Evaluation of a newly designed basket in non-radiation endoscopic lithotomy for common bile duct stones (with video) / 中华消化内镜杂志

Objective:To evaluate a newly designed basket fit for digital cholangioscope in non-radiation endoscopic lithotomy for common bile duct stones.Methods:Seventy-eight patients who underwent non-radiation endoscopic removal of common bile duct stones at Zhongda Hospital Southeast University between February and October 2021 were enrolled in the randomized controlled trial, and were randomly assigned into the new basket group ( n=35) and the conventional basket group ( n=43) by drawing lots. Procedures of cholangioscope-based biliary exploration and stone removal by baskets, volume of water irrigation, time lengths of biliary exploration, stone removal and whole endoscopic procedure, and adverse events were compared. Results:Compared with the conventional basket group, the new basket group needed less biliary explorations (1.08±0.28 VS 2.30±0.51, t=-12.535, P<0.001), smaller volume of water irrigation (46.14±11.89 mL VS 78.62±10.09 mL, t=-13.052, P<0.001), and shorter time of biliary exploration and stone removal (9.69±2.97 min VS 12.67±2.51 min, t=-4.815, P<0.001) and whole endoscopic procedure (30.17±7.19 min VS 33.44±6.69 min, t=-2.076, P=0.041). The incidence of adverse events was not significantly different between the two groups [5.7% (2/35) VS 11.6% (5/43), χ2=0.826, P=0.363]. Conclusion:This newly designed basket can facilitate digital cholangioscope-guided non-radiation endoscopic removal of common bile duct stones with the advantages of shorter operation time, less exploration time of choledochoscopy and smaller volume of water irrigation.

Efficacy analysis of Allium ureteral stent in semisupine-lithotomy position for treatment of pelvic tumour-induced ureteral stricture / 中华泌尿外科杂志

Objective:To investigate the efficacy and safety of semisupine-lithotomy position placement of Allium ureteral stent to treat ureteral stricture caused by pelvic tumours.Methods:The clinical data of 29 patients who received Allium ureteral stent(URS) placement for ureteral stricture in Sun Yat-sen Memorial Hospital, Sun Yat-sen University between April 2020 and March 2022 were retrospectively analyzed. There were 3 males and 26 females, with the median age of 56(54, 61) years old. All patients had a pathology confirmation of carcinoma before the treatment, including 26 patients with gynaecological tumours, two with urinary system tumours, and one with rectal carcinoma. A preoperative imaging examination confirmed the diagnosis of ureteral stricture. There were 15 patients with unilateral and 14 with bilateral stenosis, median stenosis length was 3.6(2.0, 4.9)cm. Preoperative median urine white blood cell count was 62(21, 354) U/L, median serum creatinine (SCR) was 170.0(85.5, 273.5) μmol/L, and renal pelvis separation was (32.98±6.64) mm. The median time of long-term indwelling double J (D-J)ureteral stent before surgery was 12.0 (6.5, 35.5) months. Seven patients had mild hydronephrosis, 18 had moderate hydronephrosis, and four had severe hydronephrosis. In all patients, Allium URS were placed in the way of the semisupine-lithotomy position (Galdakao-modified supine Valdivia position). Anterograde flexible ureteroscope was inserted into the percutaneous nephrostomy channel, and the retrogradel rigid ureteroscope were advanced simultaneously, looking for location of strictures. Allium URS were inserted retrogradely with transureteroscope when the two ureteroscope were connected. Perioperative conditions and postoperative follow-up for the last examination of SCR, renal pelvis width under ultrasound, and plain abdominal film (KUB). Allium URS patency and complications, hydronephrosis and renal function were evaluated.Results:A total of 61 Allium URS were successfully placed. Seven patients were placed in stages, and 18 patients were placed in series with multiple stents. The mean follow-up period was (12.1±5.8) months. At last follow-up, median SCR was 124.0(81.5, 193.0)μmol/L and renal pelvis separation was(14.96±5.18)mm, which were significantly decreased compared with preoperative(all P<0.01). There were 24 cases of hydronephrosis disappeared and 5 cases of mild hydronephrosis in the last follow-up. Postoperative follow-up, urinary tract infection occurred in 3 patients after operation, such as hematuria and fever within one week, and the symptoms were relieved after anti-infective and symptomatic treatment. One case had mild urine leakage, and 4 patients had occasional low back pain, which may be related to the activity. One case occurred stent displacement due to stent migration to the bladder after eight months, the URS was replaced and a D-J stent was inserted .The patency rate was 96.6%(28/29). Conclusions:Allium URS was placed in the semisupine-lithotomy position for treating pelvic tumour-induced ureteral stricture, with low incidence of complications, high patency and good curative effect.

