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OBJECTIVE@#To evaluate the efficacy of ultrasound or fluoroscopic-guided percutaneous transluminal angioplasty (PTA) combined with thrombolysis for the treatment of acutely thrombosed arteriovenous fistula (AVF) or grafts (AVG).@*METHODS@#One hundred and ninety-two hemodialysed patients, in whom the thrombosed arterio-venous AVF or AVG developed less than 72 h and there were no contraindications for thrombolysis and PTA, underwent PTA combined with thrombolysis therapy in Sir Run Run Shaw Hospital of Zhejiang University from October 2014 to October 2017. Under ultrasound and/or fluoroscopic guidance, balloon catheter was introduced to thrombosis sites along a guide wire. Then the balloon was inflated and normal saline mixed with urokinase and heparin was injected for thrombolysis. After blood flow was restored, angioplasty was performed on vascular stenosed sites.@*RESULTS@#A total of 274 endovascular interventional operations were performed for 192 patients. The procedure success rate was 98.2%, clinical success rate was 93.8%and complication rate was 1.46%. The post-intervention primary patency rates for AVF group were 87.4%, 76.7%and 63.9%at 3, 6 and 12 months, respectively; while the post-intervention secondary patency rates were 93.7%, 91.6%and 83.0%, respectively. The post-intervention primary patency rates for AVG group were 60.7%, 51.5%and 43.1%at 3, 6 and 12 months, while the post-intervention secondary patency rates were 82.7%, 77.1%and 70.8%, respectively.@*CONCLUSIONS@#PTA combined with thrombolysis is an effective and safe therapeutic option for AVF and AVG thrombosis, which would prolong hemodialysis access and save vascular resources for hemodialyzed patients.
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Humans , Angioplasty , Arteriovenous Fistula , Arteriovenous Shunt, Surgical , Renal Dialysis , Retrospective Studies , Thrombolytic Therapy , Thrombosis , General Surgery , Treatment Outcome , UltrasonographyABSTRACT
Objective To evaluate the effect on nexible ureteroscope one-step treat and step-by-step treat for impacted upper ureteral calculi. Methods The clinical data of 98 cases of impacted upper ureteral calculi were retrospectivelv analvzed between January 2016 and January 2018. The one-step nexible ureteroscopic lithotripsy was used in 48 cases (observation group), and the step-by-step nexible ureteroscopic lithotripsy was used in 50 cases (control group). During the one-step nexible ureteroscopic lithotripsy, only flexible ureteroscope was used to crush the stone, no matter whether the stone located in the ureter or returned to the renal pelvis. During step-by-step nexible ureteroscopic lithotripsy, the rigid ureteroscopy was firstly used for crushing the stone in the ureter. When the stone returned to the renal pelvis, the rigid ureteroscopy was changed into nexible uretemscope for continuous crushing the stone. Operating time, 2 weeks stone clearance rate and the cases of fever after operation were compared between two groups. Results Compared with that of the control group, the operation time of the observation group was significantly shortened [(38.3 ± 10.5) min vs. (55.1 ± 12.7) min, t=-6.415], and the proportion of postoperative body temperature ≥ 38.5 ℃ was also reduced [(4.2％ (2/48) vs. 22.0％(11/50), χ2=5.276]. The differences between the two groups were statistically significant (P<0.05). Two weeks stone clearance rate was 89.6％(43/48) in observation group and 82.0％(41/50)in control group, and there was no significant difference between two groups (χ2=0.493, P > 0.05). Conclusions Flexible ureteroscope one-step method is a safe and effective alternation for incarcerated upper ureteral calculi.
