ABSTRACT
Objective To summarize the experience of partial tubeless mPCNL. Methods A retrospective analysis of partial tubeless mPCNL surgery experience from January 2010 to December 2016. Atotal of 1320 patients underwent mPCNL surgery in these 7 years.Out fo those 1320 patients,554 patients underwent partial tubeless mPCNL,766 patients underwent standard mPCNL,and 85 exception cases of standard mPCNL were forced to abort surgery due to maximum surgery time of 2 hours and different complications such as bleeding, infections and etc, so total of 681 patients with standard mPCNL were compared with partial tubeless mPCNL.Results The rate of partialtubeless mPCNL has increased by 84% in 2016, with an indication of tubeless mPCNL being extended, while the complication rate showed no increase. Compared with the standard mPCNL, there was no significant dif-ference between the two groups in the rate of stone removal, drop in mean hemoglobin, blood transfusion and postoperative fever. There were significant differences in postoperative analgesic use rate (5%:21%,P=0.001) and hospitalization stay (2.5:4.5d,P=0.001) . The rate of postoperative bleeding complications in partial tubeless group and standard group is 1.1%and 2.5%respectively, but difference is not statistically significant. There were 1cases of urinary extravasations in the partial tubeless group which was treated by perirenal drainage, antibiotic treatment, and 1 cases of pleural injury, which were treated by open exploration, and chest tube placement. Conclusion In compared to standard mPCNL partial tubeless mPCNL significantly increased patients postoperative comfort, shorten hospital stay,and no complications increased.Partial tubless mPCNL is a safe and practicable procedure.
ABSTRACT
Ileal ureter is a suitable treatment option for patients with long ureteric strictures. Minimally invasive techniques have been shown to be as safe as open techniques but superior in terms of lesser trauma, less bleeding and less postoperative recovery time. In order to evaluate the feasibility and clinical efficacy of laparoscopic ileal ureter replacement, review of related literatures, indications, contraindications, surgical method, postoperative results combined with experience of our center has been done. Total 20 cases of laparoscopic ileal ureteral operation have been reviewed, the mean operation time was 195480 and blood loss was 50 ～ 375 ml and 7 Robotic ileal ureter replacement were reviewed median surgery time was 320720 min and bleeding is less then 10 ml100 ml. The operation complications include urinary leakage, intestinal obstruction, anastomotic site leakage, transient azotemia, urinary tract infection and so on. Postoperative renal function of all patients was improved in different degrees. Laparoscopic and Robotic ileal ureter replacement is feasible and can be used as an effective treatment for long ureteral injuries, although the curative effect is same as that of traditional open surgery, but Comparatively laparoscopic and robotic postoperative morbidity is less and have advantages such as it reduces surgical trauma, intraoperative bleeding, postoperative complications, less surgical scar and recovery time.The cases in the reports are limited, more cases need to be studied, and long-term results need to be assessed to establish and standardize these technique.
ABSTRACT
<p><b>OBJECTIVE</b>To determine the effects of irrigation fluid absorption on system hemodynamics, fluid-electrolyte and hormone during mini-percutaneous nephrolithotomy.</p><p><b>METHODS</b>In this study 128 patients with renal calculus or calculus of superior ureter from January 2007 to February 2008 were collected. Hemoglobin (Hb), hematocrit (Hct), plasma osmotic pressure (POP), fluid-electrolyte, serum creatinine (Cre), renin, angiotensin II and aldosterone were determined before and after operation. Heart rate (HR), mean arterial blood pressure (MAP) and oxygen saturation (SPO(2)) were recorded dynamically every 30 min.</p><p><b>RESULTS</b>The HR speeded up accompanied with the irrigation time. When compared with before operation, POP, Cl(-), renin and Cre were significantly increased after operation; Hb, Hct and K(+) were significantly decreased after operation; MAP, SPO(2), Na(+), aldosterone and angiotensin II did not change significantly after operation. No serious surgery-related complication occurred in all patients.</p><p><b>CONCLUSIONS</b>Irrigation fluid is absorbed during mini-percutaneous nephrolithotomy. The absorption amount is positively correlated with irrigation time. Changes of hemodynamics, fluid-electrolyte balance and renin may be caused by the irrigation fluid absorption.</p>