Strategy of laparoscopic treatment of right posterior bile duct hepatolithiasis / 中华消化外科杂志

Hepatolithiasis is a common biliary disease in China. Surgical treatment principles of hepatolithiasis include "removing lesions, cleaning stones, correcting strictures, recovering the drainage and preventing the recurrence". Laparoscopic techniques have been increasingly applied in surgical treatment of hepatolithiasis recently. Right posterior bile duct is a predilection site of hepatolithiasis. Due to its unique anatomy, right posterior lobectomy, right posterior bile duct lithotomy and plasty remain challenging under laparoscopy. Based on relevant literatures and clinical experiences, the authors explore the strategy of laparoscopic treatment right posterior bile duct hepatolithiasis, aiming to provide reference for surgical colleagues.

Application value of transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position / 中华消化外科杂志

Objective:To investigate the application value of transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position.Methods:The retrospec-tive cohort study was conducted. The clinicopathological data of 114 patients who underwent com-plete resection of presacral cyst in Henan Cancer Hospital from August 2012 to October 2021 were collected. There were 14 males and 100 females, aged (35±9)years. All patients were diagnosed as presacral cysts by preoperative magnetic resonance imaging. Of the 114 patients, 76 patients undergoing intraoperative perineal arc incision approach in the lithotomy position were divided into the innovative group, and 38 patients undergoing intraoperative Kraske approach were divided into the traditional group. Observation indicators: (1) surgical situations and specimen; (2) postoperative situations; (3) Follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and com-parison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical situations and specimen. The operation time, volume of intraoperative blood loss, cases with intraoperative combined transabdominal approach or sacrectomy were (137±20)minutes, (261±101)mL, 0 in the innovation group, versus (136±34)minutes, (261±116)mL, 15 in the tradi-tional group, showing no significant difference in the operation time and volume of intraoperative blood loss between the two groups ( t=0.18, 0, P>0.05) and showing a significant difference in cases with intraoperative combined transabdominal approach or sacrectomy between the two groups ( P<0.05). Results of postoperative specimen anatomy in patients of the two groups showed complete removal of the cyst. (2) Postoperative situations. The time to postoperative removing presacral drainage tube, duration of postoperative hospital stay, cases with postoperative second stage healing of incision were (11.4±2.1)days, (13.5±3.5)days, 23 in the innovation group, versus (11.5±1.9)days, (13.7±3.8)days, 4 in the traditional group, showing no significant difference in the time to post-operative removing presacral drainage tube and duration of postoperative hospital stay between the two groups ( t=-0.20, -0.24, P>0.05) and showing a significant difference in cases with postoperative second stage healing of incision between the two groups ( χ2=5.46, P<0.05). Cases with postoperative severe complications were 4 and 2 in the innovation group and the traditional group, respectively, showing no significant difference between the two groups ( P>0.05). (3) Follow-up. All 114 patients were followed up for 48(range, 6?108)months. Cases with recurrence of cysts were 2 and 0 in the innovation group and the traditional group, respectively, showing no significant difference between the two groups ( P>0.05). During the follow-up period, the anal defecation control function of all patients was classified as grade A?B of Williams score. Conclusions:The transverse perineal arc incision approach in complete resection of presacral cyst in the lithotomy position is safe and feasible. Compared with Kraske approach, the transverse perineal arc incision approach in the lithotomy position is more suitable for patients with high presacral cyst.

Clinical efficacy of super-mini-percutaneous nephroscope combined with flexible ureteroscopic lithotripsy in oblique supine lithotomy position in the treatment of 2.0-3.0 cm renal calculi / 现代泌尿外科杂志

