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Background: Shock wave lithotripsy (SWL) has revolutionized the treatment of renal stones. Clearance of stones after SWL depends upon a multitude of factors. The purpose of this study was to evaluate the effect of inferior calyceal anatomy on the stone clearance after SWL for renal stones. Methods: The study included a total 52 patients with age between 21 and 81 years admitted in our hospital with renal stones who were treated with SWL. The factors studied were- Infundibulo-pelvic angle (IPA), Infundibular length (IL), Infundibular width (IW) and their affect on stone clearance. Results: In the lower caliceal system three factors for stone clearance were studied; patients with an infundibulo-pelvic angle (IPA) of more than 89.3 degree had a statistically significant clearance as compared an angle less than that ( p=0.0000 ; 95% confidence interval [CI] , 0.774 to 1.1036 ); patients with an infundibular length (IL) of less than 26mm had a statistically significant clearance ( p=0.0004; 95% confidence interval [CI] , 0.616 to 0.0945 ); the infundibular width did not have a significant role in stone clearance in our study. Conclusion: In the lower calyceal system, the infundibulo-pelvic angle (IPA) and the infundibular length (IL) play a significant role in stone clearance.
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Objective To investigate the risk factors and countermeasure of residual stones after single‐channel percutaneous nephrolithotomy for higher stone‐free rate and better operation result .Methods All patients who underwent single‐channel percu‐taneous nephrolithotomy in our hospital from June 2011 to December 2013 were retrospected and the cause of residual stones were analyzed .Results There were 42 patients who had residual stones after operation among total 262 patients undergone single‐chan‐nel PCNL .21 patients had residual stones because the stones they burdened were too complex .7 patients were concerned with com‐plications such as intraoperative hemorrhage .The stone fragments scattered into the calices in 7 patients with overlarge stone during fragmentation .The other causes concerned with stone residue included anatomic structural abnormalities of the kidneys(3 patients) , operation itself inherent limitations(3 patients) ,insufficient practice and experience in operation(1 patients) .Conclusion The main causes concerned with residual stones of single‐channel PCNL are complexity of urinary calculi ,bleeding ,scattering of stone frag‐ments and anatomic structural abnormalities of the kidney .
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Hepatolithiasis is a common disease in China with a high rate of residual stones up to 30％-90％ after surgery.Patients often require re-operation because the high rate of residual stones and stone recurrence.Because the calculi are deeply distributed in the liver,and the condition is often accompanied by anatomical variations,distortion and biliary strictures,traditional preoperative imaging examinations do not easily locate the lesioos precisely,making diaguosis and treatment difficult.In recent years,three-dimensional computed imaging and visual simulation have provided a novel preoperative diagnostie method for hepatolithiasis,and have offered a clearer radiologic basis for surgical planning.The value of digital medical technology in the diagnosis and treatment of hepatolithiasis is discussed in this article.
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Objective To evaluate the safety, feasibility and curative effect of mini-incision ex-ploration of common bile duct. Methods In this study, 290 patients underwent min-incision explora-tion of common bile duct and 120 patients underwent open-incision exploration of common bile duct for bile duct stones and/or gallstones from 2005 to 2007. The iatrogenic bile duct injury, postoperative complication, residual stone, stone recurrence,therapeutic effect and clinical data were evaluated by randomized contrast analysis. Results Time of operation, bleeding, volume of drain pipe, time of re-covery of intestinal peristalsis and average duration in hospital were significantly lower in the group of min-incision exploration(MCE) than in the group of open-incision exploration(OCE). The iatrogentic bile duct injury occurred in 5 cases(1.72%), residual stone in 10 cases(3.45%), stone recurrence in 15 cases(5.18%) in the group of MCE, and in 2 cases(1.67%), 4 cases(3. 33%) and 6 cases respec-tively in the group of OCE. There was no marked difference between the two groups. Howevert post-operative complications occurred in 17 cases(6.8%) and 16(13.3%) in the group of MCE and OCE,respectively. There was remarkable difference between the 2 groups(P<0. 05). Conclusion Mini-in-cision exploration of common bile duct is a feasible and safe method resulting in fewer complications of iatrogentic bile duct injury, stone recurrence and residual stone.
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Study on 175 patients underwent Roux-en-Y hepatico-jejunostomy on the Y ansa with subcutaneous intestinal extremities because of intrahepatic and extrahepatic stones. There was no postoperative death. Short-term outcomes were good in 64.57%, moderate in 27.2%, and poor in 8.00%. Long-term outcomes were good in 71.95%, moderate in 20.12%, and poor in 7.92%. Treatment for main stone by drain lavage was good in 25.22%, moderate in 28.00% and bad in 45.94%. Treatment for residual stone under image intensifier through intestinal head was good in 31.13%, moderate in 68.17% and bad in 0%. These findings showed that this technique is good in treating postoperative residual and recurrent stones
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Derivación Gástrica , Cirugía General , TerapéuticaRESUMEN
Objective: To study the reasons and prevention of residual stones after choledo- choscopic treatment of cholelithiasis. Methods:The clinical data of 219 patients who had under- gone choledochoscopic treatment were analyzed retrospectively. Results: 21 cases were found with residual stones in the bile duct after the operations. Residual stone rate was to 9.58% . Bile duct stones of 8 patients could not be removed completely during operations. 13 patients were proved that stones still remain in their bile ducts by T-tube cholangiography and choledochoscope after opera- tions. There were 5 patients with acute obstructive suppurative cholangitis accompanying septic shock, 5 patients with stenosis in intrahepatic bile ducts, 4 patients with stones of in trahepatic bile duct and variation of bile duct, 2 patients with stones in sphincter of duodenal papilla,2 patients withstones and stenosis at the inferior segment of choledochus,3 patients were founded residual stones in bile duct obviously after the operations. Conclusions: B-type ultrasonic scanning and T-tube cholangiog- raphy are useful to reduce the rate of residual stones.
