LC联合LCHTD治疗胆总管结石合并胆囊结石的效果及术后胆总管结石复发的相关因素分析

目的 探讨腹腔镜胆囊切除（LC）联合腹腔镜胆总管切开取石T管引流术（LCHTD）治疗胆总管结石合并胆囊结石的效果及术后胆总管结石复发的相关因素。方法 回顾性分析2018 年1 月至2019 年1 月新疆医科大学第一附属医院93 例胆总管结石合并胆囊结石患者临床资料,所有患者均给予LC联合LCHTD治疗。根据是否术后胆总管结石复发分为结石复发组（24例）和结石未复发组（69例）,观察两组临床疗效、手术时间、术中出血量、总住院时间、住院费用,随访术后胆总管结石复发情况,分析术后胆总管结石复发的危险因素。结果 93例患者LC联合LCHTD治疗手术成功90 例,中转开腹3 例。手术时间（109.4±10.6）min,术中出血量（80.2±19.1）mL,总住院时间（9.2±1.2）d,住院费用（1.9±0.4）万元。所有患者均完成随访18个月,术后胆总管结石复发24例（25.81%）,平均复发时间为（10.3±2.1）个月。结石未复发组剔除中转开腹3 例,单因素分析表明,结石复发组和结石未复发组患者年龄、性别、病程、结石直径差异无统计学意义（P＞0.05）;胆总管结石类型、结石数量、胆总管直径、碎石术、胆总管扩张、胆囊管扩张、合并炎症与胆总管结石合并胆囊结石术后胆总管结石复发相关（P＜0.05）;多因素非条件Logistic分析显示,结石数量、胆总管直径、碎石术、胆总管扩张、胆囊管扩张、合并炎症是胆总管结石合并胆囊结石术后胆总管结石复发的独立危险因素（P＜0.05）。结论 在胆总管结石合并胆囊结石患者中应用LC联合LCHTD疗效显著,术后结石复发受多种因素影响,积极干预可有效降低结石复发率。     

腹腔镜胆囊切除术联合胆总管切开取石T管引流术的复发多因素分析

目的探讨胆囊结石合并胆总管结石患者采用腹腔镜胆囊切除术(LC)联合胆总管切开取石T管引流术(LCHTD)治疗后结石复发的发生率及其影响因素。方法回顾性分析2011年6月至2014年1月采用LC+LCHTD治疗的319例胆囊结石合并胆总管结石患者的临床资料,观察术后2~5年内患者胆囊结石复发情况,并探讨影响结石复发的危险因素。采用SAS 10.0软件进行统计学分析,性别、饮酒率、吸烟率、糖尿病患病率、胆囊管扩张率、高血压患病率、≥15 mm胆总管直径患者所占百分比、多发结石患者所占百分比、≥10 mm结石患者所占百分比、胆总管扩张率采用百分比(%)进行统计描述,组间比较采用χ~2检验;多因素分析方法采用非条件Logistic回归分析法;P值0.05表示差异具有统计学意义。结果术后1年累积复发14例(4.4%)、3年累积复发30例(9.4%)、5年复发累积47例(14.7%);采用非条件Logistic回归进行分析,结果显示结石数目多发、采用碎石术、胆总管扩张、胆囊管扩张是LC+LCHTD术后胆囊结石复发的独立危险因素(OR=1.721,OR=1.582,OR=1.404,OR=1.381,P0.05)。结论碎石术、胆总管扩张、胆囊管扩张是LC+LCHTD术后胆囊结石复发的独立危险因素。     

腹腔镜胆囊切除联合胆总管切开取石T管引流术后结石复发情况及术后结石复发的相关危险因素分析

目的探究腹腔镜胆囊切除(LC)联合胆总管切开取石T管引流术(LCHTD)后结石复发及复发相关危险因素。 方法回顾性分析2014年1月至2016年6月行LC联合LCHTD治疗的89例胆结石合并胆总管结石患者的临床资料,采用SPSS21.0统计软件分析,术后结石复发率、1～3年累计复发率和单因素分析采用χ²检验,多因素分析采用logistic回归分析,计算OR和95%可信区间,P<0.05为差异有统计学意义。 结果术后18例患者出现结石复发情况,复发率为20.22%,累计复发率分别为：1年2.25%(2/89),2年5.62%(5/89),3年12.36%(11/89)。单因素分析显示：年龄、胆总管直径、结石数量、碎石术、胆总管扩张、胆囊管扩张、合并胆管或胰腺炎症与联合术后结石复发有关(P<0.05);多因素分析显示：胆总管直径≥1.5 cm、胆总管扩张、胆囊管扩张、合并胆管或胰腺炎症是联合术后结石复发的独立危险因素。 结论胆囊结石合并胆总管结石行LC联合LCHTD治疗后结石复发的影响因素较多,且部分因素会合并出现,有必要采取有针对性的措施以期降低术后结石复发率。     

