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Objective To investigate the application value of choledochoscopy and imaging examination in the diagnosis and treatment of residual bile duct stones.Methods The retrospective descriptive study was conducted.The clinical data of 618 patients who underwent choledochoscopy and imaging examination after operation of hepatolithiasis in the First Affiliated Hospital of Zhengzhou University between April 2014 and September 2018 were collected,including 300 males and 318 females,aged from 19 to 89 years,with an average age of (58 ± 12)years.Observation indicators:(1) situations of residual bile duct stones diagnosed by choledochoscopy and imaging examination;(2) stone extraction situations of patients with hepatolithiasis.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were described as M (range).Count data were represented as absolute number or percentage,and analyzed using the chi-square test or Fisher exact propability.Results (1) Situations of residual bile duct stones diagnosed by choledochoscopy and imaging examination:all the 618 patients underwent choledochoscopy,and 505 of them underwent the imaging examination before choledochoscopy.① Of patients undergoing single imaging examination,72 received ultrasonography,with false-negative rate of 29.17％ (21/72);37 received CT examination,with false-negative rate of 10.81％(4/37);33 received T-tube cholangiography,with false-negative rate of 39.39％ (13/33).② Of patients undergoing combined two imaging examinations,61 received ultrasonography + CT,with false-negative rate of 8.20％ (5/61);129 received ultrasonography + T-tube cholangiography,with false-negative rate of 12.40％ (16/129);52 received CT + T-tube cholangiography,with false-negative rate of 5.77％(3/52).③ There were 121 receiving ultrasound+CT+T-tube cholangiography,with false-negative rate of 7.44％ (9/121).There were statistically significant differences in the false-negative rates of combined two or three examinations of ultrasound + CT+ T-tube cholangiography and single imaging examination (x2=40.83,P＜0.05).The further analysis showed a statistically significant difference among the single imaging examination (x2=7.70,P＜0.05).There was no statistically significant difference among the combined two of imaging examinations (x2=2.10,P＞0.05).There were statistically significant differences in the combined three examinations of ultrasound +CT+T-tube cholangiography and ultrasound and T-tube cholangiography examination respectively (x2=16.23,21.62,P＜0.05).There was no statistically significant difference in the combined three of imaging examinations and CT examination and combination of CT+T-tube cholangiography respectively (P＞ 0.05).There was no statistically significant difference in the combined three of imaging examinations and combination of ultrasound+CT examinations and combination of ultrasound+T-tube cholangiography (x2=0.33,1.71,P＞0.05).Seventy-one patients without residual bile duct stone by preoperative imaging examination were detected residual bile duct stones by intraoperative choledochoscopy,and residual bile duct stones of 36,31 and 4 patients are respectively distributed around the distal common bile duct,small intrahepatic bile duct,left and right hepatic ducts,common hepatic duct and remaining common bile duct.(2) Stone extraction situations of patients with hepatolithiasis:of 618 patients,cases with 1,2,3,4,5,6,7,8,9 and 10 times of residual bile duct stones clearance were respectively 392,116,48,39,9,6,3,2,2 and 1.Residual bile duct stones clearance frequency of patients was an average of 1.73 times.There were 63.43％(392/618) and 96.28％(595/618) of patients had stone clearance with once and ≤ 4 times of stone extraction,respectively.Conclusion The negative results of preoperative imaging examinations cannot be as standards of bile duct stone clearance before choledochoscopy,and the best choice is to detect whether there are residual bile duct stones and remove the stones combined with choledochoscopy.
