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1.
Article in Chinese | WPRIM | ID: wpr-912168

ABSTRACT

To evaluate the application of laser lithotripsy under SpyGlass for difficult pancreatic duct stones. Data of patients who underwent laser lithotripsy under SpyGlass for difficult pancreatic duct stones from January 2018 to April 2020 in Shandong Provincial Third Hospital were collected. A total of 18 patients were included in the study and the number of endoscopic retrograde cholangiopancreatography (ERCP) performed on each patient was 1.5±0.7. The total operation success rate was 88.9% (16/18) and the number of SpyGlass lithotripsy was 1.3±0.4. The diameter of the stones was 13.17±3.69 mm and the number of stones was 1.70±0.74. Nine patients had stones located in the pancreatic head and 15 cases had stenosis of the proximal pancreatic duct. One case had post-ERCP pancreatitis. No bleeding, perforation or other complications occurred. The indwelling time of the pancreatic duct stent was 10.5±2.8 months, and the follow-up was 6-30 months. There was no recurrence of pancreatic duct stenosis or pancreatic duct stones. Laser lithotripsy under SpyGlass is safe and effective for difficult pancreatic duct stones.

2.
Int. braz. j. urol ; 46(6): 1010-1018, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134262

ABSTRACT

ABSTRACT Purpose To compare the effect of general anesthesia (GA) and regional anesthesia (RA) on f-URS outcomes and surgeon comfort. Material and Methods The study was conducted between June 2017 to January 2018 and data collection was applied in a prospective, randomized fashion. 120 patients participated in the study and were divided into RA group (n=56) and GA group (n=64). Demographic, operative and post-operative parameters of patients were analysed. The end point of this study was the effect of two anesthesia regimens on the comfort of the surgeon, and the comparability of feasibility and safety against perioperative complications. Results The study including 120 randomized patients, 14 patients were excluded from the study and completed with 106 patients (45 in RA group and 61 in GA group). No difference was detected between the two groups in terms of preoperative data. During the monitorization of operative vital signs, 3 patients in RA group experienced bradycardia, and this finding was significant when compared with GA group (p=0.041). Additionally, 2 patients in RA group experienced mucosal tears and 1 patient experienced hemorrhage during the operation, but no complications were observed in the GA group (p=0.041). Postoperative surgeon comfort evaluation revealed statistically significant results in favor of GA group (p=0.001). Conclusions Both GA and RA are equally effective and safe anesthesia methods for f-URS procedures. However, RA group showed significantly increased likelihood of bradycardia and mucosal injury during surgery, and significantly decreased surgeon comfort during surgery.


Subject(s)
Humans , Male , Female , Adult , Lithotripsy, Laser/adverse effects , Anesthesia, Conduction , Prospective Studies , Retrospective Studies , Treatment Outcome , Anesthesia, General , Middle Aged
3.
Journal of Clinical Hepatology ; (12): 2833-2836, 2019.
Article in Chinese | WPRIM | ID: wpr-778699

ABSTRACT

Acute suppurative cholangitis (ASC) is an acute infectious disease of the biliary tract caused by bacterial infection and biliary obstruction. Common bile duct stone is the most common cause of biliary obstruction. Due to the characteristics of rapid onset, rapid progress, various complications, and high mortality of ASC, it has attracted more and more attention in clinical practice. The treatment of ASC includes anti-infective therapy and relief of obstruction, and early relief of obstruction is the key to successful treatment. Endoscopic therapy has long been regarded as the first choice for the relief of obstruction, and with the development of medical technology, various new endoscopic techniques are gradually applied in the treatment of ASC and have thus become the new choices for surgeons and patients. With reference to the advantages and disadvantages of different treatment techniques, this article reviews the endoscopic therapies for ASC caused by common bile duct stones.