腹腔镜下治疗胆囊结石合并胆总管结石的疗效影响因素分析

目的:探讨影响腹腔镜手术治疗胆囊结石合并胆总管结石疗效的相关因素。方法:回顾分析2009年6月至2011年6月为128例胆囊结石合并胆总管结石患者行腹腔镜手术的临床资料,根据患者术后是否复发将其分为复发组及未复发组,分别采用单因素及Logistic回归模型分析影响胆囊结石合并胆总管结石术后复发的相关因素。结果:24例术后复发,复发率18.75%。经单因素分析得出,年龄、胆总管直径、结石数量、胆总管扩张、胆囊管扩张、胆管炎、总胆红素异常、胰腺炎、结石残留、术后合并症、黄疸、结石直径及手术类型与胆囊结石合并胆总管结石术后复发相关。经Logistic回归模型分析可知,胆总管直径、胆囊管扩张、胆总管扩张、结石数量、胆管炎、结石残留、术后合并症及手术类型是影响胆囊结石合并胆总管结石患者术后复发的独立危险因素。结论:腹腔镜手术治疗胆囊结石合并胆总管结石术后复发的影响因素较多,临床应根据患者具体情况制定相应的预防控制措施,以降低术后复发率。     

腹腔镜胆道镜治疗胆囊结石合并胆总管结石两种术式的疗效比较

目的对比腹腔镜胆囊切除+经胆囊管胆道探查术(LC+LTCBDE)与腹腔镜胆囊切除术+胆总管切开探查+T管引流术(LC+LCHTD)两组微创手术方式治疗胆囊结石合并胆总管结石的临床疗效。方法 130例胆囊结石合并胆总管结石患者,其中70例行LC+LTCBDE,60例行LC+LCHTD。比较两组患者手术时间、术后住院时间、住院费用、术后恢复正常生活时间和并发症情况(胆漏、出血、胆管狭窄,胆管残余结石等)。结果 LC+LTCBDE组的手术时间、术后住院时间、住院费用、术后恢复正常生活时间均低于LC+LCHTD组,差异有统计学意义(P0.05)。两组术后并发症比较,差异无统计学意义(P0.05)。结论 LC+LTCBDE可作为胆囊结石合并胆总管结石的首选治疗,难以经胆囊管胆道探查时,LC+LCHTD仍为明智选择。     

胆囊结石合并胆总管结石术后复发的危险因素分析

目的：探讨内镜手术治疗胆囊结石合并胆总管结石患者复发的相关影响因素。 方法：回顾性分析2010年1月—2012年12月应用内镜治疗胆囊结石合并胆总管结石99例患者（51例行腹腔镜下胆囊切除+胆总管切开取石术，48例行腹腔镜下胆囊切除+十二指肠镜乳头切开取石术）的临床与随访资料，对影响结石复发的相关因素行单因素与多因素分析。 结果：术后共19例患者复发，复发率为19.19%。单因素分析显示，术后结石复发与年龄、黄疸、胆管扩张、胆总管直径、结石最大直径、结石数目、胆管、胰腺炎症以及手术类型等因素有关（均P<0.05），Logistic多因素回归分析发现，年龄（OR=2.692，P=0.011）、胆总管直径（OR=2.249，P=0.022）、结石数量（OR=2.647，P=0.017）、结石最大直径（OR=2.348，P=0.009）、合并炎症（OR=2.801，P=0.013）、手术类型（OR=2.421，P=0.018）是结石复发的独立危险因素。 结论：内镜手术治疗胆囊结石合并胆总管结石术后结石复发受多种因素影响，应当根据具体情况采用有针对性措施降低复发率。     