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Objective To investigate the proportion, risk factors and tendency of the change of stones composition in recurrent urolithiasis. Methods One hundred and fifty-six recurrent urolithiasis patients from January 2011 to January 2016 were enrolled. Compositions of initial and recurrent stones were measured by infrared spectrophotometry. Stones types, recurrence interval and recurrence frequency were studied as potential risk factors for composition change. Chi square test and Logistic regression analysis was employed in the statistical analysis. Results Stones composition changed during recurrence in 48 patients (30.8%). 22.8%(18/79) of calcium oxalate stones change to infection stones, and 25.8%(8/31) of infection stones changed to calcium oxalate. Univariate analysis showed the risk ratio of composition change in the patients with recurrence interval of 1- 5 years was 0.529(P = 0.039) , compared with those of less than 1 year or more than 5 years. Logistic regression analysis showed the odds ratio of recurrence interval of 1- 5 years was 0.242 (95%CI: 0.086- 0.718, P = 0.012). Conclusions Stones composition changes in about 30.8% of recurrent urolithiasis. The mutual conversion between calcium oxalate and infection stones is the most common. Recurrence interval is an independent risk factor to predict composition change.
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Objective To preliminarily investigate the methods,safety and short to medium-term effectiveness of the interventional ultrasound applying in the hybrid procedure to treat the thrombosis of arteriovenous graft(AVG).Methods Twenty patients with the thrombosis of AVG,who received the hybrid procedure defined as Fogarty catheter thrombectomy and percutaneous transluminal angioplasty (PTA) guided by the ultrasonography,were retrospectively investigated. The display effects of the ultrasonography were observed.The technical and clinical success rates were evaluated.All the cases were followed up every 3 months for at least 1 year to evaluate the post-interventional assisted primary patency and the post-interventional secondary patency.Results All the processes were clearly displayed and well guided by the interventional ultrasound during the procedure.The technical and the clinical success rates were both 100%.No major complications were recorded.The post-intervention assisted primary patency rate was 100%,92.9%,85.7%,71 .4% at 3,6,9,12 months,respectively.The post-intervention secondary patency was 100%,100%,89.5%,89.5% at the correspondent months.Conclusions This pilot research shows the hybrid procedure guided by the interventional ultrasound to treat the thrombosis of AVG has high success rate and satisfied patency in short to medium-term.The interventional ultrasound is an effective, safe and convenient guiding method to the hybrid procedure,and has the value for clinical application.
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Objective To investigate the clinical value of different double-J tube indwelling time in the treatment of ureteral stone-street complications after flexible ureteroscope lithotripsy. Methods Clinical data of 64 kidney calculi patients with ureteral stone-street complications after flexible ureteroscope holmium laser lithotripsy were retrospectively analyzed. The patients were divided into observation group (extubating the double-J tube 2 weeks after the surgery) and control group (retaining the double-J tube) with 32 cases in each group. The calculi clearance results and complication were compared between 2 groups. Results The success rate of stone removal in observation group was significantly higher than that in control group: 100.0% (32/32) vs. 65.6%(21/32), the calculi elimination time was significantly shorter than that in control group:(26.4 ± 6.6) d vs. (45.3 ± 10.9) d, the treatment cost was significantly lower than that in control group:(768.4 ± 152.6) yuan vs. (1 262.3 ± 156.8) yuan, the incidences of irritation symptoms of bladder and macroscopic hematuria were significantly lower than those in control group: 15.6% (5/32) vs. 90.6%(29/32) and 15.6% (5/32) vs. 100.0% (32/32), and there were statistical differences (P0.05). Conclusions Removing the double-J tube 2 weeks after flexible ureteroscope lithotripsy results in higher stone clearance rate and less complications compared with retaining the double-J tube. It can reduce the occurrence of irritation symptoms of bladder, macroscopic hematuria and treatment cost.
