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医护合作-快速康复模式在经输尿管镜钬激光碎石术中的应用及效果评价

目的 探讨医护合作-快速康复模式在经输尿管镜钬激光碎石手术中的临床应用及效果的评价。 方法 将 2015 年 10 月—2016 年 3 月入住的 166 例输尿管结石患者随机分为对照组和试验组各 83 例，对照组按传统方法进行住院治疗及围手术期护理，试验组按照医护合作-快速康复模式进行诊治及护理，包括门诊评估、术前检查的完善、麻醉评估、流程办理、家庭护理的注意事项、围手术期的饮食活动指导和疼痛管理、健康保健等。比较两组患者的住院时间、住院费用、术后并发症、术后首次进食时间和满意度的差异。 结果 试验组患者住院时间[（22.46±0.89）h]少于对照组[（76.46±0.75）h]，住院费用[（8 275.21±789.45）元]低于对照组[（12 859.11±1 047.54）元]，并发症发生率[10.8%（9/83）]低于对照组[41.0%（34/83）]，患者满意度[（99.87±5.12）%]高于对照组[90.66±5.95）%]，差异均有统计学意义（P<0.05）。 结论 医护合作-快速康复模式应用于输尿管镜钬激光碎石手术，能充分利用医疗资源，促进医患关系协调，缩短患者的住院日，减少患者的住院费用，降低术后并发症的发生，促进术后康复，早日恢复患者的正常生活。

Pneumatic Lithotripsy Combined with TURP in the Treatment of Bladder Calculi with Benign Prostate Hyperplasia

目的:探讨微创治疗BPH并发膀胱结石的方法。方法:应用气压弹道碎石术联合TURP治疗BPH并发膀胱结石26例。结果:24例一次成功,1例一期碎石,二期行TURP;1例中转开放手术。结论:气压弹道碎石术联合TURP治疗BPH并发膀胱结石创伤小,恢复快,安全高效。

Endoscopic reverse biliary tract stent placement via choledochus in treatment of situs inversus totalis complicated with choledocholithiasis

ObjectiveTo summarize experience of endoscopic reverse biliary tract stent placement via choledochus in treatment of situs inversus totalis complicated with choledocholithiasis.MethodThe clinical data of one patient with situs inversus totalis complicated with choledocholithiasis in the Department of Tumor Surgery of Lanzhou University Second Hospital were retrospectively analyzed.ResultsThe ERCP was failed at the first admission, followed by the cholecystectomy plus choledocholithotomy plus T-tube drainage, the stones were removed. Two months later, choledochoscopy revealed multiple choledocholithiasis, then the holmium laser lithotripsy and bile duct stent placement was performed at the secondary admission, the postoperative recovery was good, it had been more than 2 months after the surgery, no stone recurrence occurred.ConclusionEndoscopic reverse biliary tract stent placement via choledochus is feasible, which can be used as an option for treatment of patient with situs inversus totalis complicated with choledocholithiasis.

Application of ERCP and extracorpareal shock wave lithotripsy in the treatment of chronic pancreatitis with pancreatic duct stones

Objective To explore the value of endoscopic retrograde cholangiopancreatograph (ERCP) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of pancreatic duct stones. Methods A retrospective collection of 28 patients with chronic pancreatitis and pancreatic duct stones admitted to the Department of Gastroenterology from January 2010 to August 2021 was performed. According to the treatment of patients, they were divided into ERCP direct stone extraction group and ESWL combined ERCP stone extraction group. We compared the treatment effects of the two groups of patients, including the success rate of stone extraction, postoperative complications of ERCP, postoperative symptom improvement, and so on. Results Among the 28 patients, 19 cases underwent ERCP direct stone extraction, and 9 cases underwent ESWL combined with ERCP stone extraction. In the ERCP direct stone extraction group, 7 cases (36.84%) were completely extracted, 1 case was partially extracted (5.26%), and 11 cases (57.89%) failed to extract and only placed stents and drained; 5 cases (26.32%) had elevated white blood cells at 6 hours postoperatively, C-reactive protein increased in 4 cases (21.05%), 3 cases (15.79%) were diagnosed as ERCP-related pancreatitis, and 2 cases (10.53%) were diagnosed as hyperamylaseemia. The abdominal pain symptoms were completely relieved in 14 cases (73.68%) during a follow-up period of 3 to 6 months. The body mass of 17 cases (89.47%) increased in the 6 months after stone extraction. ESWL combined with ERCP had complete stone extraction in 5 cases (55.56%), partial stone extraction in 3 cases (33.33%), and failure in stone extraction and only stent drainage in 1 case (11.11%). One case (11.11%) had elevated white blood cells at 6 hours postoperatively, and 1 case (11.11%) had elevated C-reactive protein . One case (11.11%) was diagnosed with ERCP-related pancreatitis. One case (11.11%) got abdominal pain and transient hematuria during ESWL, which resolved spontaneously 3 days later. After 3 to 6 months of follow-up, 9 patients (100%) had complete relief of abdominal pain symptoms, and the body mass of 9 patients (100%) increased in the 6 months after stone extraction. The stone clearance rate of the ESWL combined with ERCP stone extraction group was higher than that of the ERCP direct stone extraction group (P=0.033), but there was no statistically significant difference between the two groups in terms of ERCP-related complications, relief of abdominal pain, and weight gain (P>0.05). Conclusion ESWL combined with ERCP in the treatment of chronic pancreatitis complicated with pancreatic duct stone extraction is more effective than ERCP direct stone extraction.