【Objective】 To compare the clinical safety and effectiveness of super-mini-percutaneous nephroscope (SMP) combined with flexible ureteroscopic lithotripsy (FURL) in oblique supine lithotomy position and FURL alone in the treatment of 2.0-3.0 cm renal calculi. 【Methods】 Clinical data of 55 patients treated during Jan.2018 and May 2021 were retrospectively analyzed, including 47 cases complicated renal calculi, and 14 cases of lower calyceal calculi with infundibulopelvic angle ≤30°. SMP combined with FURL was performed in 23 cases (combined group), and FURL alone was performed in 32 cases (FURL group). The operation time, hemoglobin reduction, postoperative hospital stay, hospitalization expenses, stone-clearance rate and complications were compared. 【Results】 All operations were successful. Compared with the FRUL group, the combined group had significantly more hemoglobin reduction [(16.30±10.17) g/L vs. (6.94±6.61) g/L], longer postoperative hospital stay [(5.35±1.61) d vs. (3.19±1.26) d], and higher hospitalization expenses [(22 481±2 234) yuan vs. (18 209±2 584) yuan] (P0.05]. One month after surgery, CT results showed that the combined group had higher stone-clearance rate (91.30% vs. 65.63%, P=0.027). There was no difference in the complication rate (21.74% vs. 21.88%, P>0.05). One case (4.35%) in the combined group and 5 cases (15.63%) in the FURL group received retreatment (P>0.05). 【Conclusion】 SMP combined with FURL in oblique supine lithotomy position is safe and effective in the treatment of 2.0-3.0 cm renal calculi, with high stone-clearance rate and low complication rate.

Recent progress in the treatment of intractable sialolithiasis / 北京大学学报(医学版)

Sialolithiasis occurs in approximately 0.45% to 1.20% of the general population. The typical clinical symptom manifests as a painful swelling of the affected glands after a meal or upon salivary stimulation, which extremely affects the life quality of the patients. With the development of sialendoscopy and lithotripsy, most sialoliths can be successfully removed with preservation of the gland. However, sialoliths in the deep hilar-parenchymal submandibular ducts and impacted parotid stones located in the proximal ducts continue to pose great challenges. Our research center for salivary gland diseases (in Peking University School and Hospital of Stomatology) has used sialendoscopy for 17 years and treated >2 000 patients with salivary gland calculi. The success rate was approximately 92% for submandibular gland calculi and 95% for parotid calculi. A variety of minimally invasive surgical techniques have been applied and developed, which add substantial improvements in the treatment of refractory sialolithiasis. Further, the radiographic positioning criteria and treatment strategy are proposed for these intractable stones. Most of the hilar-parenchymal submandibular stones are successfully removed by a transoral approach, including transoral duct slitting and intraductal basket grasping, while a small portion of superficial stones can be removed by a mini-incision in submandibular area. Impacted stones located in the distal third of parotid gland ducts are removed via "peri-ostium incision", which is applied to avoid a cicatricial stenosis from a direct ostium incision. Impacted parotid stones located in the middle and proximal third of the Stensen's duct are removed via a direct mini-incision or a peri-auricular flap. A direct transcutaneous mini-incision is commonly performed under local anesthesia with an imperceptible scar, and is indicated for most of impacted stones located in the middle third, hilum and intraglandular ducts. By contrast, a peri-auricular flap is performed under general anesthesia with relatively larger operational injury of the gland parenchyma, and should be best reserved for deeper intraglandular stones. Laser lithotripsy has been applied in the treatment of sialolithiasis in the past decade, and holmium ∶YAG laser is reported to have the best therapeutic effects. During the past 3 years, our research group has performed laser lithotripsy for a few cases with intractable salivary stones. From our experiences, withdrawal of the endoscopic tip 0.5-1.0 cm away from the extremity of the laser fiber, consistent saline irrigation, and careful monitoring of gland swelling are of vital importance for avoidance of injuries of the ductal wall and the vulnerable endoscope lens during lithotripsy. Larger calculi require multiple treatment procedures. The risk of ductal stenosis can be alleviated by endoscopic dilation. In summary, appropriate use of various endoscopy-assisted lithotomy helps preserve the gland function in most of the patients with refractory sialolithiasis. Further studies are needed in the following aspects: Transcervical removal of intraglandular submandibular stones, intraductal laser lithotripsy of impacted parotid stones and deep submandibular stones, evaluation of long-term postoperative function of the affected gland, et al.

A new classification on location of hepatolithiasis in guiding treatment with percutaneous transhepatic choledochoscopic lithotripsy / 中华肝胆外科杂志