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Objective To discuss the medium-term follow-up of clinically insignificant residual fragments (CIRF) after minimally invasive percutaneous nephrolithotomy lithotripsy (MPCNL).Methods The clinical data of 72 patients with CIRF medium-term follow-up were analyzed retrospectively.Results Seventy-two patients with CIRF.The anatomical distribution of CIRF was 10 at upper pole,15 at middle,35 at lower,10 at renal ureteropelvie junction and 2 at upper and lower pole.Stone analysis showed that 41 cases of calcium oxalate calculi,16 of calcium oxalate calculi mixed with carbonate calculi,3 calcium oxalate calculi mixed with uric acid,4 calcium oxalate calculi mixed with struvite stone,3 struvite stone,2 uric acid stone and 3 carbonate apatite mixed with struvite stone.Fifteen cases had clinical symptoms,including 2 renal colic pain,8 hematuria,5 lower urinary tract symptoms,4 cases CIRF located in upper pole,1 case in middle pole,4 cases in lower pole,6 cases in ureteropelvic junction,the incidence of clinical symptoms in ureteropelvic junction was significantly higher than that in other locations (6/10 vs.4/12,1/15,4/37,P ＜0.05).Eight cases required surgical procedure,5 cases underwent extracorporeal shock wave lithotripsy,3 cases with ureteral CIRF were performed with ureteroscopic lithotripsy.CIRF were clear after surgery,7 patients with ureteral CIRF had renal colic pains.The stones were excluded after spasmolytic analgesic treatments.Conclusions CIRF can be located variously in the kidney and ureter.Most CIRF are calcium oxalate calculi and locate in the lower pole.Patients with the history of previous open surgery or extracorporeal shock wave lithotripsy are more likely to get CIRF.Medium-term follow-up of CIRF reveals that CIRF located in the renal ureteropelvis junction are more likely to have clinical symptoms.
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Objective To evaluate the clinical effects and safety of percutaneous nephrolithotomy (PCNL) by middle renal calice used as the main target for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.To observe the situation calculus removal rate and complications.Results Seventy cases (88 sides) underwent one session PCNL by single access tract (middle caliees),3 cases (4 sides) underwent one session PCNL by double access tracts (2 cases by middle and low calices,1 case by up and middle caliees).After the first period of lithoclasty,17 patients (25 sides) residual stones and the stone removal rate 72.8％ (67/92),among these patients,1 case (1 side) had fragments of lateral renal calyeeal stones with no further treatment.Other 16 cases (24 sides)underwent second session PCNL,all were treated by single access tract (middle calices) and 2 cases (2 sides)had extracorporeal shock wave lithotripsy before the second PCNL.After the second period of lithoclasty,76 sides composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stone removal rate 82.6％ (76/92).The operative time lasted 120-320 min.Hemoglobin dropped 1-4 g/L,11 cases in the operation procedure and 3 cases after operation needed blood transfusion respectively.One case of renal pelvic infection after operation and 1 case had split renal dysfunction with peri-parenchyma infection.The hospitalization time was 9-18 days.Conclusion It is effective and safe to perform PCNL for staghorn stone by middle calices as a main access.Combining pneumatic and ultrasonic lithotrite will be very useful with high stone clearance,short procedure time and less complications.
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Objective To investigate the effect of pre - washing without heparin on adequacy of hemodialysis. Methods Using self-control method, fifty hemodialysis patients received pre-washing with heparin in normal saline and normal saline. Then we tested Kt/v by online clearance monitoring and observed clotting condition of dialyzer and hemodialysis tubes. Results There were no difference of Kt/v between two methods. After hemodialysis, no clotting phenomenon was found in dialyzer. There was a little pot of coagulation in artery and vein pot, but no significant difference between two methods. Conclusions Pre-washing with normal saline alone can not only ensure the adequacy of hemodialysis, but also reduce the risk of cross infection and reduce the amount of heparin, simplify operational procedures, so it should be promoted.
