perforation of an implanted lead at least 1 mo after implantation, is exceedingly rare and prone to underdiagnosis, and its optimal management is currently unclear. We report an uneventful transvenous extraction of an active fixation lead that led to delayed perforation of the right atrium, pericardium, and lung, disclosed 2 mo after implantation.CASE SUMMARY A 61-year-old woman with atrial lead perforation was transferred to our center.She had a dual-chamber pacemaker with active fixation leads implanted 8 mo previously. At 2 mo after implantation, she complained of chest pain and hemoptysis. Chest computed tomography revealed atrial lead migration into the lung. No pericardial or pleural effusion was detected. She underwent transvenous lead extraction in the electrophysiology room with surgical backup.The percutaneous subxiphoid pericardial puncture was performed first, and a pigtail catheter was left in the pericardial sac throughout the procedure. Then, a new active fixation lead was implanted at a different site with less tension. After the active screw was retracted, the culprit atrial lead was explanted successfully with simple traction. There were no complications during or after the procedure.The patient recovered well and follow-up was uneventful.CONCLUSION Percutaneous management of perforated active fixation lead outside the pericardial sac under surgical backup is safe and effective.

PTGBD治疗TG18中重度急性胆囊炎123例临床疗效分析

目的探讨经皮经肝胆囊穿刺置管外引流术(PTCBD)治疗东京指南2018(TC18)中重度急性胆囊炎临床疗效分析。方法回顾性分析我院2021年6月至2023年5月我科诊治的123例TG18中重度急性胆囊炎行PTCBD治疗患者的资料,分析其安全性、有效性,择期手术的中转开腹率。结果123例患者均一次性行PTCBD治疗成功,住院期间无PTGBD相关的并发症或死亡,术后24小时内症状基本缓解,123例患者中有99例择期行手术治疗,中转开腹2例,中转开腹率2.02%。结论对于中重度急性胆囊炎患者行PTCBD治疗安全有效,提高手术的安全性及微创率。

基于术前CT测量精准定位穿刺与传统穿刺经皮椎体成形术治疗胸腰椎压缩性骨折的对照研究

目的:通过和传统经皮穿刺方法的回顾性研究,探讨基于术前CT测量精准定位穿刺点的经皮穿刺技术辅助的经皮球囊扩张椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗骨质疏松性椎体压缩骨折(Osteoporotic vertebral compressive fractures,OVCFs)患者的临床疗效。方法:回顾性分析2017年1月至2021年6月采取经皮穿刺球囊扩张椎体后凸成形术治疗的56例骨质疏松性椎体压缩性骨折患者,均为单节段骨折,受伤至手术时间小于一个月。根据术中定位穿刺点方法的不同分为两组:A组:基于术前CT测量精准定位穿刺组,B组:传统方法定位穿刺组。每组各28例,对比两组患者术中穿刺次数、透视次数及手术时间,采用手术前后的视觉模拟评分(Visual analogue scale,VAS)评估临床疗效;同时观察手术相关并发症发生情况。结果:56例患者均获成功穿刺,术后随访8~16个月,平均随访时间10个月。基于术前CT测量方法精准定位穿刺组手术时间(34.1±7.5)min,术中穿刺过程中C臂机透视(9.9±2.5)次,每节病椎骨水泥注入量(5.7±0.8)mL。术前VAS评分(8.2±0.8),术后6月为(1.4±0.6)。传统方法定位穿刺组手术时间(48.8.±9.5)min,术中穿刺过程中C臂机透视(14.5±3.5)次,每节病椎骨水泥注入量(5.6±0.6)mL。术前VAS评分(8.2±0.7),术后6月为(1.5±0.6)。两组骨水泥注入量和及术后6月的VAS评分差异无统计学意义(P>0.05);术中穿刺次数、手术时间和术中透视次数差异有统计学意义(P<0.05)。其中基于术前CT测量定位穿刺组一次性穿刺成功率为92.9%(26/28)。远高于传统穿刺组53.6%(15/28)。A组发生2例向椎体后缘或侧方骨水泥渗漏;B组3例发生椎体后缘及椎体前方和侧方渗漏。两组术中均未出现神经脊髓损害并发症发生,无感染等伤口并发症发生。结论:相较于传统经皮穿刺方法,基于术前PACS系统CT精准测量定位穿刺点的技术,可大大提高一次性穿刺成功概率,明显改善经皮穿刺技术的精准性;从而可以减少手术穿刺过程中的C臂机透视次数及手术时间,具有更加精准、微创的特点,是一种精准有效和安全可靠的穿刺定位技术。

