Why laparoscopic cholecystectomy today?

Traditional open cholecystectomy became the gold standard of surgical treatment for symptomatic gallstone disease during the last century. In spite of its good results, clinicians have been trying to establish effective nonsurgical methods of eliminating gallstones. Although oral, percutaneous, or retrograde litholysis can be used effectively for cholesterol stones, these represent only 10% of all gallstones. Moreover, intracorporeal lithotripsy is an invasive method, and while extracorporeal shock wave lithotripsy is a promising procedure, even after careful selection, only 70%–80% of the patients become stone-free within 1 year. In fact, none of the methods which leave the gallbladder intact are free of complications, and they are followed by 50% stone recurrence within 5 years. Since 1987, laparoscopic cholecystectomy has become the procedure of choice as it is safe and only minimally invasive. We believe that the laparoscopic technique is a promising way to the surgery of the future.     

胆道镜联合钬激光碎石治疗肝内外胆管难取性残留结石

目的　探讨经胆道镜钬激光碎石治疗肝内、外胆管难取性残留结石的实用性及安全性。方法　观察 18例胆道术后肝内、外胆管难取性残留结石患者接受胆道镜下钬激光碎石治疗的临床效果 ,并进行随访。结果　经 1～ 4次胆道镜下钬激光碎石治疗 ,18例患者残石全部取尽 ,未出现近期并发症。 16例获得随访 ,随访时间 6个月～ 1年 ,无结石复发和钬激光碎石相关的胆管狭窄出现。结论　经胆道镜钬激光碎石是治疗肝内、外胆管难取性残留结石的一种安全、有效的方法     

Nephrolithiasis associated with autosomal dominant polycystic kidney disease: contemporary urological management

PURPOSE: We evaluate the role of contemporary urological intervention in patients with nephrolithiasis associated with autosomal dominant polycystic kidney disease. MATERIALS AND METHODS: Intervention for upper tract stones associated with autosomal dominant polycystic kidney disease was performed in 5 women and 2 men 29 to 65 years old (mean age 47). Indications for intervention consisted of flank pain in 6 patients and/or hematuria in 2. A total of 12 procedures (mean 1.7 per patient) were performed, including shock wave lithotripsy in 6 patients, percutaneous nephrolithotomy in 2, retrograde endoscopy or manipulation in 3 and extended pyelonephrolithotomy in 1. RESULTS: All patients were rendered stone-free or had only residual "dust." Hospital stay for 5 patients was 1 night or less and there were no complications. Renal function for each patient was stable or improved as measured by serum creatinine. CONCLUSIONS: Most patients with autosomal dominant polycystic kidney disease who require intervention for nephrolithiasis can be safely and effectively treated with essentially any or all contemporary, minimally invasive techniques. The choice of intervention can be based primarily on size and location of the upper tract stones rather than the associated presence of polycystic kidneys.     

Variation in clinical outcome following shock wave lithotripsy

PURPOSE: We measure and compare operator specific success rates of extracorporeal shock wave lithotripsy (ESWL) performed by 12 urologists in 1 unit to determine interoperator variation. MATERIALS AND METHODS: From January 1, 1994 to September 1, 1997 a total of 5,769 renal and ureteral stones received 9,607 ESWL treatments by 15 urologists with a Dornier MFL 5000 lithotriptor. The 3-month followup data are available for 4,409 stones. Outcome measures consisted of patient demographics, stone characteristics, technical details of lithotripsy, and stone-free and success rates by treating urologists. RESULTS: Treatment results were analyzed for 12 urologists (surgeons A to L) who treated more than 100 stones each, totaling 4,244 with followup information available. Mean stone-free and success rates were 50.6% and 72.3%, respectively. Surgeon A had significantly higher stone-free and success rates of 56.2% and 76.7%, respectively (p<0.05), with treatment results from 877 stones, which was a significantly higher number than others (p<0.05). Significant differences existed in mean number of shocks delivered among urologists (p = 0.0001), with surgeons A and J delivering the highest mean numbers (2,317 and 2,801, respectively). There was no difference in treatment duration (p = 0.75) but variation existed among urologists in terms of mean maximum treatment voltage (p = 0.0001). Mean fluoroscopy time at 4.1 minutes was higher for surgeon A than others (p<0.05). Mean complication rate following ESWL was 4.9% with no difference among urologists (p = 0.175). Re-treatment was required in 21.7% of cases and surgeon A had the lowest rate (15.9%, p<0.05). CONCLUSIONS: We demonstrated clinically and statistically significant intra-institutional differences in success rates following ESWL. The best results were obtained by the urologist who treated the greatest number of patients, used a high number of shocks and had the longest fluoroscopy time. Accurate targeting is crucial when using a lithotriptor, such as the Dornier MFL 5000, with a narrow focal zone of 6.5 mm. in diameter. Other centers should be encouraged to develop similar programs of outcome analysis in an attempt to improve performance.     

