ObjectiveTo investigate clinical efficacy of percutaneous nephroscope in treatment of patients with severe acute pancreatitis (SAP). MethodsEighty-six patients with SAP in this hospital from August 2012 to November 2015 were selected, which were divided into percutaneous nephroscope treatment group (43 cases) and laparotomy treat-ment group (43 cases) according to the difference of therapy modality. The conventional drug therapy was performed for all of them. The postoperative recovery, content of serum C reactive protein (CRP) on day 14 after operation, and post-operative complications were observed in these two groups. Results① The abdominal pain relief time, postoperative bowel sounds recovery time, normal body temperature recovery time, and postoperative hospitalization time in the percu-taneous nephroscope treatment group were significantly shorter than those in the laparotomy treatment group (P<0.05). ② The contents of serum CRP in the percutaneous nephroscope treatment group and in the laparotomy treatment group on day 14 after operation were significantly lower than those on day 1 before operation[(8.35±2.13) mg/L versus (31.44±3.45) mg/L, P<0.05; (16.42±2.44) mg/L versus (32.09±2.98) mg/L, P<0.05]. On day 14 after operation, the content of serum CRP in the percutaneous nephroscope treatment group was significantly lower than that in the laparotomy treat-ment group[(8.35±2.13) mg/L versus (16.42±2.44) mg/L, P<0.05]. ③ The incidence rate of postoperative complications in the percutaneous nephroscope treatment group was significantly lower than that in the laparotomy treatment group[14.0% (6/43) versus 32.6% (14/43), P<0.05]. ConclusionPercutaneous nephroscope in treatment of patients with SAP is effect, it has advantages of shorter hospital stay and early recovery, which could reduce incidence of postoperative complications, and it's mechanism might be related to systemic inflammatory response.
【摘要】 目的 探讨微创经皮肾镜碎石术后并发感染性休克的原因和防治措施。 方法 回顾性分析2005年1月-2010年12月5例经皮肾镜术300例，其中术后并发感染性休克5例的临床资料。男1例，女4例，均表现为术后2~8 h内出现寒战、高热、烦燥不安，血压降至80/50 mm Hg（1 mm Hg=0.133 kPa）以下，心率超过120次/min。所有患者均行抗感染和抗休克治疗。 结果 所有患者均在72 h内停用升压药，1周内体温及血常规恢复正常，术后15 d治愈出院。 结论 感染性休克是微创经皮肾镜碎石术严重的并发症之一，术前有效抗感染、术中低压灌注、术后加强生命体征的监测、早期发现并合理处理，可有效防治感染性休克的发生。【Abstract】 Objective To explore the etiology and treatment of septic shock after percutaneous nephrolithotomy. Methods From Janurary 2005 to December 2010, the clinical data of five patients with septic shock after percutaneous nephrolithotomy in our hospital were retrospectively analyzed. The patients, including one male and four females, had chillness and high temperature after the nephrolithotomy. The blood pressure decreased to under 80/50 mm Hg （1 mm Hg=0.133 kPa）, and the heart rate was more than 120 per minute. All patients underwent anti-shock and anti-infection therapies rapidly. Results Five patients were cured in the end, their temperature and blood routine tests returned to normal within one week. Conclusions Septic shock is one of the serious complications after percutaneous nephrolithotomy. Effective preoperative preparation, low pressure irrigation during operation, early diagnosis and treatment postoperatively are the effective ways to prevent the septic shock.