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Objective To investigate the accuracy of observing common bile duct ( CBD ) residual stones by saline injection through endoscopic nasobiliary drainage ( ENBD ) under the guidance of ultrasound after endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic stone extraction . Methods From October 2014 to August 2015, 58 patients with CBD stones received ENBD after endoscopic stone extraction .Ultrasound examination was performed on the 1-5 postoperative days .After routine examination by a professional ultrasound doctor , a total of 50-200 ml saline was injected through ENBD slowly at a rate of 100 ml/min.Ultrasonic results, including changes of bile duct diameter and detection rate of CBD residual stones , were compared before and after the injection . Results All the 58 patients were given ENBD cholangiography after endoscopic stone extraction .Among them, CBD residual stones were detected positive in 3 patients and negative in 55 patients by ENBD cholangiography .Among the 55 patients, CBD residual stones were detected in 1 patient by routine ultrasound which was confirmed after injection .Among the other 54 patients who were not detected stones by routine ultrasound , failure of injection occurred in 1 patient due to the damage of ENBD , and 2 patients showed bad tolerance of abdominal pain after injection of 20 ml saline and 3 patients were detected CBD residual stones after injection .While the other 48 patients were negative with CBD residual stones.For the 3 patients who were detected residual stones by cholangiography , routine ultrasound showed negative results but stones were detected after injection .Stone removal was achieved in 5 patients.The Youden index for CBD residual stones by saline injection through ENBD under ultrasound was 0.98, which was higher than cholangiography (0.4) and routine ultrasound (0.2).Among the 57 patients who underwent injection , obvious dilation of the diameter and length of the CBD was observed after injection in 56 patients (P<0.05). Conclusions For patients with ENBD, observing CBD residual stones by saline injection through ENBD under ultrasound has advantages of non-invasion, non-radiation, inexpensive cost , repeatedly checking and dynamic observation .It has a very important reference value in diagnosing CBD stones and proposes a new examination .
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Objective To investigate the application value of percutaneous sinus-tract cholangioscopy in the diagnosis and treatment of residual intra-and extra-hepatic bile duct stones.Methods The retrospective cross-sectional study was conducted.The clinical data of 1 045 patients with intra-and extra-hepatic bile duct stones who underwent percutaneous sinus-tract cholangioscopy or stone extraction in the Second Affiliated Hospital of Zhejiang University from January 2003 to June 2016 were collected.Patients received percutaneous sinus-tract cholangioscopy or stone extraction at 6-8 weeks after T tube drainage.Observation indicators:(1) diagnosis and stone extraction situstions:cases with residual stones,stone extraction frequency and clearance rate;the critics of clearance rate are no residual stone dnring operation combined with B ultrasound or T-tube cholangiography;(2) postoperative complications:incidence and management of postoperative complications,prognosis and ClavienDindo classification for postoperative complication;(3) follow-up situation.T-tube was removed when there was no residual stone.Patients were followed up by outpatient examination up to April 2017.B ultrasound reexamination was performed to detect the recurrence of stone once every 3-6 months.Results (1) Diagnosis and stone extraction situstions:among 1 045 patients,results of cholangioscopy showed 147 wihout bile duct stones and 898with bile duct stones.Of 898 patients,2 618 times cholangioscopic explorations for stone extraction were performed,with a maximum frequency of 16 times,and 851 had stones clearance,with a overall clearance rate of 94.77％(851/898).The clearance rates of extra-and intra-hepatic bile duct stones were 100.00％(221/221) and 93.06％(630/677).Of 47 patients with residual stones,16 didn't receive cholangioscopy due to branches stricture or occlusion of intrahepatic duct,13 failed to take out stone due to T-tube dislodgement (9 cases) and improper placement (4 cases) induced closed T-tube sinus tract,7 had T-tube sinus tract duodenal fistula,6 gave up stone extraction,3 was due to longer sinus tract induced bending and 2 was due to T-tube sinus tract fracture.(2)Postoperative complications:among 1 045 patients,297 had level Ⅰ-Ⅱ mild complications and 13 had level Ⅲand above severe complications.The common complications included fever,vomiting,diarrhea and so on;the special complications included T-tube sinus tract duodenal fistula of 13 patients,T-tube sinus tract fracture of 4 patients,rupture of broken stones pole of 3 patients,massive hemobilia of 2 patients,acute pancreatitis of 2patients and cardiac arrest of 1 patient.The above complications were improved by symptomatic and supportive treatments.(3) Follow-up situation:among 1 045 patients,558 received long-term follow-up,with follow-up time of 10-171 months and a median time of 79 months.Eight-four patients had stone recurrence.Of 13 patients with recurrence of extrahepatic bile duct stones,7 took out stones by endoscopic retrograde cholangio pancreatography (ERCP) and 6 underwent reoperations.Of 71 patients with recurrence of intrahepatic bile duct stones,43underwent reoperations and 28 received conservative treatment.Conclusions Percutaneous sinus-tract cholangioscopy for residual intra-and extra-hepatic bile duct stones is safe and effective,with good diagnosis and treatment values and a high clerance rate.The integrity of T-tube sinus-tract is a key of complete stones removal.