Objective:To study the clinical application of a new classification on location of hepatolithiasis in guiding treatment using percutaneous transhepatic choledochoscopic lithotomy (PTCSL).Methods:The clinical data of 85 consecutive patients with preoperatively diagnosed hepatolithiasis who underwent PTCSL at the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were prospectively collected. There were 27 males and 58 females, aged from 15 to 86(62±14) years. Hepatolithiasis was classified into five types of stone location based on preoperative imagings: type Ⅰ ( n=12) , stones located in central bile duct, including hilar bile duct and common hepatic duct; type Ⅱ ( n=17) in unilateral hepatic duct with multiple branches; type Ⅲ ( n=24) in unilateral hepatic duct with multiple branches plus central bile duct; type Ⅳ ( n=31) in bilateral hepatic ducts with multiple branches; and type Ⅴ ( n=1) in unilateral hepatic duct with a single branch. Fistulation path, number of procedures, number of bile duct fistula, and complications were recorded. The residual stone rate and stone recurrence rate were compared among the five types. The follow-up was performed to analyse prognosis. Results:A total of 99 biliary fistulae were performed, with one single tract created in 74 patients, two tracts in 9 patients, three tracts in 1 patient, and four tracts in 1 patient. The fistulation path was B2 in 12 patients, B3 in 18 patients, B4 in 1 patient, B5 in 4 patients, B6 in 10 patients, B7 in 4 patients, and B8 in 50 patients. Altogether, 151 choledochoscopic lithotomy procedures were performed (1-3 times per patient, mean 1.78 times). For the 9 patients with residual stones (10.6%, 9/85), there were 3 patients with type Ⅱ and 6 patients with type Ⅳ. There were significant differences in the residual stone rates among the 5 types (χ 2=11.13, P=0.025). Stone recurrence developed in 33 (38.8%) patients, including 2 patients with type Ⅰ, 7 patients with type Ⅱ, 10 patients with type Ⅲ and 14 patients with type Ⅳ (χ 2=9.07, P=0.046). The total intraoperative and postoperative complications rates was 28.2% (24/85). The follow-up period was 4-58 months with the median follow-up time of 30 months. Twelve patients died during the follow-up period, including 1 patient who died from postoperative bleeding, 3 cholangiocarcinoma, 7 biliary cirrhosis-related liver failure, and 1 stone-unrelated disease. Conclusion:Type Ⅳ in the location classification of hepatolithiasis based on PTCSL had significantly higher rates of residual stones and stone recurrence. This new classification is helpful for clinicaians to determine the optimal path using a smaller number of fistulation tracts to clear stones. It improved the efficacy of PTCSL in treating hepatolithiasis.

Síndrome compartimental bilateral de pierna tras posición de litotomía prolongada: presentación de un caso clínico / Bilateral leg compartment syndrome after prolonged lithotomy position: clinical case report

INTRODUCCIÓN: El síndrome compartimental es una complicación infrecuente pero severa que puede aparecer ante una posición de litotomía prolongada y el uso de perneras. OBJETIVO: Presentar un caso de síndrome compartimental bilateral tras posición de litotomía prolongada asociada con el uso de perneras. MATERIAL Y MÉTODOS: Paciente varón de 43 años sometido a una cirugía urológica en posición habitual de litotomía durante un periodo de 6 horas. A las 2 horas de finalizar la cirugía, el paciente presentó dolor intenso y endurecimiento de compartimento anterior y lateral de ambas piernas, junto con una elevación de la creatina quinasa sérica (valor inicial de 109 U/L que se elevó hasta 7.689 U/L a las 12 horas) y una imposibilidad para la flexión dorsal pasiva de ambos tobillos. El paciente no sentía dolor en el resto de los compartimentos. RESULTADOS: Ante la sospecha de un síndrome compartimental anterolateral, se realizó fasciotomía bilateral urgente, y se observó una disminución de la perfusión muscular y mejoría de la misma tras apertura de la fascia. Se realizaron curas periódicas cada 48 horas, y se observó viabilidad del tejido hasta su cierre definitivo a los 4 días. A las 2 semanas, el paciente presentó fatiga ligera para la deambulación sin ayuda, con tumefacción en el compartimento lateral de ambas piernas. A los 10 meses de evolución, el paciente caminaba sin ayuda y con función muscular completa. CONCLUSIONES: El conocimiento de la asociación del síndrome compartimental y la cirugía laparoscópica prolongada es esencial para un diagnóstico precoz y un tratamiento quirúrgico inmediato, para evitar graves secuelas. Los buenos resultados de nuestro paciente se deben a la rápida actuación, ya que normalmente se suele demorar. Para evitar su aparición o disminuir su incidencia, la posición de litotomía debería limitarse a aquellos momentos de la cirugía en los que sea imprescindible, modificando la posición de las piernas cada dos horas en caso de cirugías prolongadas, para prevenir dicha complicación.

