Percutaneous nephrolithotripsy under assisted local anaesthesia for high risk patients: Is it effective?

ObjectivesThe aim of the present study is to evaluate the feasibility and safety of performing PNL under local anesthesia in a selected group of patients who are at high risk for general anesthesia.Patients and methodsForty seven patients underwent PNL under local anesthesia. There were 38 males and 9 females with a mean age of 62 years. All patients were at medical high-risk for general anesthesia, with an American Society of Anesthesiologists (ASA) score of 3. The indications for local anesthesia in this study were obstructed single functioning kidney with azotemia in 29 patients, hepatic insufficiency in 8 patients, cardiac problems in 7 patients and 3 patients had hepatocellular carcinoma. The mean stone size was 2.7 cm (range 2–3.1 cm). Local infiltration with 10–20 cc of 2% lidocaine at the site of puncture was used in all cases. Narcotics were given 30 min prior to the procedure and medazolam was given intraoperatively upon demand. Utrasound guided puncture was performed in all cases and tract dilatation was then done under fluoroscopy using high pressure balloon catheter in 35 and Alken's metal dilators in 12 cases. Stones were then retrieved after disintegration in the same cession in 33 patients, while the other 14 patients underwent staged PNL, where a 12 Fr. nephrostomy tube was placed in the first stage, followed by tract dilatation and stone retrieval one week later.ResultsOut of 47 patients included, 44 had successful PNL either one stage (30 patients) or two stages (14 patients). Only 3 patients could not tolerate pain and the procedure was terminated after placement of nephrostomy tube and stone retrieval was completed later under general anesthesia.ConclusionOur results demonstrated that PNL under local anesthesia with narcotics and sedatives seems to be a satisfying solution for the treatment of a selected group of patients with renal pelvic stones and who have high anesthetic risk. However, additional studies with different groups of patients are required to validate our results.     

Bedside score predicting retained common bile duct stone in acute biliary pancreatitis

BACKGROUND Retained common bile duct(CBD) stone after an acute episode of biliary pancreatitis is of paramount importance since stone extraction is mandatory.AIM To generate a simple non-invasive score to predict the presence of CBD stone in patients with biliary pancreatitis.METHODS We performed a retrospective study including patients with a diagnosis of biliary pancreatitis. One hundred and fifty-four patients were included. Thirty-three patients(21.5%) were diagnosed with CBD stone by endoscopic ultrasound(US).RESULTS In univariate analysis, age(OR: 1.048, P = 0.0004), aspartate transaminase(OR:1.002, P = 0.0015), alkaline phosphatase(OR: 1.005, P = 0.0005), gamma-glutamyl transferase(OR: 1.003, P = 0.0002) and CBD width by US(OR: 1.187, P = 0.0445)were associated with CBD stone. In multivariate analysis, three parameters were identified to predict CBD stone;age(OR: 1.062, P = 0.0005), gamma-glutamyl transferase level(OR: 1.003, P = 0.0003) and dilated CBD(OR: 3.685, P = 0.027),with area under the curve of 0.8433. We developed a diagnostic score that included the three significant parameters on multivariate analysis, with assignment of weights for each variable according to the co-efficient estimate. A score that ranges from 51.28 to 73.7 has a very high specificity(90%-100%) for CBD stones, while a low score that ranges from 9.16 to 41.04 has a high sensitivity(82%-100%). By performing internal validation, the negative predictive value of the low score group was 93%.CONCLUSION We recommend incorporating this score as an aid for stratifying patients with acute biliary pancreatitis into low or high probability for the presence of CBD stone.     

Ureteroscopy for treatment of obstructing ureteral calculi in pregnant women: Single center experience

ObjectivesTo evaluate our experiences with ureteroscopic treatment of ureteral calculi in pregnancy.Patients and methodsBetween April 2006 and October 2013, 41 pregnant women with persistent renal colics and/or hematuria refractory to conservative measures were treated with ureteroscopy. The patients’ mean age was 23 (range 19–37) years. Most of the patients (56.1%) presented in the 2nd trimester.Loin pain and colic were the most common presenting symptoms (90.2%). Twenty-seven patients (65.9%) had an obstruction on the right side. All patients underwent ureteroscopy under epidural anesthesia.ResultsUreteroscopy revealed the presence of ureteric stones in 36 of the 41 cases. The stone size ranged from 5 to 16 (mean 8.9) mm. Distal ureteric stones were found in 29 patients. The pneumatic lithoclast was used for stone fragmentation in 22 of them (75.9%), while the stone was directly extracted in 4 patients. In 3 patients the stone migrated proximally and was not accessible any more. Proximal ureteric stones were detected in 7 of the remaining 12 cases. When attempting to manipulate these stones, they migrated more proximally and became unreachable. In the last 5 patients the entire ureter was free of stones; they only had edema at the ureteric orifice. A long lasting JJ stent was left until the end of the pregnancy in all cases with migrated inaccessible stones. In all patients successfully treated, a JJ stent with dangle extraction strings was left for two weeks. Minor urologic complications were encountered in the form of mild dysuria in 12 cases (29.2%) and mild hematuria in 5 cases (12.2%). All patients completed their pregnancy until full term without any serious obstetric complications requiring intervention.ConclusionUreteroscopy is a safe and effective therapeutic option for the treatment of obstructing ureteral stones in pregnancy with stone-free and complication rates comparable to the non-pregnant population.     