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Objective:To study the curative effect of standard channel (percutaneous nephrolithotomy) PCNL combined with ultrasonic pneumatic lithotripsy in the treatment of upper urinary tract calculi under the guidance of ultrasound, and analyze the influence factors of post-operative residual calculi.Methods: The data of 94 patients with upper urinary tract calculi were researched by using retrospective analysis. All of patients underwent the treatment of standard channel PCNL combined with ultrasonic pneumatic lithotripsy for upper urinary tract calculi under the guidance of ultrasound. The curative effects of upper ureteral calculi, pelvis calculi, multiple renal calculi, kidney stone with ureteral calculi and renal staghorn calculi were observed, and the post-operative complications were further detected so as to grasp the situation of residual calculi and calculate the clearance rate of calculus. The difference of general documents between patients with residual calculi and those without residual calculi were compared, and the influence factors of residual calculi were analyzed by using Logistic regression equation.Results:The incidence of post-operative complication was 27.66%, the clearance rate of calculus was 67.2% and residual rate of calculus was 32.98%. The differences of location puncture time, establishing channel time and ostomy fistula time among the five kinds of patients were no significant (F=1.89,F=2.46, F=0.91,P>0.05). While the differences of calculus removed time, amount of bleeding in intra-operative period and length of stay among various kinds of patients were significant (F=81.90,F=35.84,F=4.17,P<0.05). Depended on the results of Logistic regression equation, the types of calculus, size of calculus, hydronephrosis, urinary tract infection and renal insufficiency were the influence factors of post-operative residual calculus of patients with upper urinary tract calculi who received the treatment of PCNL combined with ultrasonic pneumatic lithotripsy.Conclusion: PCNL combined with ultrasound pneumatic lithotripsy under the guidance of B ultrasound without major complications has better curative effect, and its clearance rate of calculus is higher. Besides, the types of calculus, size of calculus, hydronephrosis, urinary tract infection and renal insufficiency can increase the incidence of post-operative residual calculus and affect the curative effect.
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Objective To observe and assess the effect about bundles of cure Rule of three three in the treatment for residual stones after Flexible Ureteroscope.Methods 120 patients with a single stone after urinary lithotripsy were divided into two groups according to the different indwelling time.Two cases of the control group were rejected because of severe hematuria.The control group (n=58) was subjected to the regular education (drinking water 3 000 ml per day with moderate exercise);The experiment group (n=60) was subjected to the Rule of three three (drinking 3 cups of water in thc morning、midday and night,with contralateral position 30 minutes,hot towel applying and gently tapping the kidney region 30 minutes).Results The calculi discharge rate and the net rate of experiment group [86.67％ (52/60),55.00％ (33/60)] were higher than the control group [53.45％(32/58),18.97％(11/58)] 14 days after surgery.The difference was statistically significant (P ＜ 0.01).Further analysis showed that the discharge rate of residual stones in lower renal calyx in experiment group [86.67％(26/30)] was higher than the control group [32.14％(9/28)].The difference was statistically significant (P ＜ 0.01).Conclusions The bundles of cure called rule of three three can improve the discharge rate of residual calculi after flexible ureteroscope and increase the discharge rate of residual stones in lower renal calyx significantly.