4.
Article in Chinese | WPRIM | ID: wpr-711520

ABSTRACT

Objective To evaluate the clinical application value of SpyGlass DS cholangioscopy in diagnosis and therapy of patients with biliary tract diseases. Methods Seven patients with biliary tract diseases were examined and treated with SpyGlass DS system. Three patients with large choledocholithiasis underwent laser lithotripsy under SpyGlass DS system, and then the broken stones were removed by ERCP. Four patients with indeterminate bile duct stricture underwent SpyGlass DS examination and SpyGlass DS-guided biopsies if necessary.Results SpyGlass DS cholangioscopy was successfully performed in all patients with a mean procedure time of 12. 6 min. Complete stone clearance was achieved in 3 patients with large biliary stones. Of the 4 patients with indeterminate biliary stricture, 2 underwent SpyGlass DS-guided biopsies and were diagnosed as malignant biliary tumor; the other 2 patients were diagnosed as inflammatory bile duct stenosis after visualizing the target lesions without biopsy. Two patients developed hyperamylasemia after the procedure, and recovered spontaneously. Conclusion SpyGlass DS cholangioscopy can provide accurate diagnosis in indeterminate biliary strictures and facilitate therapy in patients with challenging biliary stones.

5.
Acta cir. bras ; 32(7): 550-558, July 2017. tab, graf
Article in English | LILACS | ID: biblio-886220

ABSTRACT

Abstract Purpose: To evaluate whether low energy shock wave preconditioning could reduce renal ischemic reperfusion injury caused by renal artery occlusion. Methods: The right kidneys of 64 male Sprague Dawley rats were removed to establish an isolated kidney model. The rats were then divided into four treatment groups: Group 1 was the sham treatment group; Group 2, received only low-energy (12 kv, 1 Hz, 200 times) shock wave preconditioning; Group 3 received the same low-energy shock wave preconditioning as Group 2, and then the left renal artery was occluded for 45 minutes; and Group 4 had the left renal artery occluded for 45 minutes. At 24 hours and one-week time points after reperfusion, serum inducible nitric oxide synthase (iNOS), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), creatinine (Cr), and cystatin C (Cys C) levels were measured, malondialdehyde (MDA) in kidney tissue was detected, and changes in nephric morphology were evaluated by light and electron microscopy. Results: Twenty-four hours after reperfusion, serum iNOS, NGAL, Cr, Cys C, and MDA levels in Group 3 were significantly lower than those in Group 4; light and electron microscopy showed that the renal tissue injury in Group 3 was significantly lighter than that in Group 4. One week after reperfusion, serum NGAL, KIM-1, and Cys C levels in Group 3 were significantly lower than those in Group 4. Conclusion: Low-energy shock wave preconditioning can reduce renal ischemic reperfusion injury caused by renal artery occlusion in an isolated kidney rat model.


Subject(s)
Animals , Male , Rats , Renal Artery Obstruction/complications , Short-Wave Therapy/methods , Reperfusion Injury/etiology , Reperfusion Injury/therapy , Ischemic Preconditioning/methods , Kidney/blood supply , Rats, Sprague-Dawley , Disease Models, Animal
6.
Chinese Journal of Surgery ; (12): 751-754, 2017.
Article in Chinese | WPRIM | ID: wpr-809373