Compartment syndrome is a rare but severe complication resulting from a prolonged lithotomy position and the use of leg loops. PURPOSE: To present a case of bilateral compartment syndrome after prolonged lithotomy position associated with the use of leg loops. METHODS: A 43-year-old man underwent urological surgery in the usual lithotomy position for a 6-hour period. Two hours after the end of the surgery, the patient presented severe pain and stiffening of the anterior and lateral compartments of both legs, elevated serum creatine kinase levels (the baseline value of 109 U/L increased to 7,689 U/L at 12 hours), and inability for passive dorsiflexion of both ankles. The patient reported no pain in the other compartments. RESULTS: Suspicion of an anterolateral compartment syndrome resulted in an urgent bilateral fasciotomy; muscle perfusion was decreased, and it improved after fascial opening. Dressings were changed every 48 hours, and tissue viability was observed until the final closure at 4 days. At two weeks, the patient presented slight fatigue when walking with no assistance, in addition to swelling in the lateral compartment of both legs. Ten months after surgery, the patient walked with no assistance and with complete muscle function. CONCLUSION: Knowledge of the association between compartment syndrome and prolonged laparoscopic surgery is essential for an early diagnosis and immediate surgical treatment to avoid serious sequelae. In our patient, the good outcomes resulted from quick action, since diagnosis is often delayed. Limiting the lithotomy position to those surgical moments in which it is essential and changing the position of the legs every 2 hours during prolonged procedures can reduce the occurrence and incidence of compartment syndrome, preventing this complication.

Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture / 中国修复重建外科杂志

Objective: To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation. Methods: The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness. Results: Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( P0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( P<0.05). Conclusion: Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.

Comparison of head-down lithotomy position and Trendelenburg position on cardiac output in patients undergoing gynecological laparoscopic surgery / 复旦学报（医学版）

Objective To compare the changes in cardiac output (CO) and other hemodynamic parameters in patients undergoing gynecological laparoscopic surgery in head-down lithotomy position and Trendelenburg position. Methods Sixty patients were divided into head-down lithotomy group and Trendelenburg group. CO was recorded as baseline by a noninvasive cardiac output monitor NICOM? system after the placement of patients. These measurements were also acquired when the patients were placed in the 30° head-down tilt(T0)following pneumoperitoneum establishment.Stroke volume(SV), heart rate(HR)and CO were monitored at 1-minute intervals thereafter for a total of 10 minutes(T1-T10),and mean arterial pressure(MAP)and total peripheral resistance(TPR)were monitored every 5 minutes. Results The reduction of CO in head-down lithotomy group was greater than that in Trendelenburg group(T0:-31％±19％ vs.-9％±34％;T1:-32％±18％ vs.-16％±38％;T2:-33％± 19％vs.-16％±26％;T3:-32％±22％vs.-16％±28％;T4:-31％±18％vs.-12％±38％;T5:-30％± 17％vs.-14％±37％;T6:-31％±17％ vs.-14％±33％,all P<0.05)during the first 6 minutes. MAP at baseline in head-down lithotomy group was significantly higher than that in Trendelenburg group[(97±11) mmHg vs.(85±6)mmHg,P<0.05].MAP decreased in head-down lithotomy group at T0(-8％±16％) and increased in Trendelenburg group at T5 and T10(T5:9％±15％,T10:12％±18％). Conclusion CO reduction was greater in patients in head-down lithotomy position than that in Trendelenburg position group during the first 10 minutes after adjusting the position following pneumoperitoneum establishment.

Clinical analysis of thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach / 中国胸心血管外科临床杂志

@#Objective    To discuss the safety, feasibility and short-term clinical efficacy of thoracoscopic anterior mediastinal mass resection in lithotomy position via subxiphoid approach or lateral position via transthoracic approach. Methods    A total of 44 patients suffering anterior mediastinal tumor enrolled, including 21 patients (10 males and 11 females as a trial group) with an average age of 43.6±11.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lithotomy position via subxiphoid approach and 23 patients (13 males and 10 females as a control group) with an average age of 45.3±10.8 years who have been performed thoracoscopic anterior mediastinal tumor resection in lateral position via transthoracic approach. The clinical efficacy of the two groups was compared. Results    Postoperative chest drainage time (3.8±1.3 d vs. 5.0±1.8 d, P=0.017), postoperative drainage volume (238.8±66.2 mL vs. 467.2±120.0 mL, P=0.000), postoperative mean  visual analogue score at 24 h (2.5±0.9 point vs. 4.9±1.0 point, P=0.000), times of self-pressure analgesic pump (3.7±0.9 vs. 8.4±2.0, P=0.000), duration of postoperative hospital stay (4.7±1.3 d vs. 7.4±3.1 d, P=0.000) and hospitalization cost (34±8 kyaun vs. 44±11 kyuan P=0.001) in the trial group were all better than those in the control group. There was no significant difference between the two groups in surgical duration (59.0±18.1 min vs. 60.4±16.4 min) (P>0.05). During follow-up, no recurrence or metastasis occurred in either group. Conclusion    Compared with the lateral position through the transthoracic approach, the lithotomy position through subxiphoid approach of thoracoscopic anterior mediastinal mass resection is safe and feasible, and has certain advantages.