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OBJECTIVE:To observe therapeutic efficacy of Sanjin granules in the treatment of residual stones after extracorpo-real shock wave lithotripsy(ESWL). METHODS:72 patients with residual stones after ESWL were selected and randomly divided into group A and B with 36 cases in each. Patients in group A were given Sanjin granules with warm water,2 times/d,20g/time;B group were treated with conventional therapy as drinking more water combined with jumping movement. Therapeutic efficacies of two groups were observed after 4 and 8 weeks of treatment. RESULTS:After 4 weeks treatment,the total effective rate was 33.33% in group A and 13.89% in group B,there was statistically significant difference(P<0.05);After 8 weeks treatment,the total effective rate was 63.89% in group A and 19.44% in group B,there was statistically significant difference(P<0.05). CON-CLUSIONS:Sanjin granules can pass the residual gallstones after ESWL effectively,showing a significant therapeutic efficacy.
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Objective To investigate factors affecting residual stones in pediatric patients with the upper urinary calculi un ‐dergoing minimally invasive percutaneous nephrolithotomy (MPCNL ) and evaluate MPCNL curative effect before the operation . Methods A total of 240 children underwent MPCNL to remove the upper urinary calculi in People′s Hospital of Xinjiang Uygur Autonomous Region during the period of January 2009 to November 2014 were analyzed retrospectively .Pediatric patients were di‐vided into two groups by the stone‐free rate after the first operation :those who were stone‐free after the first operation (n= 202) as the control group and those who were residual stones (n= 38) as residual stones observation group .Then the clinical data were sta‐tistically analyzed and find out risk factors which lead to residual stone .Results The stone‐free rate after primary M PCNL was 84 . 2% (202/240) .Univariate analysis showed that stone size (P= 0 .001) ,stone location(P= 0 .014) and number of stones(P= 0 .005) were significant factors which could affect residual stones between the two groups ,while did not relate with gender ,age ,stone side , urinary irritation symptom ,hematuria ,renal colic ,preoperative infection and the degree of hydronephrosis (P > 0 .05) .Multivariate analysis showed that stone size(OR = 2 .593 ,95% CI :1 .228 - 5 .475) ,stone location(OR = 2 .674 ,95% CI :1 .290 - 5 .540)and num‐ber of stones(OR = 2 .397 ,95% CI :1 .145 - 5 .019)were independent predictors of the surgical outcome .Conclusion Stone size , stone location and number of stones are significant factors affecting residual stones in pediatric patients with the upper urinary cal ‐culi undergoing MPCNL .According to the the clinical features of pediatric patients ,we can chose suitable management of upper uri‐nary tract calculi .
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Se realizo un análisis retrospectivo en 5754 protocolos de CPRE seleccionando aquellos cuyo diagnóstico endoscópico fue la litiasis biliar. Quedaron para su estudio un total de 1878 protocolos de CPRE (33%), 947 (50%) eran portadores de litiasis residual del colédoco, 675 (36%) tenían litiasis coledociana con vesícula en situ y 256 (14%) presentaban solamente litiasis vesicular. 1118 (69%) pertenecían al sexo femenino, 504 (31%) al masculino. Se les realizo esfinterotomía endoscópica como proceder básico a 1377 (84,9%), de ellos, 1359 (99,87%) se les realizo extracción de los cálculos, 164 (11,9%) necesitaron colocación de endoprótesis en la VBP, 67 (4,13%) del total de 1622 pacientes se les realizó pre-corte de tipo terapéutico y a 22 (1,35%) de tipo diagnóstico. A 28 (1,7%) enfermos se les realizo litotricia mecánica y a 11 (0,67%) se les dejo colocada una sonda nasobiliar como solución paliativa. Presentamos un total de 39 complicaciones de 1622 CPRE terapéuticas analizadas (2,40%), de ellas 15 fatales. Se concluye que la esfinterotomía es un proceder eficaz en la solución de la litiasis biliar, pero no está exenta de riesgos...