ABSTRACT

Objective@#To explore the clinical effects of retroperitoneal laparoscopic ureterolithotomy (RPLU) and flexible-ureteroscopic holmium laser lithotripsy (f-UHLL) for complicated upper ureteral calculi.@*Methods@#A total of 45 cases of complicated upper ureteral calculi between March 2014 and January 2016 in Department of Urology, Affiliated Jiangyin Hospital of Southeast University Medical College were retrospectively analyzed, there were 32 males and 13 females, ranging from 27 to 45 years with an average age of (34.1±9.5) years. Of the 45 patients, 28 had ureteral distortion and 17 had concurrent ureteral stones in the lower or middle ipsilateral ureter. In those patients, 20 cases underwent f-UHLL, and 25 cases received RPLU. The stone size, operation time, hospital stay, stone clearance rates and postoperative fever rates between the two groups were compared with t test and χ2test.@*Results@#The operation was successfully performed in all patients, no complications with leakage of urine or ureteral perforation occurred, and no significant difference in renal function between the two methods were founded in postoperative period. There was no significant difference in operation time((78.4±8.5) minuetes vs.(73.3±11.3) minuetes, t=0.61, P=0.67), time of double J tube removed ((33.8±3.4)days vs. (37.6±8.9) d, t=2.37, P=0.08) and ipsilateral renal glomerular filtration rates ((41.3±7.6)ml/minuetes vs.(40.5±7.1) ml/min, t=0.78, P=1.27) between the two groups. However, the hospitalization time ((5.9±1.7)days vs. (4.2±1.6) days, t=1.92, P=0.04), postoperative fever rates (4% vs.30%, χ2=5.72, P=0.03) and calculus clearance rates (100% vs. 75%, χ2=7.03, P=0.01) in RPLU were significantly higher than f-UHLL. Besides, 5 patients in the f-UHLL group had postoperative stone residue and were treated with extracorpore shock wave lithotripsy.@*Conclusions@#Both RPLU and f-UHLL are safety and validity for complex upper ureteral calculi. RPLU can improve the rate of calculus removal and reduce the rate of postoperative fever.

7.
Chinese Journal of Urology ; (12): 371-374, 2017.
Article in Chinese | WPRIM | ID: wpr-610024

ABSTRACT

Objective To evaluate the effect of one step flexible ureteroscopic lithotripsy for incarcerated upper ureteral calculi.Methods The clinical data of 80 cases of incarcerated upper ureteral calculi were retrospectively analyzed between August 2015 and September 2016.Theone step flexible ureteroscopic lithotripsy was used in 40 cases (one step group),including 22 male cases and 18 female cases.The average age was (40.0 ± 9.5) years.The maximal stone diameter was (i.8 ± 0.5) cm.The widest width of the ureter above the stone was (2.5 ± 1.1) cm.The CT value of stone was (1 089.0 ± 111.3) HU.Two step method was used in 40 cases (two step group),including 21 male cases and 19 female cases.The average age was (41.0 ± 10.7).The maximal stone diameter was (1.7 ± 0.6)cm.The widest width of the ureter above the stone was (2.3 ± 0.9) cm.The CT value of stone was (1 002.0 ± 97.2) HU.During the one step flexible ureteroscopic lithotripsy,only flexible ureteroscope was used to crush the stone,no matter whether the stone located in the ureter or return to the renal pelvis.During two stepmethod,the rigid ureteroscopy was firstly used for crushing the stone in the ureter.When the stone return to the renal pelvis,the rigid ureteroscopy was change into flexible ureteroscope for continuous crushing the stone.Compared two groups' operating time,2 weeks stone clearance rate and the cases of fever after operation.Results The mean operative time in the one step group was (37.45 ± 11.34) min.The mean operative time in the two step group was (55.07 ± 13.57) min.The difference was statistically significant (P < 0.05).The number of infection 2 cases in one step group and 9 cases in two step group.The difference was statistically significant (P < 0.05).2 weeks stone clearance rate was 87.5% (35/40) in one step group and 82.5% (33/40)in two step group.There was no significant difference between two groups.Conclusions Flexible ureteroscope one step method is a safe and effective alternation for incarcerated upper ureteral calculi.