A comparative study of ureteroscopic lithotripsy combined with occlusion device and the supine and lithoto-my position mini-invasive percutaneous nephrolithotomy for the treatment of upper incarcerated ureteral stones / 实用医学杂志

Objective To compare the efficacy of ureteroscopic lithotripsy(URL)combined with occlusion device and the supine and lithotomy position mini-invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper incarcerated ureteral stones. No difference could be found in age,sex and size of stones between the two groups. Method From Jan. 2014 to Dec. 2016 in our hospital,all cases of upper incarcerated ureteral stones were diviede into two groups:52 in ureteroscopic lithotripsy combined with occlusion device group and 45 in mini-inva-sive percutaneous nephrolithotomy group. Result The hospitalization and operation time in URL group were(5.5 ± 1.4)days and(53.3 ± 12.4)mins,which were significantly shorter than that in mPCNL group with(9.1 ± 3.2)days and(78.2 ± 14.1)mins,(P 0.05),stone clearance rate(100% vs 91.8,P > 0.05)and complication rate (4.4%vs 3.9%,P>0.05). Conclusion URL combined with occlusion device can obtain satifactory results as well as the supine and lithotomy position mPCNL in the treatment of upper incarcerated ureteral stones.

Analysis of Clinical Features and Risk Factors of Recurrence after Choledocholithotomy / 现代生物医学进展

Objective:To explore the clinical features of recurrence after choledocholithotomy and to analyze the risk factors.Methods:The clinical data of 730 patients with choledocholithiasis who were treated in our hospital from January 2005 to July 2016 were analyzed retrospectively,550 cases who were received choledocholithotomy were defined as laparotomy group,30 cases with laparoscopic common bile duct exploration (LCBDE) were defined as the LCBDE group,and 150 cases with endoscopic sphincterotomy (EST) were defined as EST group.The recurrence rate of the three groups were compared.The patients of three groups were divided into recurrence group (n=227) and non recurrence group (n=503) according to the recurrent situation,then the clinical features and risk factors of recurrent patients were analyzed by univariate and multivariate Logistic regression analysis.Results:The recurrence rate of EST group was 38.67％,which was significantly higher than that of LCBDE group with 26.67％ and the laparotomy group with 29.27％,and there was statistical difference (P＜0.05).The results of univariate analysis showed that there were statistically significant differences in age,history of HBV infection,jaundice,abnormal total bilirubin,peripapillary diverticulum,biliary infection,biliary stricture,papillary stenosis,sphincter of Oddis dysfunction,history of biliary surgery,cholecystectomy,bile duct diameter ≥ 15 mm,bile duct angle ≤120°,operation type,stone quantity ≥ 2 grains,stone diameter ≥ 10 mm,with or without gallstones (P＜0.05).The results of Logistic multivariate regression analysis showed that age,having peripapillary diverticulum,having history of biliary surgery,bile duct diameter ≥ 15 mm,stone quantity ≥ 2grains and EST operation type were the independent risk factors of the recurrence after choledocholithotomy (P＜0.05).Conclusion:There are many risk factors of recurrence after choledocholithotomy,and operation method should be based on the size and the number of the stones,and the constitution of patients.Preventive measures should be strengthened to control the recurrence after choledocholithotomy.