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Objective To elucidate the role of renal progenitor-like tubular cells in the repair process after acute tubular necrosis(ATN)induced by ischemia. Methods Rat ATN was developed by clamping left kidney artery for 60 minutes,and bromodeoxyuridine(BrdU),a cell division and proliferation marker,was administrated one hour before rats were sacrificed.Kidneys were isolated at 1,3,5,7,14,21,28 days after injury.The proliferative and apoptotic cells were determined by immunostaining using anti-BrdU,Pax2(an embryonic renal marker),vimentin(an immature mesenchymal cell marker),and activated caspase-3(a cell apoptosis marker). Results Cell death was found in tubules at day 1 after ischemia and reperfusion injury.BrdU-positive cells were dramatically increased and reached peak at day 3 after injury.In addition,the number of BrdU positive cells in the contralateral kidney was significantly increased compared to sham operated group.Double immunostaining showed that BrdU-positive cells co-expressed Pax2 or vimentin,but not activated caspase-3. Conclusions Renal progenitor-like tubular cells may play a predominant role in repair process following ATN in rats.They may dedifferentiate,proliferate,and then redifferentiate into mature tubular cells.Growth factors may regulate the repair process.
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Objective To compare the outcomes of antegrade and retrograde approach ureteroscopy for impacted upper ureteric calculi and assess the safety and efficiency of the two types of minimally invasive technique. Methods A total of 106 patients with impacted upper ureteric calculi were treated with ureteroscopy. The procedure was performed via antegrade percutaneous nephrostomy tract in 50 patients (antegrade group) and via retrograde transurethral access in 56 patients (retrograde group). Results The success rate of retrograde group was 92.9% (52/56). Operating time was (45 ± 5 ) min, hospital stay was (6 ± 1) days. The stone free rate was 80.4%(45/56) at 1 month follow-up,7 patients with residual calculi required ESWL combination. Complication rate was 5.4% (3/56). The success rate of antegrade group was 100.0% (50/50). Operating time was (55 ± 8 ) min, hospital stay was (8 ± 2) days. The stone free rate was 100.0% (50/50) and no complication was noted. The stone free rate and the complication rate indicated significant difference between the two groups (P ＜ 0.05). Conclusions Antegrade and retrograde access ureteroscopy for impacted upper ureteric calculi are safe and effective. Success rate and stone free rate of antegrade approach are higher than those of retrograde approach.
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Objective To explore the observation and nursing on complications of artificial vessel arteriovenous fistula in hemodialysis patients. Methods The targeted treatment and nursing care were implemented according to different complications in 40 hemodialysis patients with artificial vessel arteriovenous fistula. Results A total of 25 complications happened in 13 patients. All the patients were cured without dysfunctions after targeted treatment and nursing care. Conclusion Detecting and dealing with the symptoms of complications of artificial vessel arteriovenous fistula in time is important to prolong the using time of artificial vessel arteriovenous fistula.
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Objective To investigate the therapeutics of solitary kidney complicated with complexcalculi,and improve the effect and safety of treatment.Methods Experiences in the treatment of 32 patients with solitary kidney complicated with complex calculi were summarized.Congenital solitary kidney was 6 cases (18.8%),postnatal reason was 26 cases(81.2%),left was 12 cases(37.5%),right was 20 cases (62.5%).All patients were with mould or multiple calculi,9 cases were complicated with ureter calculi,and 8 cases were hospitalized because of obstructive anuria.The patients with mould calculi received extracorporeal shock-wave lithotripsy (ESWL) prior to percutaneous nephrolithotomy(PCNL).While the patients with multiple calculi received PCNL prior to ESWL. Some cases were treated by lithedialysis.Results Twenty-nine cases (90.6%)were cured by ESWL combined with PCNL 12 cases received lithodialysis during PCNL. Eight cases with obstructive anuria recovered in 12 hours after emergent ESWL or lithodialysis,3 cases(9.4%)underwent open operation because of deformity or obstruction in renal pelvis and ureter,1 case had to keep nephrostomy because of repeated infection.Followed up 4-36 months,29 cases (90.6%)kept good kidney function,3 cases(9.4%)had renal insufficiency,2 cases(6.2%)reoccurred calculi.Conclusions The therapeutics of ESWL combined with PCNL may clear complex calculi of solitary kidney effectively and safely.It is necessary to take emergent ESWL in renal obstructive calculi cases.And the patients with lower ureter obstructive calculi may take lithodialysis first.It is proper to choose open operation on the patients with deformity of renal pelvis or obstruction of ureter.