Therapeutic effect of direct vision-guided lithotripsy with SpyGlass DS for pancreatic duct stones

Objective To evaluate the efficacy of direct vision guided lithotripsy with SpyGlass DS in the treatment of pancreatic duct obstruction caused by chronic calcified pancreatitis and pancreatic duct stones. Methods The clinical data of 9 patients with chronic calcified pancreatitis and pancreatic duct stone who underwent direct-vision guided pancreatic duct stone lithotripsy with SpyGlass DS from July 2017 to September 2017 in the Department of Gastroenterology of Jilin People’s Hospital were retrospectively analyzed, then assessment of technical success rate, clinical success rate, and incidence of adverse event were performed. Results A total of 13 times of intervention were performed in 9 patients, the overall technical success rate of SpyGlass DS direct vision lithotripsy and drainage was 88.9% (8/9). Three of the 9 patients (30.3%) had adverse reactions, including self-limiting bleeding after sphincterotomy (n=1), post-encoscopic retrograde cholangio-pancreatography pancreatitis (n=2), and mild abdominal pain (n=2). Nine patients were followed-up for 3－50 months (median of 21 months), 8 patients (88.89%) reported improvement in abdominal pain, and the mean visual analogue scale score decreased from 6.22±1.47 to 2.78±1.23, P<0.01. Eight patients (88.9%) patients achieved clinical success. Conclusion The SpyGlass DS direct vision-guided lithotripsy is safe and effective for patients with pancreatic duct stones.

微通道经皮肾镜激光碎石术后全身炎症反应综合征致弥散性血管内凝血一例

Treatment of Acute Renal Failure Induced by Upper Ureteric Obstruction with Ureterorenoscope

目的:探讨急性上尿路梗阻性肾功能衰竭的治疗方法。方法:采用输尿管镜检查,酌情钬激光碎石,放置双J管内引流治疗32例急性上尿路梗阻性肾功能衰竭患者。结果:术后患者血清BUN、SCr均明显下降,尿量不同程度恢复,结石排净率90.6%(29/32)。结论:对于上尿路结石梗阻性急性肾功能衰竭的患者,急诊输尿管镜下钬激光碎石,疗效确切,创伤小,可同时处理双侧输尿管结石。

Exploration of New Perioperative Nursing Mode for Percutaneous Nephrolithotomy

ObjectiveTo explore the perioperative nursing mode for percutaneous nephrolithotomy (PCNL). MethodsA total of 866 patients with PCNL having undergone lithotripsy between January 2012 and December 2013 in our hospital were included in our study. Before surgery, they received position training, health education and psychological nursing. After surgery, patients received an integral medical wound care and pipeline management, as well as management of infectious shock and intercostal neuralgia. At the same time, we gave them dietary guidance and other health guidance. ResultsAll the patients were successfully discharged from hospital. Postoperative infection rate was 2.4%, septic shock rate was 0.2%, bleeding rate was 2.2%, urinary leakage rate was 1.5%, the rate of pneumothorax was 0.6%, subcutaneous emphysema rate was 0.3%, and intercostal neuralgia rate was 0.6%. The average hospital stay was (11.2±2.8) days. ConclusionThe innovative nursing mode and techniques have great significance on the success of PCNL surgery.

Holmium Laser Combined with Choledochoscopy for Treatment of Refractory Intra-Hepatic or Extra-Hepatic Bile Duct Stones

目的 探讨经胆道镜联合钬激光碎石治疗肝内外胆管难取性结石的价值。方法 纤维胆道镜窥视下用钬激光碎石治疗肝内外胆管难取性结石29例，观察临床效果。结果 经1～3次胆道镜下钬激光碎石治疗，28例患者结石全部取尽，1例未完全取净，成功率为96.55%（28/29）； 近期无胆道出血、漏胆、黄疸等并发症发生。26例获得随访，随访时间6～20个月，平均13个月，未发现结石复发及胆管狭窄。结论 经胆道镜钬激光碎石是一种治疗肝内外胆管难取性结石简便、安全及有效的方法。

Application of ultrasound-guided percutaneous transhepatic cholangioscopy in treatment of complicated hepatolithiasis

Objective To investigate feasibility and curative effect of ultrasound-guided percutaneous transhepatic cholangioscopy in treatment of complicated hepatolithiasis. Methods The data of 42 patients with complicated hepatolithiasis from June 2012 to June 2017 in the Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed. All the patients were treated with ultrasound-guided percutaneous transhepatic cholangioscopy, including the first stage of dilation and drainage and the second stage choledochoscopy. Results The operations of the 42 patients were successfully performed. No case was converted to the conventional laparotomy. The puncture sites of 10 cases were at the right intrahepatic bile duct, 25 cases were at the left intrahepatic bile duct, and 7 cases were at the bilateral intrahepatic bile duct. The residual stones were removed by two stage choledochoscopy in the 31 patients, 11 patients had the residual stones. After the first stage, there were 4 cases of the bile duct hemorrhage, 8 cases of the cholangitis, 1 case of the pleural effusion and 1 case of the infection, 2 cases of the postoperative drainage tube shedding. After the second stage, there were 3 cases of the cholangitis and 3 cases of the postoperative drainage tube shedding. The stones of the 10/31 patients with stone removal occurred and the diseases of 9/11 patients with stone residual were stable during the following-up of (18.6±7.8) months. Conclusion Ultrasound-guided percutaneous transhepatic cholangioscopy including the first stage of dilation and drainage plus the second stage choledochoscopy is safe and effective in treatment of complex intrahepatic bile duct stones, it is an effective supplement to traditional surgery.