经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术治疗急性重症胆囊炎的临床疗效分析

目的探讨急性重症胆囊炎患者给予经皮经肝胆囊穿刺引流+腹腔镜胆囊切除术的临床有效性。方法随机选取2020年2月—2023年12月安徽省池州市人民医院收治的90例急性重症胆囊炎患者为研究对象,根据随机数字表法分为对照组和观察组,每组45例。对照组给予腹腔镜胆囊切除术治疗,观察组联合经皮经肝胆囊穿刺引流治疗。分析两组患者的手术情况、炎症反应、并发症发生率。结果观察组的手术时间、术后肛门排气时间、住院时间、术中出血量优于对照组,差异有统计学意义(P均<0.05);观察组术后C反应蛋白为(58.13±15.65)mg/L、降钙素原为(1.77±0.35)ng/mL,低于对照组的(79.98±21.35)mg/L、(2.23±0.42)ng/mL,差异有统计学意义(t=5.537、5.644,P均<0.05);观察组的并发症发生率(胆总管损伤、胆瘘、感染、胆管损伤)为2.22%,低于对照组的22.22%,差异有统计学意义(χ^(2)=8.389,P<0.05)。结论采用经皮经肝胆囊穿刺引流联合腹腔镜胆囊切除术可改善临床症状,降低并发症、手术情况佳。

基于放疗科大孔径CT的自适应迭代重建技术在肺结节穿刺中的应用研究

目的:研究大孔径CT自适应统计迭代重建(ASIR)对肺结节经皮穿刺中图像质量的影响。方法:选取2023年1月—7月于深圳市宝安区人民医院接受大孔径CT引导穿刺的肺结节患者20例。分别应用滤波反投影技术(FBP)和ASIR技术重建图像并评价两组图像质量。主观评价采用Likert评分,客观评价对结节区噪声标准差(SD)、对比噪声比(CNR)和穿刺针针尖位置CT值等资料。结果:图像的主观评价均满足穿刺要求且一致性较好(Kappa值=0.740)。ASIR图像质量随着权重先增加后降低,权重为60%时最佳。和FBP相比,ASIR 60%的Likert评分更高,结节SD和CNR值比较,差异有统计学意义(P=0.004、0.043)。其他统计参数比较,差异均没有统计学意义(P>0.05)。结论:放疗用大孔径CT常规扫描不影响穿刺图像质量,ASIR 60%图像质量更优,可以用于引导肺结节经皮穿刺。

介入超声经皮穿刺活检技术在鉴别乳腺肿瘤良恶性中的应用效果

目的:分析介入超声经皮穿刺活检技术在鉴别乳腺肿瘤良恶性中的应用效果。方法:选取2021年1月—2023年12月泰州市第四人民医院收治的乳腺肿瘤患者62例为研究对象。患者均接受常规超声与介入超声经皮穿刺活检技术进行诊断。以病理学诊断结果为“金标准”,比较常规超声与介入超声经皮穿刺活检技术的灵敏度、特异度、准确率。结果:病理学诊断结果显示,良性乳腺肿瘤患者32例,占比51.61%,恶性肿瘤患者30例,占比48.39%。介入超声经皮穿刺活检术检查灵敏度及准确率高于常规超声检查,差异有统计学意义(P<0.05);两种检查方法特异度比较,差异无统计学意义(P>0.05)。结论:介入超声经皮穿刺活检术在鉴别乳腺肿瘤良恶性中的效果较好,可提高灵敏度和准确率。

F4.8可视化穿刺辅助微通道经皮肾镜治疗肾盏憩室结石的应用

目的探讨F4.8可视化穿刺辅助微通道经皮肾镜碎石术(mPCNL)治疗肾盏憩室结石患者的应用效果。方法选取2020年1月至2023年1月合肥市第一人民医院收治的肾盏憩室结石患者86例,按照随机数字表法分为观察组和常规组,每组43例。常规组患者行mPCNL,观察组患者行F4.8可视化穿刺辅助mPCNL。比较2组患者术后即刻及术后4周的结石清除率、手术及术后恢复情况、并发症及手术前后创伤应激指标[血清皮质醇(Cor)、去甲肾上腺素(NE)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、肾叶间动脉血流动力学指标[收缩期峰流速(Vmax)、舒张末期流速(EDV)、阻力指数(RI)]、肾功能指标[尿液中肾损伤分子-1(KIM-1)、24 h尿蛋白定量(24 h Upro)、血尿素氮(BUN)、血肌酐(Scr)]水平。结果观察组患者术后即刻结石清除率高于常规组,术中失血量少于常规组,手术时间、术后下床活动时间、留置肾造瘘管时间、住院时间短于常规组,差异均有统计学意义(P<0.05)。2组患者术后1 d、3 d的血清Cor、NE、CRP、IL-6水平较术前升高(P<0.05),观察组术后1 d、3 d的血清Cor、NE、CRP、IL-6水平均低于常规组(P<0.05)。观察组患者术后1 d的肾叶间动脉Vmax、EDV较术前降低(P<0.05),RI较术前升高(P<0.05);常规组患者术后1 d、3 d的肾叶间动脉Vmax、EDV较术前降低(P<0.05),RI较术前升高(P<0.05);观察组术后1 d、3 d的肾叶间动脉Vmax、EDV高于常规组,RI低于常规组,差异均有统计学意义(P<0.05)。2组患者术后7 d尿液中KIM-1、24 h Upro、BUN、Scr水平较术前降低,且观察组低于常规组,差异均有统计学意义(P<0.05)。2组并发症发生率比较,差异无统计学意义(P>0.05)。结论F4.8可视化穿刺辅助mPCNL治疗肾盏憩室结石能提高手术效果,减轻手术创伤应激,促进肾功能恢复。