A retrospective analysis was conducted in 5754 ERCP protocols; selecting those of whose endoscopic diagnosis was biliary lithiasis. A total of 1878 protocols of ERCP (33%) were left for study; 947 (50%) had residual lithiasis of the common bile duct, 675 (36%) had common bile duct stones with gallbladder in situ and 256 (14%) had only biliary lithiasis. 1118 (69%) were female and 504 (31%) were men. Endoscopic sphincterotomy was performed as a basic procedure to 1377 (84.9%), of which, 1359 (99.87%) underwent stone removal, 164 (11.9%) required endoprosthesis in the Principal Biliary Tree (abbreviated to VBP in Spanish) 67 patients (4.13%) and 22 (1.35%) of a total of 1622 patients, underwent therapeutic and diagnostic pre-cut, respectively. Mechanical lithotripsy was conducted in 28 (1.7%) patients and a nasobiliary stent was left in place on 11 (0.67%) patients as a palliative solution. We present a total of 39 complications of 1622 therapeutic ERCP analyzed (2.40%), of which, 15 were fatal. It is concluded that sphincterotomy is an effective procedure in the solution of biliary lithiasis, but is not risk exempted...
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Humans , Male , Adult , Female , Middle Aged , Lithiasis/surgery , Lithiasis , Sphincterotomy, Endoscopic , Gastroenterology , Gastrointestinal DiseasesABSTRACT
Objective To observe the effect of extraeorporeal shock wave lithotripsy (ESWL) on residual stones after different methods of surgery. Methods Clinical resources of 100 patients with residual stones after different methods of surgery treated with extracorporeal shock wave lithotripsy from May 2006 to May 2008 were retrospeetively studied. Of the 100 patients, ureteroscopic laser lithotripsy was used for 15 patients (Group Ⅰ) , ureteroscopic pneumatic lithotripsy was used for 25 (Group Ⅱ), mini-percutaneous nephrolithotomy (MPCNL) with holmium laser for 11 (Group Ⅲ), mini-percutaneous nephrolithotomy (MPCNL) with airpressure path lithotripterfor 12 (Group Ⅳ) , open surgery for the other 37 (Group Ⅴ). Results About 94% of the residual stones were shattered, and 86 % of the residual stones were cleared successfully. The clearance rate of residual stones from Group Ⅰ to Ⅴ was 100% , 100% , 81.8% , 83.3% , and 73.0% , respectively. The clearance rate of residual stones in Group Ⅰ + Ⅱ was higher than that of Group Ⅲ + Ⅳ and Group V (P<0.05). Conclusion Extracorporeal shock wave lithotripsy is good for the treatmentof residual stones after different methods of surgery, especially the management of residual stones after trans-urethral ureteroscope technique.
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Objective To evaluate the treatment of postoperative bile-duct residual stones with rigid cholangioscopy. Methods Three hundred and twenty-seven cases of bile duct residual stones were treated with rigid cholangioscopy. As a route for the rigid cholangioscopy, the T-tube tract (315 cases), the U-tube tract (5 cases) and the jejunostomy tube tract of efferent limb (7 cases) were used. Results Four hundred and eighty-six rigid cholangioscopic sessions were carried out, 1.5 sessions on the average for each patient. Treatment was successful in all but one patient in whom rigid cholangioscopic access to bile duct was difficult since the T-tube tract was too long. The rate of complete removal of the stones was 95.4%. There were no serious complications. Conclusions It′s possible to pass the instrument into the common bile duct and the majority of the intrahepatic bile duct. Many of the problems associated with residual stones can be overcome by this method and good results achieved. This technique seems to be a useful new alternative in patients with difficult retained bile duct stones.