Percutaneous Nephrolithotomy Combined with Semirigid Ureteroscopic Lithotripsy in Semisupine-lithotomy Position for Encrusted Ureteral Stents:Report of 5 Cases / 中国微创外科杂志

Objective To evaluate the safety and efficacy of percutaneous nephrolithotomy with semirigid ureteroscopic lithotripsy in semisupine-lithotomy position for treatment of encrusted ureteral stents . Methods Patients were placed in semisupine-lithotomy position .The bladder stones and ureteral encrusted stones were treated with ureteroscopy , and then percutaneous holmium laser nephrolithotomy was used to break and wash out the renal pelvis stones and renal new stones . Results The stone fragmentation and stent removal were completed in one session in all 5 cases without conversion to open surgery .The mean operative time was 65 min (range, 40-130 min).No massive hemorrhage, ureteral avulsion, or ureteral perforration occurred during the operation .Two cases had postoperative fever without sepsis .No patients had ureteral stricture or recurrent calculus within follow-ups for 3 -6 months. Conclusion Percutaneous nephrolithotomy combined with semirigid ureteroscopic lithotripsy in semisupine-lithotomy position for treatment of encrusted ureteral stents is safe and effective , being worthy of clinical promotion .

The efficacy of supine half-sitting lithotomy position in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy / 中华泌尿外科杂志

Objective To evaluate the efficacy and economic results in the treatment of upper ureteral calculi by surgery of ureteroscopic Holmium laser lithotripsy under the supine half-sitting lithotomy position.Methods To analyze the clinical data of upper ureter calculi patients who underwent ureteroscopy Holmium laser lithotripsy retrospectively.Patients in traditional lithotomy position with assistance of stone basket during the surgery were in group A.Those in traditional position surgery without stone basket were in group B.Those in supine,half-sitting,lithotomy position and without the assistance of stone basket were in group C.There were 62,31 and 75 patients in group A,B and C respectively.In group A,there were 32 males and 30 females;37 cases in left side,25 in right side,with degree of hydronephrosis of (2.9 ±0.6) cm and stone size of (1.7 ±0.4) cm.In group B,there were 18 males and 13 females;14 cases in left side,17 in right side,with degree of hydronephrosis of (2.8 ± 0.6) cm and stone size of (1.6 ±0.5) cm.In group C,there were 44 males and 31 females;36 cases in left side,39 in right side,with degree of hydronephrosis of (2.8 ± 0.7) cm and stone size of (1.7 ± 0.5) cm.There was no significant difference in aspects of age,degree of hydronephrosis and stone maximum diameter.Statistical analysis was performed regarding operation time,fee for hospitalization and stone free rate among the three groups.Results Ittook (71.8±9.6) min,(62.2±ll.4) min and (65.4±6.8) min in group A,BandC respectively,and there was significant difference among three groups.When comparing two groups respectively,the operation time in group A was more than group B and C significantly,while group B and C shared no difference.As for fees in hospitalization,they were (27.2 ± 4.0),(22.4 ± 5.0) and (22.4 ±3.8) thousand Yuan in three groups,and significant difference was found.By comparing two groups,we found that the fees in group A were more than group B and C significantly,while group B and C had no difference.Finally,stone free rate was compared among three groups,they were 90.3％,64.5％,96％ respectively,and there was significant difference as well.By further study,we found that stone free rate in group C was the highest,followed by A and B group.Conclusions There were higher stone free rates,less operation time and expense to perform ureteroscopic Holmium laser lithotripsy in supine half-sitting lithotomy position.

Evaluation of effect of endoscopic retrograde cholangiopancreatography and laparoscopic bile duct exploration lithotomy in treatment of intra/extra-hepatic duct stones / 中国内镜杂志

Objective To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic bile duct exploration lithotomy (LBDEL) in treatment of intra/extra-hepatic duct stones. Methods There were 110 patients whose intrahepatic stones located in Ⅰ , Ⅱ hepatic duct and 378 patients whose stones only located in the common bile duct. These patients respectively underwent LBDE combined with choledochoscope laser lithotripsy or ERCP combined with endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to remove the stones. Common bile ducts were performed primary suture or T tube placement in the LBDEL cases. The evaluation was carried out for perioperative complications and postoperative recovery of the surgical methods. Results The residual stone rate was 31.82% in 110 cases. The rate was higher in ERCP group (51.06%) than that in LBDEL group (17.46%) (P < 0.05). Postoperative recovery was better in LBDEL group than that in ERCP group. The residual stone rate was 8.20% in 378 cases. The rate was lower in ERCP group (3.68%) than that in LBDEL group(11.63%) (P < 0.05). Between the two groups, there had no statistical significance in postoperative recovery. The incidences of bile leakage and pulmonary infection were higher in LBDEL group than in ERCP group. The incidences of abdominal cavity infection, acute pancreatitis, digestive tract perforation and gastrointestinal bleeding were higher in ERCP group than that in LBDEL group. 2 of the 378 patients occurred death were happened digestive tract perforation which were induced during ERCP procedure. Conclusion LBDEL and ERCP demonstrated the same therapeutic effects in the treatment of common bile duct stones. However, ERCP has no large advantages in the treatment of hepatolithiasis, and shows higher complication rates. LBDEL has a significant curative effect for intra-and extrahepatic bile duct calculi and can maintain the integrity of Oddi sphincter. This technology is easy to spread to the basic-level hospital to benefit the majority of patients.