8.
Article in Chinese | WPRIM | ID: wpr-606962

ABSTRACT

Objective To evaluate the feasibility and safety of direct peroral cholangioscopy (DPCS) by freehand intubation using routine straight-view endoscope for diagnosis and therapy of biliary diseases.Methods Patients with unexplained choledochal stenosis and choledocholithiasis underwent standard ERCP.Native papilla was dilated using endoscopic papillary large balloon dilation (EPLBD)according to the size of papilla and the diameter of common bile duct.DPCS was performed using routine straight-view endoscope,and biopsy or laser lithotripsy was performed according to imaging of DPCS.General data of patients,procedure of ERCP,diagnosis of DPCS,and complications were recorded.Serum amylase after 2 hours and 24 hours,total bilirubin,direct bilirubin,leukocyte count,neutrophilic granulocyte percentage,and C-reactive protein were measured.Results A total of 15 patients underwent DPCS,including 5 cases of huge common bile duct stones and 10 cases of common bile duct stricture.The diameter of common bile duct ranged from 1.5 cm to 2.5 cm.Single EPLBD was required in 3 cases,endoscopic sphincteropapillotomy and EPLBD was required in 12 cases to facilitate DPCS.DPCS was successfully completed in 14 cases,including 11 cases in distal common bile duct,3 cases in proximal common bile duct.Among the 14 cases,4 cases used ordinary gastroscope,and 10 cases used ultrathin gastroscope.Laser lithotripsy was successfully completed in 4 choledocholithiasis patients.DPCS was successfully completed in 9 patients of common bile duct stenosis.The reasons of stenosis included 5 calculi,2 normal,1 scar and 2 adenoma.There were 1 case of cholangitis and 4 cases of hyperamylasemia after operation.No procedure related death occurred.Conclusion Freehand DPCS using ordinary gastroscope or ultrathin gastroscope is feasible and safe,and may be clinically useful for diagnosis and therapy of unexplained choledocholithiasis and common bile duct stenosis.

9.
Article in Chinese | WPRIM | ID: wpr-509201

ABSTRACT

Objective To analyze the clinical effect of minimally invasive percutaneous nephrolithotomy titanium laser lithotripsy(MPCNL)on upper ureteral calculi.Methods According to digital table,68 patients with upper ureteral calculi were randomly divided into the study group and control group,cach group in 34 cases.The study group received the MPCNL treatment,the control group received extracorporeal shock wave lithotripsy(ESWL)therapy. The therapeutic effects were compared.Results The success rate of gravel,stone clearance rates of the study group were 91 .1 8% and 91 .1 8%,which were higher than 70.59%,67.65% of the control group,there were significant differences between the two groups(χ2 =4.660,5.757,P =0.031 ,0.0164).Conclusion Percutaneous nerve titanium laser lithotripsy for upper ureteral stones can achieve good therapeutic effect.

10.
Chongqing Medicine ; (36): 3917-3919, 2017.
Article in Chinese | WPRIM | ID: wpr-658561

ABSTRACT

Objective To evaluate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) combined with holmium laser for the concurrent treatment of bilateral upper ureteral tract calculi.Methods The clinical data in 43 patients with bilateral upper ureteral tract calculi concurrently treated by FURL combined with holmium laser in our hospital from September 2014 to November 2016 were retrospectively analyzed.All cases conducted CT scanning before operation.The flexible ureteroscope was intraoperatively placed and the lithotripsy was conducted by using 200 μm optical fiber at a power of 0.8-1.0 J/10-20Hz,which was coordinated by reticular basket.After lithotripsy,bilateral urethral stents were placed.KUB or CT was re-examined on postoperative 1 d.The cases of residual stone were performed KUB again after removing urethral stent after 4-6 weeks.Results All cases were successfully placed the flexible ureteroscope by one time.The mean operation time was (101.5±37.2) min and the overall stone-free rate (SFR) was 81.4 % (35/43).SFR was 100% in the patients with the stone burden less than 30 mm and 63.2% in the patients with the stone burden ≥30 mm,the difference was statistically significant(P<0.05).One case appeared fever (39.5 ℃) after operation,1 case developed subcapsular renal hematoma and no other severe complications occurred.Conclusion FURL combined with holmium laser is an effective means to concurrently treating bilateral upper ureteral calculi,especially for the patients with stone burden <30 mm,which has higher stone clearance rate with good safety.