腹腔镜胆总管探查术治疗胆总管结石合并胆囊结石

目的 探讨腹腔镜胆总管探查术( LC BDE)治疗胆总管结石合并胆囊结石的临床疗效和价值.方法 2006年7月至2010年6月期间对127例胆总管结石合并胆囊结石患者进行微创治疗.其中78例采用LCBDE+腹腔镜胆囊切除术(LC)治疗,49例采用内镜十二指肠括约肌切开术(EST) +LC治疗.比较二组的手术治疗成功率、术后并发症发生率、残余结石率、胃肠功能恢复时间、住院时间和费用等指标,并随访二组远期并发症发生率.结果 LCBDE+ LC组:手术成功率94.87％,术后并发症发生率5.41％.EST+LC组:手术成功率95.92％,术后并发症发生率12.77％.两组手术成功率差异无统计学意义(P＞0.05),术后并发症发生率差异有统计学意义(P＜0.05).手术时间、住院费用的比较差异有统计学意义(P＜0.05).出院后随访1～5年,平均(3.2±0.8)年,LCBDE+LC组结石复发率、胆管积气发生率、反流性胆管炎发生率显著低于EST+LC组(P＜0.05).结论 LCBDE+LC是治疗胆囊结石合并胆总管结石的安全、有效、可行的微创术式,对于适宜的患者行胆总管一期缝合更能体现微创的优势.     

腹腔镜胆囊切除联合胆总管切开取石在胆囊结石合并正常直径胆总管结石患者中的应用

目的探讨腹腔镜胆囊切除(laparoscopic cholecystectomy, LC)联合胆总管切开取石(laparoscopic common bile duct exploration, LCBDE)在胆囊结石合并正常直径胆总管结石患者中的应用效果。方法回顾性分析合肥市第二人民医院普通外科2014年3月至2021年7月期间通过LC 联合LCBDE 治疗的393例胆囊结石合并胆总管结石患者的临床资料。结果通过测量胆总管十二指肠上段直径的不同将患者分为两组。扩张组胆总管直径>8 mm, 共280例, 正常直径(5 mm≤胆总管直径≤8 mm)胆总管结石113例。两组在手术时间术中及术后并发症上差异无统计学意义(均P>0.05)。随访期间胆总管正常直径组结石复发3例, 均通过ERCP取出。扩张组结石复发8例, 7例通过ERCP取出, 1例患者拒绝进一步治疗。结论在胆囊结石合并正常直径胆总管结石患者中行LC+LCBDE是安全、可行的。     

腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石手术困难因素分析及临床对策

目的:探讨腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的困难因素,并提出相应的临床对策。方法:回顾分析2013年9月至2018年10月为116例患者行腹腔镜胆囊切除(LC)联合腹腔镜胆总管探查(LCBDE)的临床资料,按手术时间、是否中转开腹、有无结石残留分组,应用单因素分析及多因素Logistic回归分析,探讨LC联合LCBDE手术困难的独立危险因素。结果:116例患者中容易组63例、困难组53例。单因素分析显示:胆囊大小、胆囊壁炎症严重程度、胆囊三角解剖关系显露情况、胆总管下段有无结石嵌顿及胆总管直径均是LC联合LCBDE手术难度较大的危险因素(P<0.05)。多因素Logistic回归结果显示,胆囊三角显露不清(OR=14.090,P<0.001)、胆囊壁化脓坏疽(OR=20.057,P=0.011)、胆总管下段结石嵌顿(OR=23.001,P=0.006)及胆总管直径≥12 mm(OR=3.950,P=0.008)是LC联合LCBDE手术困难的独立危险因素。结论:胆囊结石合并胆总管结石伴有胆囊三角显露不清、胆囊壁化脓坏疽、胆总管下段结石嵌顿、胆总管直径≥12 mm时,LC联合LCBDE的手术困难、危险性明显增加,临床应重视此类患者的术前评估及术中操作,以降低手术困难发生率。     