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BACKGROUND/AIMS: There has been a lot of controversy about the treatment methods in the management of residual & recurrent biliary stones. So we performed the study to clarify the important factors in choosing the treatment modality of the residual & recurrent biliary stones. METHODS: 154 patients who were diagnosed as residual or recurrent biliary stone between January 1995 and August 2000 were divided into 4 groups according to their first re- treatment methods (surgery, stone removal via T-tube, PTBD*, ESTP**) and analyzed the results of these treatments to determine what is the significant factor affecting the prognoses. RESULTS: The necessity of the second re-treatment for residual & recurrent stones was affected by the complete- ness of stone removal only, and no other factors affected it in view of multivariate analysis. The rate of residual & recurrent stones among the patients who have had the first operation in our department was 6.7%. Furthermore the clearance rate of residual & recurrent stones was relatively high value (82.2%), as a result of multidisciplinary treatments. CONCLUSION: Thus, as long as the residual stones can be removed completely, any treatment modality can be applied to these patients. We don't have to insist on surgery.
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Humanos , Análisis Multivariante , PronósticoRESUMEN
Objective To summarize our experience in choledochofiberscopic treatment for residual stones of biliary tract. Methods 1105 cases of residual stones of biliary tract diagnosed and treated with choledochofiberscope in the past 19 years were reviewed retrospectively. Results The 1067 patients with residual stones of bile duct were treated with choledochofiberscope for 1483 times altogether. The stones were completely removed in 1035 cases, while the stones were not cleared in other 32 cases. The clearance rate of residual stones was 97.0%(1035/1067). No patient died of choledochofiberscopic treatment. Conclusions Choledochofiberscopic treatment plays an important role in the treatment of residual stones of bile duct, because it not only reduces residual stones of bile duct to avoid repeated operation, but also has some advantages such as excellent safety, minimal invasion, low cost and quicker recovery.
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PURPOSE: Intrahepatic duct stones have been known to be a benign disease but because of the associated serious complications and the high recurrence rate, the management of the hepatolithiasis is very difficult. This purpose of this study was to classify the patterns of intrahepatic duct stones, and to evaluate the effect of surgical treatment according to their type and the residual stones that were present. METHODS: The clinical records of 212 patients who underwent a hepatic resection or drainage procedures between January 1988 and December 2000 were reviewed. RESULTS: We classified the intrahepatic duct stones as being either a localized simple type, a localized complicated type, a diffuse simple type, or a diffuse complicated type. Hepatic resections were performed in 177 (83.5%) cases. Among these we performed a hepatic resection along with drainage procedures in 41 cases (19.3%). In 35 (16.5%) cases, only drainage procedures were performed. Of a total of 25 cases of postoperative residual stones (25 cases), 13 (52%) cases were removed completely or partially by choledochoscopic procedures in 13 (52%) cases and in 15 (60.0%) cases they were removed completely or partially by spontaneous drainages. CONCLUSION: Our conclusions were that the, localized type of the IHD stones were treated successfully by a hepatic resection and the localized complicated type and the diffuse type IHD stones were treated effectively by hepatic resection and drainage procedures which reduced the opportunity for residual stones to develop following an accurate preoperative diagnosis of the location of the stones. Therefore, treatment methods should be individualized for each type of stone and by surgical treatments that combine endoscopic and resolution methods.
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Humanos , Clasificación , Diagnóstico , Drenaje , RecurrenciaRESUMEN
BACKGROUND: Residual and recurrent bile duct stones after biliary surgery cause many difficult problems. and reoperation on biliary tract has limitation due to its high morbidity and mortality. In recent years, various non-operative modalities for management in residual and recurrent stone have been developed. METHODS: We analyzed 69 cases of residual and recurrent bile duct stones which were managed with non-operative modalities at the Department of surgery, Dae Dong Hospital from Jan. 1994 to Dec. 1997, and evaluated the efficacy of these modalities. RESULTS: Female exceeded male with a ratio 1.76:1. and the peak incidence of age group was 6th decade. The most common diagnostic procedure was T-tube cholangiography (53.6%). Interval between previous operation and second procedure for residual or recurrent stones was within 6 months in most cases (82%). Cholecystectomy with T-tube choledochostomy was performed most frequently in previous operation. Residual and recurrent stones were found only at common bile duct in 34 cases (49.3%) most commonly. Common bile duct stones were managed most frequently with endoscopic sphincterotomy (39.5%), but the complete removal rate was heighest in choledochoscopic stone removal (100%). Complete removal rate of intrahepatic duct stone was heighest with interventional radiologic stone removal as well as choledochoscopic stone removal (43.6%), but average number of session was smaller in choledochoscopic stone removal (2.5) than interventional radiologic stone removal (3.5). Associated complication with non-operative management modalities were very low, except three cases of hepaticocutaneous jejunostomy. The latter required reoperation due to continuous bile fistula in two cases, and long jejunal loop in one case. CONCLUSIONS: Choledochoscopic stone removal is most effective method in the management of residual and recurrent bile duct stones.