11.
Chongqing Medicine ; (36): 3917-3919, 2017.
Article in Chinese | WPRIM | ID: wpr-661480

ABSTRACT

Objective To evaluate the effectiveness and safety of flexible ureteroscopy lithotripsy (FURL) combined with holmium laser for the concurrent treatment of bilateral upper ureteral tract calculi.Methods The clinical data in 43 patients with bilateral upper ureteral tract calculi concurrently treated by FURL combined with holmium laser in our hospital from September 2014 to November 2016 were retrospectively analyzed.All cases conducted CT scanning before operation.The flexible ureteroscope was intraoperatively placed and the lithotripsy was conducted by using 200 μm optical fiber at a power of 0.8-1.0 J/10-20Hz,which was coordinated by reticular basket.After lithotripsy,bilateral urethral stents were placed.KUB or CT was re-examined on postoperative 1 d.The cases of residual stone were performed KUB again after removing urethral stent after 4-6 weeks.Results All cases were successfully placed the flexible ureteroscope by one time.The mean operation time was (101.5±37.2) min and the overall stone-free rate (SFR) was 81.4 % (35/43).SFR was 100% in the patients with the stone burden less than 30 mm and 63.2% in the patients with the stone burden ≥30 mm,the difference was statistically significant(P<0.05).One case appeared fever (39.5 ℃) after operation,1 case developed subcapsular renal hematoma and no other severe complications occurred.Conclusion FURL combined with holmium laser is an effective means to concurrently treating bilateral upper ureteral calculi,especially for the patients with stone burden <30 mm,which has higher stone clearance rate with good safety.

12.
Int. braz. j. urol ; 42(6): 1178-1182, Nov.-Dec. 2016. tab
Article in English | LILACS-Express | LILACS | ID: biblio-828939

ABSTRACT

ABSTRACT Objective: To analyse outcomes of holmium laser and pneumatic lithotripsy in treatment of lower ureteric calculus in pediatric patients. Materials and methods: Prospective study conducted between August 2013 and July 2015. Inclusion criteria were lower ureteric calculus with stone size ≤1.5cms. Exclusion criteria were other than lower ureteric calculus, stone size ≥1.5cms, congenital renal anomalies, previous ureteral stone surgery. Patients were divided into two groups. Group A underwent pneumatic and group B underwent laser lithotripsy procedure. Patient's baseline demographic and peri-operative data were recorded and analysed. Post operatively X-ray/ultrasound KUB (Kidney, ureter and bladder) was performed to assess stone free status. Results: A total of 76 patients who met the inclusion criteria to ureteroscopic intracorporeal lithotripsy were included. Group A and B included 38 patients in each. Mean age was 12.5±2.49 in Group A and 11.97±2.74 years in Group B respectively (p=0.38). Overall success rate was 94.73% in Group A and 100% in Group B, respectively (p=0.87). Conclusion: Holmium Laser lithotripsy is as efficacious as pneumatic lithotripsy and can be used safely for the endoscopic management of lower ureteric calculus in pediatric patients. However, holmium laser requires more expertise and it is a costly alternative.

13.
Int. braz. j. urol ; 42(3): 479-486, tab
Article in English | LILACS | ID: lil-785743

ABSTRACT

ABSTRACT Purpose The aim of this study was to describe the outcomes and the complications of retrograde intrarenal surgery (RIRS) for renal stones in a multi-institutional working group. Materials and Methods From 2012 to 2014, we conducted a prospective study including all RIRS performed for kidney stones in 4 European centers. Demographic information, disease characteristics, and perioperative and postoperative data were gathered. Patients and stone data, procedure characteristics, results and safety outcomes were analyzed and compared by descriptive statistics. Complications were reported using the standardized Clavien system. Results Three hundred and fifty-six patients underwent 377 RIRS with holmium laser lithotripsy for renal stones. The RIRS was completed in all patients with a mean operative time of 63.5 min. The stone-free status was confirmed endoscopically and through fluoroscopic imaging after the first procedure in 73.6%. The second procedure was performed in twenty patients (5.6%) achieving an overall stone free rate of 78.9%. The overall complication rate was 15.1%. Intra-operative and post-operative complications were seen in 24 (6.7%) and 30 (8.4%) cases, respectively. Conclusions RIRS is a minimally invasive procedure with good results in terms of stone-free and complications rate.


