微创治疗方法在输尿管上段结石中应用进展

输尿管上段结石为临床中常见泌尿系结石类型之一,如不能及时诊治,可引起重度积水、泌尿系感染,甚至脓毒血症,对患者肾功能、健康造成严重影响。随着微创治疗技术在泌尿系结石中应用,微创治疗方法能降低对患者造成治疗性创伤,降低相关并发症发生率,促进患者康复,了解临床中微创治疗输尿管上段结石方法,对临床中合理治疗输尿管上段结石有重要价值。     

Fluorescence ureteral navigation during laparoscopic surgery for clinically suspected stage T4 colorectal cancer: A cohort study

BackgroundApproximately 15% of patients with colorectal cancer present with locally advanced tumors (T4 stage). Laparoscopic surgery for stage T4 disease has not yet been established.The near-infrared ray catheter fluorescent ureteral catheter (NIRFUC) is a new device that uses near-infrared fluorescence resin.We examined the utility of fluorescence ureteral navigation (FUN) with the NIRFUC during laparoscopic surgery for stage T4 colorectal cancer.Materials and methodsPatients with stage T4 colorectal cancer (n = 143, from January 2017 to March 2021) were divided into a T4FUN + group, in which the NIRFUC was used (n = 21), and a T4FUN- group, in which the NIRFUC was not used (n = 122). Short-term outcomes were compared between the groups.Next, the laparoscopic surgery rate and incidence of ureteral injury from January 2017 to March 2021 were compared between the T4FUN- group and the non-stage T4FUN- group (n = 434, from January 2017 to March 2021), in which fluorescence ureter navigation was not used.ResultsRectal cancer, stage T4b disease, and invasion into the urinary tract were observed more often in the T4FUN + group than in the T4FUN- group.In the comparisons of the T4FUN + versus T4FUN- groups, the operative time was 398 (161–1090) vs. 256 (93–839) minutes, the blood loss was 10 (1–710) vs. 25 (0–1360) ml, and the ratio of laparoscopic surgery to open surgery was 21:0 vs. 79:43. Postoperative complications (Clavien-Dindo grade ≥ III) were present in 2 (10%; 0 ureteral injury) patients in the T4FUN + group and 13 (11%; 2 ureteral injury) patients in the T4FUN- group.In the T4FUN + group, the operative time was longer (p < 0.0001), but the laparoscopic ratio was higher (p = 0.0002), and the blood loss volume and incidence of ureteral injury tended to be lower.In the comparisons of the T4FUN- versus non-stage T4FUN- groups, the ratio of laparoscopic surgery to open surgery was 79:43 vs. 384:50, the incidence of open conversion was 8 (6.6%) vs. 15 (3.5%), and the incidence of ureteral injury was 2 (1.6%) vs. 0 (0%). In the T4FUN- group, the open surgery rate (<0.0001), open conversion rate (p = 0.0205) and incidence of ureteral injury (p = 0.0478) were high, with a significant difference observed between the groups.ConclusionPatients with stage T4 disease have an increased risk of ureteral injury and are more likely to be converted to open surgery.FUN can help to safely increase the laparoscopic surgery rate while safely visualizing the ureter. FUN is recommended for laparoscopic surgery in patients with stage T4 colorectal cancer.Clinical trial registrationExamination of fluorescence navigation for laparoscopic colorectal cancer surgery; Research Ethics Committee of the Kawaguchi Municipal Medical Center (Saitama, Japan) approval number: 2020-3. https://kawaguchi-mmc.org/wp-content/uploads/clinical research-r02.pdf;     

Ureteral length in live donor kidney transplantation; Does size matter?

The aim of this study was to evaluate the role of ureteral length on urological complications. Data were retrospective collected from the INEX‐trial database, a RCT to compare the intravesical to the extravesical ureteroneocystostomy. Ureteral length was measured in 198 recipients and used to divide recipients into three categories based on interquartile ranges: short (≤8.5 cm), medium (8.6–10.9 cm) and long ureters (≥11 cm). Urological complications were defined as the number of percutaneous nephrostomy placements (PCN). Fifty recipients fell into the short, 98 into the medium and 50 recipients into the long ureter category. Median follow‐up was 26 (range 2–45) months. There was no significant difference in number of PCN placements between the categories. There were 9 (18%) PCN placements in the short ureter category, 21 (20%) in medium ureter category and 10 (21%) in the long ureter category, P = 0.886. Risk factor analysis for gender, arterial multiplicity and type of ureteroneocystostomy showed no differences in PCN placements between the three ureteral length categories. We conclude that ureteral length alone does not seem to influence the number of urological complications.     

“放-放-冲”三步改良尿管拔除模式临床应用

目的:探讨脊柱手术后患者尿管拔除的最佳时机,最大限度减少患者尿潴留及排尿踌躇症状的发生率,缩短术后留置尿管时间。方法:将脊柱手术留置尿管的住院患者360例依据所属责任护士分管床位不同分为观察组、对照组,入组后其他术前术后护理2组相同,观察组采用"放-放-冲"三步尿管拔除模式,对照组采用患者膀胱排空后拔除尿管模式,观察2组患者排尿踌躇症状的发生率即拔管后至首次自然排尿的等待时间以及排尿舒适度、尿潴留发生率。结果:2组在拔管后患者首次自然排尿的等待时间、排尿舒适度评定及尿潴留的发生率方面比较差异具有统计学意义(P0.01)。结论:采用"放-放-冲"三步改良尿管拔除模式可显著缩短患者首次自然排尿的等待时间,提高排尿舒适度并降低尿潴留的发生率。     

腹腔镜输尿管上段切开取石术的技巧及并发症的处理

目的:探讨腹腔镜输尿管切开取石术的手术技巧及常见并发症的处理。方法:回顾性分析2005～2010年间,在我科行腹腔镜输尿管上段切开取石术的89例患者资料,其中15例之前行输尿管镜碎石失败,22例行ESWL失败,其他52例结石大于1.5cm,伴有中到重度肾积水,其中3例孤立肾结石平均大小1.7cm。均经腹腔途径,保留双J管,间断缝合输尿管。结果:无中转开放,86例取出结石,结石清除率96.6%,3例结石漂移,其中1例最终未能处理,2例在输尿管软镜辅助下取出结石。3例患者发生尿漏,均保持引流通畅后自愈,1例严重血尿,保守治疗后缓解。结论:腹腔镜输尿管切开取石术是体外冲击波碎石和输尿管镜碎石术失败后的有效补救术式,也可以作为较大的(>1.5cm)、积水显著的嵌顿结石尤其是孤立肾结石的首选术式,结石清除率高,也较为更安全。