ObjectiveTo explore the clinical efficacy and surgical techniques of laparoscopic choledocholithotomy and primary suture. MethodsWe retrospectively analyzed the clinical data of 58 patients who underwent laparoscopic choledocholithotomy and primary suture between January 2009 and December 2014. ResultsAll the 58 patients underwent the surgery successfully. Operation time was 45-125 minutes, averaging 75 minutes. Intraoperative blood loss was between 10 and 50 mL with an average of 20 mL. Postoperative hospital stay was 5-14 days with an average of 7 days. Four cases of biliary leakage were cured by conservative treatment. ConclusionWith operation indications strictly grasped and skillful operation techniques, laparoscopic choledocholithotomy and primary suture are safe and reliable with a good curative effect.
摘要:目的:探讨后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石的临床价值和技术要点。 方法:2006年12月至 2009年3月,对58例嵌顿性输尿管中上段结石采用后腹腔镜输尿管切开取石术,术中取石后于镜下直接置入双J管,间段缝合输尿管切口。 结果:58例手术均获成功,无中转开放手术,结石清除率100%。术后创腔引流液量少,3～5d拔除引流管,1周出院,术后3周膀胱镜下拔除双J管。随访1～27个月,B超复查显示肾积水明显好转或消失,无结石复发。 结论:后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石具有创伤小\疗效好、术后恢复快等特点,明显优于开放手术及其它手术,值得推广应用。Abstract: Objective: To summarize our experience and evaluate the outcome of retroperitoneal laparoscopic ureterolithotomy of the upper ureter impacted stone. Methods: Between December 2006 and March 2009, 58 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. After removal of the stones, the double J was put in and interrupted suture was performed for upper ureter. Results: Retroperitoneoscopic ureterolithotomy was successful in all patients, there was neither ureteral stricture nor recurrent calculus, the blood loss ranged from 510 mL, without urine leakage occurred.The mean hospital stay was 7 days, after 3 weeks double J was removed by cystoscopy. With 127 months followup, the hydronephrosis relieved and no recurrence of ureter calculus founded. Conclusion:Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive operation, and worth to generalization.
目的 探讨纤维胆道镜在肝胆管结石手术术中及术后的操作技巧，提高肝胆管结石的临床治愈率。方法 总结分析180例肝胆管结石病例，在纤维胆道镜下观察，使用取石篮取石、钳咬、抓取、冲洗，行术中、术后经T管窦道取出结石。结果 本组180例中158例行术中取石，结石取净率为94.3%（149/158）； 余22例系术后再次经Ｔ管窦道取石，结石取净率为86.4%（19/22）。术中、术后取净结石共168例，结石取净率93.3%（168/180）。结论 纤维胆道镜能有效治疗肝胆管结石，降低术中、术后残余结石发生率，提高治愈率。
目的 采用腹腔镜、内镜联合技术处理胆囊结石合并肝外胆管结石，对同期及分期治疗的结果进行比较。方法 患者60例，其中同期处理36例，分期处理24例。术前诊断依据B超、ERCP或MRCP检查，术中诊断依据术中胆道镜检查和胆道造影，全部病例均诊断为慢性胆囊炎合并胆总管结石。同期手术者直接行腹腔镜胆囊切除术，胆道镜和（或）造影检查后行腹腔镜经胆囊管或胆总管胆道镜取石，闭合胆管开口或放置T管。分期手术者先行或者后行ERCP+经内镜乳头切开术/经内镜乳头气囊扩张术取石，再行常规的腹腔镜胆囊切除术。结果 60例患者腹腔镜胆囊切除术均成功，同期手术者手术时间40～90 min，平均68 min，术后发生1例漏胆； 分期手术者2次手术时间共60～120 min，平均80 min。同期手术者手术时间明显短于分期手术者（P＜0.01），而术后并发症发生情况二者间差异则无统计学意义（Pgt;0.05）。同期手术者住院费用较少（P＜0.01），同时在胆总管一期缝合或胆囊管一期结扎的情况下，住院时间相对较短（P＜0.01）。结论 腹腔镜胆囊切除术＋腹腔镜下胆道镜胆总管探查术或经胆囊管探查术同期治疗胆囊结石合并肝外胆管结石安全可靠，值得进一步研究、推广。
Objective To introduce the current status of clinical research on endoscopic cholecystolithotomy with reservation of gallbladder. Methods Literatures related to the basis, advantage, indication, contraindication, operative method and current controversy were reviewed and summarized. Results The objective evidences were afforded by postoperative complications of cholecystectomy for endoscopic cholecystolithotomy with reservation of gallbladder. The progress of endoscopic technique made it possible for reservation of gallbladder. The controversy in endoscopic cholecystolithotomy with reservation of gallbladder was focused on the choice of indications and operative procedure. Incorrect patient selection and undue pursuit of cholecystolithotomy with reservation of gallbladder would be completely opposite to the treatment of gallstone. Conclusion It is feasible for endoscopic cholecystolithotomy with reservation of gallbladder to remove completely stone and reserve gallbladder function, but further investigation and long-term follow up are required to delineate gallstone recurrence after operation.