Subject(s)
Humans , Male , Female , Adult , Aged , Kidney Calculi/surgery , Lithotripsy, Laser/methods , Ureteroscopy/instrumentation , Ureteroscopy/methods , Ureteroscopes , Postoperative Complications , Fluoroscopy/methods , Prospective Studies , Reproducibility of Results , Treatment Outcome , Lithotripsy, Laser/instrumentation , Ureteroscopy/adverse effects , Equipment Design , Europe , Operative Time , Length of Stay , Middle Aged
14.
Journal of Clinical Hepatology ; (12): 2138-2140, 2016.
Article in Chinese | WPRIM | ID: wpr-778370

ABSTRACT

ObjectiveTo investigate the value of cold laser combined with choledochoscopy in the treatment of residual stones after biliary surgery. MethodsA retrospective analysis was performed for the clinical data of 79 patients with residual stones after biliary surgery who were admitted to Fuzhou General Hospital of Nanjing Military Area Command from January 2015 to June 2016. All the patients underwent cold laser combined with choledochoscopy at 6 weeks after surgery. The cure rate and complications were observed. ResultsAll the patients underwent successful lithotripsy, and the cure rate was 100%. Of all the patients, 68 did not experience any postoperative complication, 7 experienced abdominal distension, abdominal pain, and diarrhea, which achieved spontaneous remission after observation, and 4 experienced fear of cold and chill, which were improved after symptomatic treatment. No patients experienced serious complications, such as bile duct injury, biliary tract perforation, bile leakage, and hematobilia. ConclusionCold laser combined with choledochoscopy has a good effect, a high level of safety, and good repeatability in the treatment of residual stones after biliary surgery; therefore, it holds promise for clinical application.

15.
Chinese Journal of Urology ; (12): 932-935, 2016.
Article in Chinese | WPRIM | ID: wpr-506393

ABSTRACT

Objective To investigate the clinical efficacy of inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope.Methods From March 2013 to July 2015,there were 68 patients accepted a ureteral access sheath in flexible ureteroscopy with the help of rigid ureteroscope for the treatment of kidney stones.There were 46 cases male,22 cases female,aged from 22 to 76 years old,average 43.9 years.There were 68 cases with backaches or hematuria.There were 48 cases with single stone,20 patients with multiple stones.There were 5 cases with stones on both sides.The stone diameter were from 1.2 to 2.5 cm,the average (1.83 ± 0.16) cm.There was no hydronephrosis in 18 cases,mild hydronephrosis 42 cases.The operations were carry out under general anesthesia.By using rigid ureteroscope placed zebra guidewire,then intercept F8 single lumen tip to 1.0 cm section on rigid ureteroscope,was placed into a modified 42 cm ureteral access sheath.Then the modified 42 cm ureteral access sheath was inserted under direct view with the help of rigid ureteroscope.Preoperative patient characteristics,radiographic stone size,operation time,success rate of lithotripsy,serious complications especially ureteral injury was recorded.4 weeks and 12 weeks after operation,ultrasound and/or CT were reexamined to assess the success rate of lithotripsy and the incidence ureteral stricture.Results All the procedures were successful.The operation time was (62.2 ± 6.5)min,the hospital stay was (3.1 ± 0.2) d.The success rate of ureteral access sheath completely placement was 97.1%,partially placement was 2.9%.Postoperative complications included Clavien classification grade Ⅰ 6 cases and grade II 2 cases.The postoperative follow-up averaged (12 ± 1.2) months for all case.The success rate of lithotripsy was 76.5% in 4 weeks postoperative,and it was 95.6% in 12 weeks.During the follow-up,compared with the preoperative cases,62 cases were not found to increase the degree of hydronephrosis.There were 58 cases (58/62) without hydronephrosis.4 cases were mild hydronephrosis (4/62).CT showed normal ureter 52 cases (52/52).Conclusions It was safe and reliable procedure with good results.It would be a safe procedure to inserting a ureteral access sheath under direct view in flexible ureteroscopy with the help of rigid ureteroscope.