保留胆囊对胆总管结石合并胆囊结石患者经内镜逆行胰胆管造影术后恢复的影响

目的探讨保留胆囊对胆总管结石合并胆囊结石患者经内镜逆行胰胆管造影术(ERCP)后恢复的影响。方法回顾性分析我院2016年1月至2019年1月收治的80例胆总管结石合并胆囊结石患者,所有患者均行ERCP术取石,依据胆囊是否切除分为胆囊保留组(37例)和胆囊切除组(43例),比较两组肠道恢复时间、住院时间、住院费用、生活质量[体力状况评分(ZPS)、功能状态评分(KPS)]及胆道事件发生率。结果胆囊保留组肠道恢复时间、住院时间、住院费用显著少于胆囊切除组(P<0.05);胆囊保留组ZPS评分显著低于胆囊切除组(P<0.05),KPS评分显著高于胆囊切除组(P<0.05);胆囊切除组胆道事件发生率为13.95%,胆囊保留组胆道事件发生率为21.62%,两组比较无显著差异(P>0.05)。结论保留胆囊能够缩短胆总管结石合并胆囊结石患者ERCP术后肠道恢复时间、住院时间,减少住院费用,促进术后恢复,提高生活质量,因此针对不存在胆囊切除绝对手术指征患者,推荐ERCP术取石后保留胆囊。     

延续性护理干预对降低泌尿系结石患者复发率的影响

目的探讨延续性护理干预对降低泌尿系结石患者复发率的影响。方法选择2016年2月至2017年6月250例在达州市中西医结合医院进行治疗的泌尿系结石患者,采用随机数字表法将患者分为两组,每组各125例。对照组实施常规护理,观察组在此基础上加以延续性护理。对比两组患者的复发率、自我护理能力及治疗依从性。结果对照组复发率为14. 4%,明显高于观察组的4. 0%(P<0. 05)。干预后两组患者心理、躯体活动、饮食及治疗方面自我护理能力均得到明显提升,但观察组提升幅度更大(P<0. 05)。观察组治疗依从良好率为96. 0%,明显高于对照组的88. 0%(P<0. 05)。结论延续性护理较常规护理可明显降低泌尿系结石患者复发率,提高其自我护理能力及治疗依从性。     

Pitfalls in urinary stone identification using CT attenuation values: Are we getting the same information on different scanner models?

Introduction

Evaluate the capability of different Computed Tomography scanners to determine urinary stone compositions based on CT attenuation values and to evaluate potential differences between each model.

Methods

241 human urinary stones were obtained and their biochemical composition determined. Four different CT scanners (Siemens, Philips, GEMS and Toshiba) were evaluated. Mean CT-attenuation values and the standard deviation were recorded separately and compared with a t-paired test.

Results

For all tested CT scanners, when the classification of the various types of stones was arranged according to the mean CT-attenuation values and to the confidence interval, large overlappings between stone types were highlighted. The t-paired test showed that most stone types could not be identified. Some types of stones presented mean CT attenuation values significantly different from one CT scanner to another. At 80 kV, the mean CT attenuation values obtained with the Toshiba Aquilion were significantly different from those obtained with the Siemens Sensation. On the other hand, mean values obtained with the Philips Brilliance were all significantly equal to those obtained with the Siemens Sensation and with the Toshiba Aquilion. At 120 kV mean CT attenuation values of uric acid, cystine and struvite stones obtained with the Philips model are significantly different from those obtained with the Siemens and the Toshiba but equal to those obtained with the GE 64.

Conclusions

According to our study, there is a great variability when different brands and models of scanners are compared directly. Furthermore, the CT scan analysis and HU evaluation appears to gather insufficient information in order to characterize and identify the composition of renal stones.     

腹腔镜治疗胆囊颈部结石临床体会

目的探讨腹腔镜胆囊切除术胆囊颈部结石的处理方法。方法 2002年10月至2008年10月间,我们对286例胆囊颈部结石分别采用腹腔镜胆囊顺行切除、逆行切除和顺逆结合切除术治疗。结果手术均获成功,术后恢复顺利,无严重并发症出现。结论腹腔镜胆囊切除术中对不同情况的胆囊颈部结石采用不同的处理方法,可以有效避免术中胆管损伤等严重并发症。     

中西医结合治疗多发肾结石临床观察

目的观察中西医结合治疗多发肾结石的疗效。方法将2005年10月～2012年8月收治的90例多发单侧肾结石患者随机分为治疗组和对照组,每组45例。治疗组采用中药金钱草颗粒配合经皮肾镜钬激光碎石治疗多发肾结石,术后口服金钱草颗粒1个月,对照组仅单纯使用经皮肾镜钬激光碎石治疗,两组患者均于手术后3个月后复查B超、卧位腹平片,根据结石治疗标准评价治疗效果。结果治疗组有效率为95.6%,对照组为80%,两组比较差异有统计学意义(P<0.05)。两组均未见明显不良反应。结论中药金钱草颗粒配合经皮肾镜钬激光碎石治疗多发肾结石使用安全,效果好,结石排净率高。