Suctioning flexible ureteroscopic lithotripsy in the oblique supine position and lithotomy position: a comparative study / 中国内镜杂志

Objective To compare the safety and efficacy of oblique supine position and lithotomy position in suctioning flexible ureteroscopic lithotripsy. Methods 82 patients with upper urinary calculi were divided into two groups. Group 1 included 47 patients who were treated by suctioning flexible ureteroscopy in oblique supine position. Group 2 included 35 patients who were treated in lithotomy position. There was no significant statistical difference in age, gender and complications between the two groups before surgery (P > 0.05). The operative time, stone-free rates at postoperative 30 d, renal pelvic pressure (RPP), postoperative complications (graded by the Clavien system) and length of stay were compared. Results Retrograde Intrarenal Surgery (RIRS) was successful in 73 cases, and 9 cases of patients were done successfully after indwelling DJ tube 2 weeks. Compared with lithotomy position, a significantly greater stone-free rate of 30 d, shorter operative time (P 0.05). Conclusions Suctioning flexible ureteroscopic lithotripsy in the oblique supine position is safe, and more effective than supine lithotomy position.

The clinical application of laparoscopic common bile duct stone removal / 中华肝胆外科杂志

Cholecystolithiasis with choledocholithiasis (CCL) is a common disease.The removal of common bile stone is a challenge for the surgery.This paper discussed the clinical application of three stone removal techniques including direct stone removal,irrigation and stone extraction by basket under cholangioscopy in order to take the stones effectively and safely,shorten the procedure time,avoid the injuries of common bile duct wall caused by the repetition of a single method such as biliary endoscopic stone extraction,reduce the difficulty of taking stone and enhance recovery of patients.

Clinical analysis of the lie delivery in promoting natural delivery functionsmothly / 中国综合临床

Objective To investigate the effect of lie delivery in promoting natural delivery functionsmoothly.Methods One hundred and sixty pregnant women hospitalized and deliveried in the Maternal and Child Care Service Centre of Shijiazhuang from June 2013 to June 2014 were randomly divided into observation group of lie delivery and control group of bladder lithotomy postion delivery,80 cases in each group,The second stage of labor time,postpartum hemorrhage (2 h ＞ 500 ml),postpartum comfort and neonatal asphyxia (Apgar score ≤ 7 points) of two groups were observed and compared.Results The second stage of labor time of observation group was significantly shorter than that of the control group taking lithotomy position childbirth,and thepostpartum hemorrhage (2.5％ vs 7.5％;x2 =3.247,P=0.034),cervical laceration(3.75％ vs 21.25％;x2 =4.657,P=0.047) and the incidence of postpartumdiscomfort incidence(16.25％ vs 50.0％;x2 =18.357,P =0.008) were less than that in the control group,the differences between two groups were statistically significant (P＜0.05).Fetal distress (2.50％ vs 8.75％;x2 =4.672,P =0.030),neonatal asphyxia rate(1.25％ vs 7.50％;x2 =4.142,P =0.035) of two groups have statistical significance (P ＜ 0.05).Conclusion The parturient labor process in lying position to take,can effectively shorten the birth process,reduce the incidence of fetal distress and neonatal asphyxia.

Application of self-made one-piece shoulder pillow in patients undergoing gynecological laparoscopy with lithotomy position and trendelenburg position / 现代临床护理

Objective To explore the effect of one-piece shoulder pillow on patients suffering from shoulder pain and skin erubescence during gynecological laparoscopy with lithotomy position and trendelenburg position. Methods Two hundred and six patients who underwent gynecological laparoscopic operation were divided into control and experiment groups according to cardinal or even number of registration. The patients in both groups were set in lithotomy position and trendelenburg position during the operation, with the difference in the use of a common shoulder pillow for support in the control group but no use in the experiment one. On-position time and incidence rate of shoulder pain and skin erubescence were compared between two groups. Result The sholder pain and skin erubescence were less than those of control group (P < 0.05). Conclusion Use of one-piece shoulder pillow can reduce the incidence rates of shoulder pain and skin erubescence after gynecological laparoscopic operation with lithotomy position and trendelenburg position.