16.
Chinese Journal of Urology ; (12): 923-927, 2016.
Article in Chinese | WPRIM | ID: wpr-506391

ABSTRACT

Objective To analyze the risk factors that affect severe infection following flexible ureteroscope Holmium laser lithotripsy for upper urinary tract calculus,and to construct the regression model and nomogram for predicting the probability of postoperative SIRS.Methods We retrospectively analyzed the clinical data from 457 cases (male 302 and female 155) of upper urinary calculi treated by flexible ureteroscopy from January 2014 to May 2016,with mean age of 49.9 (ranged 20-76) years.The mean maximum size of stones was (16.5 ± 3.0) mm (ranged 12-22rmm).There were 51 cases (11.2%) with a recent infectious febrile history related to stones.The patients were divided into two groups as patients developing SIRS or not.Univariate and multivariate statistical analyses were performed to determine factors affecting the development of postoperative SIRS,and then a nomogram was built based on regression coefficients.Results The incidence of SIRS after flexible ureteroscopic lithtripsy was 5.9% (27/457).Multivariable logistic regression analysis identified febrile history related to urinary stones (OR =1.5569,P =0.009),without preoperative placement of ureteral stent (OR =1.4004,P =0.004),small-caliber (F 13-14) ureteral access sheath (OR =1.1120,P =0.016),endoscopic signs of infection (OR =2.0176,P =0.000) and infectious stones (OR =1.0981,P =0.013) as independent risk factors for postoperative SIRS.The concordance index was 0.845 in the nomogram model sample and 0.79 in the validation sample.Conclusions Febrile history related to urinary stones,without preoperative placement of ureteral stent,small-caliber ureteral access sheath,endoscopic signs of infection and infectious stones would be independent risk factors to predict SIRS after flexible ureteroscope holmium laser lithtripsy.A nomogram based on perioperative clinical factors could be used to predict the risk of SIRS.

17.
Article in Chinese | WPRIM | ID: wpr-495459

ABSTRACT

Objective To evaluate the clinical effects of block calculus extraction catheter in the ureteroscopic lasertripsy. Methods Two hundred and thirty patients with ureter calculus were enrolled. Ninety-six patients were treated with block calculus extraction catheter (test group), and 134 patients were treated without block calculus extraction catheter (control group). The patients in 2 groups were treated with holmium laser ureteroscopic lithotripsy of Lumenis PowerSuite60W, and the treatment effectiveness was compared. Results The operation time and primary stone clearance rate in test group were significantly better than those in control group: (23.3 ± 7.4) min vs. (35.6 ± 11.1) min, 98.92%(92/93) vs. 88.89%(112/126), and there were significantly differences (P 0.05). Conclusions The block calculus extraction catheter is very useful and safe in preventing the calculus shift, shortening the operation time and improving the calculus elimination rate .