ObjectiveTo evaluate the efficacy and safety of the third-generation super-mini percutaneous nephrolithotomy (SMP) for the treatment of kidney calculi with diameter of ≤2.5 cm and CT value of ≥700 Hu, and discuss the feasibility of adopting the technology in primary hospitals.MethodsThe clinical data of 64 patients with unilateral kidney calculi (CT value ≥700 Hu, diameter ≤2.5 cm) treated in the People’s Hospital of Leshan Central District between July 2017 and July 2018 were retrospectively analyzed. After random assignment, 30 patients were treated with SMP and 34 were with mini percutaneous nephrolithotomy (MPCNL). The pre-, intra-, and post-operative data were compared and analyzed to evaluate the efficacy and safety.ResultsThe unilateral lesion operations of both groups were successfully completed in the first phase. All patients were given double J tubes after operation, and there were no major complications such as post-operative hemorrhage and sepsis. There was no statistically significant difference in the post-operative hemoglobin decrease, post-operative immediate stone removal rate, post-operative stone removal rate after one month, or the rate of procalcitonin >0.1 μg/L between the two groups (P>0.05). The differences in the lithotripsy time [(29.63±6.28) vs. (25.21±5.19) minutes], post-operative hospital stay [(5.33±0.61) vs. (9.44±0.96) days], rate of indwelling renal fistula (3.3% vs. 50.0%), analgesic demand rate (10.0% vs. 58.8%), and postoperative infectious fever rate (6.7% vs. 26.5%) between SMP group and MPCNL group were statistically significant (P<0.05).ConclusionsSMP has the advantages of less trauma, low systemic inflammatory response syndrome incidence, less pain, quick rehabilitation, short hospital stay, tubeless after surgery, etc. It is worthy of extensive promotion in primary hospitals.
ObjectiveTo assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) versus ureteroscopic lithotripsy (URL) in the treatment of impacted proximal ureteral stones>1 cm. MethodsWe electronically searched PubMed, Cochrane library, Embase, WanFang, Chinese National Knowledge Infrastructure and VIP database (by the end of July 2015) to collect randomized controlled trials involving PCNL vs. URL for the treatment of impacted proximal ureteral stones> 1 cm. The quality of those trials were assessed. Data were extracted and analyzed with RevMan 5.3 software. ResultsSix randomized controlled trials were finally obtained after screening. A total of 487 patients were included for a Meta-analysis. The results showed that, as compared with the control group (URL), the patients in the trial group (PCNL) had the following features: ① There was a remarkable improvement of stone clearance rate [RR=1.20, 95% CI (1.09, 1.33), P=0.000 3].② There was no statistical difference in postoperative fever rates, urinary tract perforation rates [RR=1.73, 95%CI (0.43, 7.00), P=0.45; RR=1.02, 95%CI (0.11, 9.37), P=0.99], but the incidence of hematuria was higher [RR=1.99, 95%CI (1.09, 3.62), P=0.03], and the mean operative duration was longer [WMD=30.03 minutes, 95%CI (10.04, 50.02) minuntes, P=0.003].③ The mean hospitalization stay was delayed by an average of 3.73 days [WMD=3.73 days, 95%CI (3.02, 4.44) days, P<0.000 01]. ConclusionPCNL is better than URL in the stone clearance rate, while patients in the PCNL group have to stay in the hospital much longer, and should bear longer mean operative duration.
ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.
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.
ObjectiveTo explore the impact of different tracts on the effectiveness and safety of percutaneous nephrolithotomy (PCNL) on complete staghorn calculus.MethodsPatients with complete staghorn calculus who underwent single channel PCNL by the same surgeon in West China Hospital of Sichuan University from October 2009 to August 2019 were included. The removing time, the rate of immediate stone removal, the average extubating time, and the incidences of postoperate complications such as fever and bleeding were analyzed statistically.ResultsA total of 379 patients were included. There were 146 cases in the upper tract group, 170 cases in the lower tract group and 63 cases in the middle tract group. Compared with the upper and middle tract groups, the lower tract group had shorter stone removing time [(50.34±18.52) vs. (53.41±22.75) vs. (41.79±17.45) min, P<0.001], shorter average extubating time [(5.53±1.83) vs. (6.17±1.44) vs. (4.96±1.91) d, P=0.007]. The rate of immediate stone removal was higher in the the upper tract group (40.56% vs. 32.79% vs. 34.71% ), but there was no statistical difference among the three groups (P=0.447). There was no significant difference among the three groups in the fever incidence (25.44% vs. 24.24% vs. 26.85%, P=0.938) or bleeding incidence (3.54% vs. 3.03% vs. 4.03%, P=1.000). In addition, there were 8 cases of pleural injury in the upper tract group.ConclusionsCompared with the lower and middle tract, PCNL with upper tract has a higher rate of removing stones for complete staghorn calculus, but there was no significant difference among the three groups. The incidences of bleeding and fever after surgery are similar in the three groups, but the risk of pleural injury may be increased in the upper tract group.