影响胆囊结石合并胆总管结石手术治疗效果的因素分析

目的:探讨影响胆囊结石合并胆总管结石手术治疗效果的因素.方法:收集临床2007年9月-2011年9月期间腹腔镜下手术治疗的162例胆囊结石合并胆总管结石患者临床资料,并根据有无结石残留(残留组和取尽组)和术后是否复发(复发和未复发)将患者分组,并回顾性分析一般资料、围术期常规指标、术后并发症等,并采用Logistic回归模型分析影响结石清除和术后复发的因素.结果:(1)资料中有34例结石残留,128例结石取尽;25例术后复发,137例未复发;(2)年龄、总胆红素异常、胆总管直径、结石最大直径、结石数目、胆总管扩张、胆管扩张、胆管炎、胰腺炎、手术类型是导致结石残留和手术复发的影响因素,此外,导致手术复发的因素还包括结石残留和术后并发症;(3)胆总管直径、结石数目、胆总管扩张、胆管扩张、胆管炎和手术类型是影响胆囊结石合并胆总管结石患者取石效果和手术复发的独立危险因素,此外,影响手术复发的独立危险因素还包括独立因素、结石残留和术后并发症.结论:腹腔镜手术治疗胆囊结石合并胆总管结石的手术成功率较高,同时影响胆囊结石合并胆总管结石手术治疗效果的因素较多,应根据患者的具体情况制定相应的方案.     

Urease stones

Summary Urinary stones form as a consequence of urinary supersaturation. Supersaturation occurs as a result of elevated concentrations of urinary solutes. Dietary, metabolic, endocrine, hereditary, and infectious processes alter urinary solute concentrations. Struvite (MgNH₄PO₄. 6H₂O) and carbonate-apatite [Ca₁₀(PO₄)₆CO₃]stones form in urine that becomes supersaturated as a by-product of the hydrolysis of urea by the bacterial enzyme urease. Urease-induced stones manifest primarily as branched renal calculi and as bladder calculi. Conventional therapy has usually consisted of surgical removal of the stone combined with a short course of antimicrobial therapy. Such treatment is curative in about 50% of cases. Recurrent stone formation and progressive pyelonephritis occur in those who are not cured. Adjunctive medical treatment with acetohydroxamic acid or hydroxyurea lessens the risk of calculogenesis and decreases growth of residual stones in patients who are not cured by conventional therapy. Patients with urea-splitting urinary infection and renal stones have a major life-threatening disease. The morbidity and expense that result from this disease are great. Long-term (perhaps lifetime) chemotherapy with antimicrobial agents and/or urease-inhibiting drugs combined with judicious and expert surgical intervention can be expected to significantly improve the plight of these unfortunate patients.Supported in part by grants from the Veterans Administration, the Urolithiasis Laboratory and NIH Grant 1 RO 1 AM20159-O1A1     

Cystine stones

We report on 9 patients, 5 men and 4 women, with cystine stones. Eight were seen previously at other hospitals, and a total of 18 operations were performed for stones before the diagnosis of cystinuria was made and medical treatment instituted. The pathogenesis and rationale for medical treatment is reviewed, and the need for early diagnosis is emphasized.     

Spurious stones

One hundred and sixteen (3.5%) of 3,300 specimens submitted by 72 patients as urinary stones were artifacts, i.e. not formed of accepted constituents of urinary calculi. The laboratory diagnostic methods included infrared and wet chemical analysis, and X-ray diffraction. Twenty-eight were of organic origin and some of these were undoubtedly submitted by accident as calculi. Eighty-eight were of mineral origin, mainly quartz and feldspar, and it is believed that the great majority were submitted for secondary gain or for psychiatric reasons. Ten patients each submitted from 2 to 10 artifacts. Five cases studies are presented which illustrate some confounding clinical and laboratory findings. Spurious stones can lead to difficult clinical and laboratory problems.     

Symptomatic gallbladder stones

In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shockwave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy (LC).Data were analyzed from 55 patients who were treated by ESWL, 45 patients who had CC, and 47 patients who had LC. The study was performed by analysis of patients charts and a written questionnaire.After ESWL 35% of the patients were free of stones, 23% had fragments5mm, and 42% had fragments>5 mm at 1-year follow-up. Persistent complaints were reported by 59% after ESWL, 11% after CC, and 14% after LC (P<0.001). New complaints arose in 12% after ESWL, 11% after CC, and in 5% after LC (P=NS). Patient appreciation score was highest for LC and lowest for ESWL. Mean hospital stay was 2.4 days for ESWL, 10 days for CC, and 3.5 days for LC. Overall costs of treatment were: $5,066 for ESWL; $5,893 for CC; and $3,117 for LC.This study reveals that laparoscopic cholecystectomy is the most effective treatment of the large majority of patients with symptomatic cholelithiasis. ESWL should only be considered in the case of a solitary, relatively small, completely radiolucent stone.