18.
Article in Chinese | WPRIM | ID: wpr-493505

ABSTRACT

Objective To explore the application value of MSCT 3D reconstruction technique in flexible ureteroscopy and holium laser lithotripsy (FURL) for subrenal calyx calculus. Methods Data of 67 subrenal calyx calculus patients treated with FURL were analyzed retrospectively. The anatomic difference between surgically cured group and uncured one was compared by measuring the renal pelvis subrenal calyx infundibulopelvic angle (IPA), the calyx width and length, as well as the minimum ratio of subrenal calyx neck width and calyx transverse diameter (minN/T) with MSCT 3D reconstruction technique. The anatomic structure factors that may impact the operative success rate were discussed. Results Among the 67 patients, 52 patients were cured and in cured group, and 15 patients were in uncured group. The average IPA value in cured group was significantly higher than that in uncured group:(54.12 ± 21.32)° vs. (42.12 ± 22.68)° , and there was significantly difference (P<0.05). Twenty-six patients performed CT 3D reconstruction and IVU examination at the same time. The level of IPA in CT 3D reconstruction was significantly higher than that in IVU examination : (53.12 ± 10.16)° vs. (47.67 ± 11.25)° , and there was significant difference (t=1.676, P<0.05). Logistic regression analysis showed that IPA and minN/T levels were the influencing factors of FURL for subrenal calyx calculus. Conclusions The MSCT 3D reconstruction technique can better describe the anatomical relationship of the subrenal calyx. The success rate of FURL relates to the IPA value and the min N/T, which is significant in preoperative indication evaluation.

19.
Article in Chinese | WPRIM | ID: wpr-492709

ABSTRACT

Objective To evaluate the therapeutic effect and application value of laparoscopy combined with holmium laser in the treatment of intrahepatic and extrahepatic bile duct stones.Methods Retrospectively analyzed the clinical data of 22 cases with intrahepatic and extrahepatic bile duct stones who treated with laparoscopy choledo-choscopy combined with holmium laser lithotripsy(the observation group),and 21 cases who treated with laparoscopy combined with choledochoscopic lithotomy(the control group).The clinical curative effect was compared between the two groups.Results In the observation group,the residual stones completely removed in 21 cases(95.4%),the mean operation time was (130 ±13)min,the intraoperative bleeding volume was (85 ±20)mL,the average hospitali-zation time was (8.3 ±2.0)days,without conversion to open surgery,no incision infection,1 case had residual stones after operation,through T tube sinus tract choledochoscopy took a stone again.In the control group,took net calculi in 13 cases(61.9%),the average operation time was (135 ±20)min,the intraoperative hemorrhage volume was (70 ± 15)mL,the average hospitalization time was (14.5 ±2)days,6 cases converted to laparotomy,incision infection in 2 cases,8 cases had residual stones after operation,through T tube sinus combined with choledochoscopy again take stone,which 2 secondary mirror lithotomy in 6 cases,3 cases of 2 stones.The differences of the two groups in stone from the net rate,conversion rate,average hospitalization time were statistically significant(χ2 =2.203,2.897,t =4.293,P =0.033,0.006,0.017).The differences of mean operation time,intraoperative hemorrhage had were not statistically significant(t =1.176,1.629,P =0.246,0.111).Conclusion It is safe,effective and minimally invasive for the treatment of intrahepatic and extrahepatic bile duct stones with holmium laser combined with endoscopic holmi-um laser.

20.
Article in Chinese | WPRIM | ID: wpr-602408

ABSTRACT

Objective To investigate the clinical efficacy and related factors of holmium laser lithotripsy under ureteroscopy in treating mid -upper ureteral calculi.Methods The clinical data of 65 patients with mid -up-per ureteral calculi were retrospectively analyzed.Results The overall stone -free rate was 90.7% (59 /65 ). 4 weeks after operation,the stone -free rate was 94.9%(56 /59).The incidence rate of complications was 3.3%(2 /59).Stone size,hydronephrosis,ureteral stricture and twist,complicated with ureteral polypus were related to the success of lithotripsy(P =0.028).Conclusion Holmium laser lithotripsy under ureteroscopy in treating mid -upper ureteral calculi is safe and effective,improve surgical techniques and pay attention to cases screening may improve the success rate.

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