ObjectiveTo systematically review the effectiveness and safety of transurethral ureteroscopy lithotripsy in the treatment of upper ureteral calculi. MethodsWe electronically searched The Cochrane Library (Issue 3, 2013), PubMed (1966 to 2013.8), EMbase (1990 to 2013.8), CNKI (1949 to 2013.9), CBM (1978 to 2013.9), VIP (1989 to 2013.8) and WanFang Data (1990 to 2013.8) for the randomized controlled studies (RCTs) related to retroperitoneoscopy ureterolithotomy versus transurethral ureteroscopy lithotripsy for upper ureteral calculi. Two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 410 patients (transurethral ureteroscopy lithotripsy:747 cases; etroperitoneal laparoscopic ureterolithotomy:663 cases) were included. The results of meta-analysis showed that, transurethral ureteroscopy lithotripsy was lower than retroperitoneoscopy ureterolithotomy in success rates of surgery (OR=0.26, 95%CI 0.14 to 0.51), 3-day stone clearance rates (OR=0.06, 95%CI 0.03 to 0.11), and 1-month stone clearance rates (OR=0.21, 95%CI 0.08 to 0.53), while it showed superiority in operation time (MD=-22.35, 95%CI-35.29 to-9.41) and postoperative hospital stay (MD=-1.84, 95%CI-3.44 to-0.24). ConclusionCurrent evidence shows that, in the treatment of upper ureteral calculi, transurethral ureteroscopy lithotripsy causes less operation time and postoperative hospital stay, but it had no advantage in success rates of surgery, 3-day stone clearance rates, and 1-month stone clearance rates.
目的 探讨腹腔镜胆总管切开取石术的优势，总结手术操作经验及常见并发症的预防与处理。方法回顾性分析我院1999年6月至2010年4月期间收治的108 例胆管结石患者行腹腔镜胆总管探查取石术的手术方法、操作要点及并发症的处理。结果 腹腔镜手术成功 105例, 中转开腹3例; 手术时间（120±20） min,出血量（25±5） ml,住院时间（9±1） d; 术后发生胆道出血3例,漏胆7 例,残余结石6 例; 全组无死亡病例。结论 腹腔镜胆总管切开取石术具有创伤小、痛苦轻、恢复快、对腹腔脏器干扰小、住院时间短等优点，值得临床推广。
目的 探讨腹腔镜下联合胆道镜微创保胆取石术治疗胆囊结石的疗效。方法 解放军第452医院普外科2005年1月至2010年1月期间行腹腔镜保胆取石术治疗胆囊结石患者70例，与同期行腹腔镜胆囊切除术的患者对比，观察2组的手术时间、术中出血量、术后住院时间、住院费用及术后饮食恢复时间。结果 在术中出血量及术后饮食恢复时间上，保胆取石组明显少于或短于胆囊切除组（P＜0.05）；在手术时间、术后住院时间及住院费用上2组间差异无统计学意义（P＞0.05）。结论 相比胆囊切除术，腹腔镜联合胆道镜保胆取石术创伤较小且恢复较快，但是保胆取石术后结石的复发有待长期观察和研究。
【摘要】 目的 探讨微创经皮肾镜下钬激光碎石术治疗上尿路结石的方法及疗效。 方法 2007年9月-2010年10月在B型超声引导下应用微创经皮肾镜下钬激光碎石术治疗上尿路结石138例，其中肾鹿角形结石64例，单发肾盂、肾盏结石38例，双肾结石8例，输尿管上段结石28例，孤立肾结石2例。 结果 136例取石成功，其中95例一期取石成功（包括双通道取石5例），41例二期取石，2例因经皮肾穿失败改行开放手术取石。27例术后体外震波碎石治疗。平均结石清除率78.9%（109/138）。平均手术时间112 min，平均住院时间10 d，肾造瘘管平均留置时间4 d，双J管平均留置时间4周。5例因术中出血较多需输血。11例术后1周内出血较多，其中3例需要输血。12例出现尿外渗。7例术后出现高热（gt;39 ℃）。随访: 98例伴有肾积水，时间3~6个月，平均4个月，24例积水消失，68例积水减轻，6例无改善也无加重；22例残余结石随访4~9个月，平均6个月，6例结石增大，16例结石无变化；87例随访12个月无残余结石，7例结石复发。 结论 微创经皮肾镜下钬激光碎石术治疗上尿路结石创伤小，恢复快，并发症少，疗效满意。【Abstract】 Objective To discuss the method and the curative effect of minimally invasive percataneous nephrolithotomy (mini PCNL) with holmium laser in treating upper urinary tract calculi. Methods From September 2007 to October 2010, 138 patients with upper urinary tract calculi were treated with mini PCNL with holmium laser under the conduction by type-B ultrasonography. Of the 138 cases, 64 patients had staghorn calculi, 38 had single renal pelvis or renal calyx stones, eight had bilateral renal calculi, 28 had upper-ureteral calculi, and two had solitary kidney calculi. Results Successful stone removal was achieved in 136 cases, among which there were 95 cases of stage-one nephrolithotomy (double tracts were used in five cases) and 41 cases of sfage-two neploolithotomy. Two cases were changed to open operation due to failures of percutaneous nephrolithotory. Extracorporeal shock-wave lithotomy was used in 27 cases after operation. The average stone removal rate was 78.9% (109/138). The average operation time was 112 minutes. The average hospital stay was 10 days. The average nephrostomy tube stay was four days. The average double J tube stay was four weeks. Five patients needed blood transfusion in operations due to a large amount of blood loss. Eleven patients suffered from massive hemorrhage one week after operation and blood transfusion was performed in three patients. Urine exosmosis happened in 12 cases. And there were seven cases of high fever (gt;39 ℃) after operation. Follow-up was done for 98 patients accompanied by hydronephrosis for a time period ranged from three to six months averaging at four months. Hydronephrosis disappeared in 24 patients, alleviated in 68 cases, and did not change in six cases. Twenty-two cases of residual calculi were followed up for a period ranged from four to nine months averaging at six months. Enlarged calculi occurred in six cases and no change happened to the calculi in 16 cases. Eighty-seven patients without residual calculi were followed up for 12 months, and there were seven cases of reoccurrence. Conclusion Treatment of upper urinary tract calculi with minimally invasive percutaneous nephrolithotomy with holmium laser is a simple and safe method with little injury, quick recovery, few complications and satisfactory results.