经尿道输尿管镜气压弹道碎石治疗输尿管结石160例分析

目的探讨经尿道输尿管镜气压弹道碎石术治疗输尿管结石的临床疗效。方法经尿道在输尿管镜窥视下采用气压弹道碎石机对160例输尿管结石患者进行碎石治疗。结果152例原位碎石成功,成功率为95.0%,术后1￣3个月结石排净率100%。术中主要并发症输尿管穿孔3例,黏膜下损伤4例。结论经尿道输尿管镜气压弹道碎石术治疗输尿管结石有效、安全、微创。     

低能量长间距ESWL治疗尿路结石1200例报告

目的探讨低能量长间距冲击波技术在体外冲击波碎石(ESWL)中的应用以及X线、B超双定位技术在ESWL中的优势。方法应用低能量长间距冲击波及X线、B超双定位技术进行ESWL1200例。结果总碎石成功率为99.5%,3个月结石排净率为83.6%。结论低能量长间距冲击波技术碎石率高、组织损伤小、无严重并发症。X线、B超双定位技术值得推广。     

输尿管镜气压弹道碎石治疗输尿管结石(附200例报告)

目的总结输尿管镜气压弹道碎石术（URSL）治疗输尿管结石的疗效。方法回顾性分析200例采用输尿管镜气压弹道碎石治疗输尿管结石患者的资料。结果碎石成功率为96％（192／200），其中一次性碎石成功率为90．5％（181／200），4～7W内结石全部排尽。8例失败者中5例合并输尿管狭窄，其中2例因操作困难，视野不清直接改开放手术，3例碎石成功，因术后放置双J管失败改开放手术；结石移位造成手术失败3例，其中1例改开放手术，2例结石移位入肾孟，留置双J管后行ESWL治疗；74例（37％）术后有肉眼或镜下血尿，多于1～2d内消失，200例均无穿孔、感染等并发症。结论输尿管镜气压弹道碎石术（URSL）治疗输尿管结石疗效确切、安全、组织损伤小、清除彻底、并发症少，可作为输尿管中段和下段结石的首选治疗方法。     

输尿管镜下气压弹道碎石术治疗146例输尿管中下段结石

目的:探讨在输尿管镜下气压弹道碎石术治疗输尿管中下段结石的疗效及临床价值。方法:回顾性分析经输尿管镜气压弹道碎石术治疗输尿管中下段结石146例。结果:一次性碎石成功率95%(138/146),2例联合应用体外震波碎石(ESWL)术成功(1.4%),因结石质硬失败6例(4.2%)。结论:输尿管镜气压弹道碎石术治疗输尿管中下段结石具有安全、可靠、创伤小及并发症少等优点,可作为输尿管中下段结石的首选方法。     

经皮肾镜气压弹道碎石术治疗肾结石的护理

经皮肾镜气压弹道碎石术（PCNL）是治疗肾结石的有效手段。手术过程中出血少．结石清除率高，对肾脏影响很小，逐步取代了传统的开放手术，成为肾蛄石的主要治疗方法。2010年1月~2011年6月，我科应用PCNL治疗肾结石52例，效果满意。现将结果报告如下。