超声引导肾锥体精准穿刺钝性分离法在无积水肾盂造瘘术中的临床应用:一种无积水肾盂造瘘新方法

目的:探讨超声造影辅助下超声引导肾锥体精准穿刺钝性分离法在无积水肾盂造瘘术中的临床应用情况。方法:回顾性分析2022年5月至2024年4月在解放军总医院第一医学中心进行超声引导下无积水肾盂造瘘的患者11例,其中单侧肾盂造瘘6例,双侧肾盂造瘘5例,共16例次无积水肾盂穿刺造瘘术。均在超声引导下徒手穿刺目标肾锥体并采用钝性分离法置入导丝。统计穿刺过程中的首次穿刺成功率、平均穿刺针数、穿刺时间、总置管时间、并发症情况。结果:所有患者均穿刺成功,首针穿刺成功率为81.25%,平均穿刺针数为1.19±0.4、平均穿刺时间为(122.19±22.55)s、平均置管时间为(674.19±46.61)s;所有肾盂穿刺造瘘均未出现活动性出血及其他严重并发症,2例次术后第2天引流不畅重新调整引流管。结论:超声造影辅助下超声引导肾锥体精准穿刺钝性分离法在无积水肾盂造瘘术中应用效果良好,具有较高的安全性和可行性,为泌尿系损伤无法行输尿管支架的患者提供了安全有效的治疗方法,值得推广。

弹性髓内钉固定技术联合经皮穿刺人工骨注射治疗单纯性骨囊肿的应用研究

目的:探究弹性髓内钉固定技术联合经皮穿刺人工骨注射治疗单纯性骨囊肿的效果。方法:纳入萍乡市人民医院儿外科于2015年7月—2020年7月经病理学检查确诊的64例单纯性骨囊肿患儿作为研究对象。采用随机数字表法将患儿分为联合组与对照组,其中对照组采用经皮穿刺人工骨注射+外固定+甲泼尼龙琥珀酸钠治疗,在此基础上联合组加弹性髓内钉固定技术治疗。所有患儿均需给予6个月连续随访。比较两组临床疗效、肌肉骨骼肿瘤协会(MSTS)评分、炎症因子[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、手术时间、术中出血量、住院时间;记录两组住院期间不良反应发生情况。结果:研究期间,联合组因未完成随访脱落1例,因改用其他治疗方案脱落1例,对照组因未完成后续随访脱落2例。联合组30例,对照组30例。联合组临床总有效率明显高于对照组,差异有统计学意义(P<0.05);术后1、3个月,两组MSTS评分较术前均增高,且联合组MSTS评分均高于对照组,差异均有统计学意义(P<0.05)。术后第7天,联合组的IL-6、TNF-α均明显低于对照组,差异均有统计学意义(P<0.05)。两组术中出血量比较,差异无统计学意义(P>0.05)。联合组住院时间明显短于对照组,手术时间明显长于对照组,差异均有统计学意义(P<0.05)。两组患儿均未出现不良反应。结论:弹性髓内钉固定技术联合经皮穿刺人工骨注射治疗可改善单纯性骨囊肿患儿肢体功能、降低炎症因子水平、缩短住院时间。

双平面穿刺经皮椎体后凸成形术治疗ASOTLF的疗效分析

目的探讨双平面穿刺经皮椎体后凸成形术(PKP)治疗急性症状性骨质疏松性椎体压缩骨折(ASOTLF)的疗效。方法选择行PKP手术的ASOTLF患者85例,按照不同穿刺方法分为观察组(双平面穿刺)和对照组(传统单侧穿刺)。比较两组手术时间、术中透视次数、骨水泥注入量、骨水泥渗漏率、骨水泥分布均匀度、功能恢复和疼痛改善情况。结果与对照组比较,观察组手术时间明显更长,术中透视次数明显更多(P<0.05)。观察组骨水泥分布均匀度明显高于对照组(P<0.05),两组其余手术相关指标比较,差异均无统计学意义(P>0.05)。两组术后1天、术后12月的伤椎前缘高度明显高于术前(P<0.05),Cobb角明显小于术前(P<0.05)。手术前、术后1天、术后12月,观察组与对照组伤椎前缘高度和伤椎Cobb角比较差异均无显著性(P>0.05)。两组术后1天、术后12月的VAS、ODI明显低于术前(P<0.05)。手术前、术后1天、术后12月,观察组与对照组VAS评分和ODI比较差异均无显著性(P>0.05)。结论双平面穿刺PKP治疗ASOTLF疗效满意,且双平面穿刺入路骨水泥分布均匀程度更好。