加长型鞘在MPCNL治疗嵌顿性输尿管上段结石中的应用

目的：探讨加长型鞘在MPCNL术治疗嵌顿性输尿管上段结石中的应用效果。方法：回顾性分析本院2010年1月-2013年12月经MPCNL治疗嵌顿性输尿管上段结石112例患者的临床资料，其中2010年1月-2012年2月的60例作为对照组，术中仅用普通peel-away鞘，2012年3月-2013年12月的52例作为加长型鞘组，在普通peel-away鞘基础加用加长型鞘，观察比较两组患者的手术时间、术中出血量、术后并发症发生情况。结果：加长型鞘组的手术时间、术中出血量均明显少于对照组，术后并发症发生率明显低于对照组，差异均有统计学意义（P〈0.05）。结论：应用加长型鞘能明显提高MPCNL治疗嵌顿性输尿管上段结石的有效率，且安全性更高，值得临床推广应用。     

基于全科医生视角的《2020年美国风湿病学会痛风治疗指南》解读

近年来，国内外痛风治疗指南不断更新，使痛风诊治逐渐变得规范。随着《2020年美国风湿病学会痛风治疗指南》的公布，一些模糊的概念越来越清晰。痛风作为一种常见病、多发病，全科医生在痛风的治疗中起着至关重要的作用。本文将从全科医生的角度论述《2020年美国风湿病学会痛风治疗指南》，并与我国最新版痛风治疗指南进行对比，为全科医生诊治痛风提供参考建议。     

腹腔镜胆总管探查胆总管一期缝合54例体会

目的探讨胆道探查术后一期缝合胆总管的可行性及手术指征和手术方法。方法 2010年12月~2015年6月,采用联合腹腔镜及胆道镜实施胆总管切开取石、胆总管一期缝合术54例。结果根据术前病历选择标准实施的54例手术均获得成功,手术时间68~137 min,平均92 min。术中出血20~150 m L,平均82 m L;术后住院5~14天,平均6.8天。3例术后胆漏,经腹腔引流1周至12天后痊愈,其余51例术后48~72 h拔出腹腔引流管。术后随访1个月至3年,复查彩超均未发现结石残留及胆道狭窄。结论腹腔镜胆总管探查胆总管一期缝合术治疗胆总管结石具有创伤小、住院时间短及并发症少的优势,但应严格把握适应证及掌握操作技巧。     

弹道碎石技术在鹿角型肾结石开放手术中的应用(附52例分析)

目的:介绍弹道碎石技术在鹿角型肾结石开放手术中的应用效果。方法:回顾性分析52例鹿角型肾结石患者的临床资料。结果:成功完整取石47例,成功率为90.38%,出血量60～470 ml,平均出血约160 ml,手术时间93～189 min,平均134 min。结论:应用弹道碎石技术在肾鹿角型结石开放手术中可以提高取石率并减少出血量。     

开腹胆道旁路手术治疗胆管癌的效果分析

目的：探讨开腹胆道旁路手术治疗胆管癌的效果。方法60例胆管癌患者，根据随机数字表法分为治疗组与对照组，各30例。对照组采用传统手术切除治疗，治疗组采用开腹胆道旁路手术治疗。结果所有患者都顺利完成手术，治疗组的术中出血量、术后住院时间、术后下床活动时间与术后肛门排气时间明显低于对照组（P＜0．05），而2组手术时间对比差异无统计学意义。2组术前的血清总胆红素值都呈现为高位状况，术后都明显降低（P＜0．05），同时术后治疗组的血清总胆红素值明显低于对照组（P＜0．05）；治疗组术后切口感染、肺部感染、胆漏、低氧血症、粘连性肠梗阻等并发症发生率明显低于对照组（P＜0．05）。术后随访6个月，治疗组复发率为0，对照组为16．7％，治疗组复发率明显低于对照组（P＜0．05）。结论开腹胆道旁路手术治疗胆管癌具有明显的微创优势，能促进胆功能的恢复，减少术后并发症的发生与远期复发率，值得推广应用。     

Role of Oxalobacter formigenes in preventing calcium oxalate kidney stones

Objective To screen Oxalobacter formigenes (OxF) from fresh feces of healthy adults, and study its effect on the the prevention of calcium oxalate kidney stones. Methods OxF was screened and cultured from fresh feces of healthy adults. The rat model of calcium oxalate stone was established by esophageal gavage of 0.8% of ethylene glycol. Rats were divided into a control group and four groups of rats with ethylene glycol-induced calcium oxalate kidney stones according to random number table. Three groups were treated with 106 CFU, 107 CFU, 108 CFU viable OxF every day, respectively, for 4 weeks. The blood and 24-hour urine samples were collected to detect the serum creatinine, urea nitrogen, serum and urine calcium, phosphorus, magnesium and urine oxalate every week. At the end of the 4th week, the rats were sacrificed and the kidney tissues were stained with HE and Yasue. The deposition and content of calcium oxalate crystals were observed under a light microscope. Results The bacteria strain isolated from fresh feces of healthy adults was 100% as same as the known ATCC35274 bacteria strain, which means the strain screened is OxF. Among the 5 groups, there were no significant differences in body weight, Scr, BUN, serum calcium, blood magnesium, blood phosphorus, urinary magnesium and urinary phosphorus. The 24-hour urinary calcium excretion in the model group was significantly lower than that of the control group (P＜0.05). After intervention with OxF solution, the 24-hour urinary calcium excretion in the 108 CFU OxF group was significantly higher than that in the model group (P＜0.05), while there was no significant difference between the other intervention groups and the model. The oxalic acid excretion of 106 CFU OxF group and 107 CFU OxF group was lower than that of the model, but the difference did not reach statistical significance (P＞0.05). The 24 h oxalic acid excretion in the 108 CFU OxF group was significantly lower than that of the model at the end of first week (P＜0.05), and continued to decrease for the next 3 weeks. After 4 weeks of intervention, no crystal formation was observed in the control group under the deflection microscope, but a large amount of calcium oxalate crystals were formed in the renal cortex and renal medulla. The crystals were piled up and connected to each other. Yasue staining coincided with the calcium oxalate crystal in the same part of the kidneys. Compared with the model, there was no significant change in the score of calcium oxalate crystal in the kidneys of 106 CFU OxF group and 107 CFU OxF group, while the score of calcium oxalate crystal in the kidneys of 108 CFU OxF group was significantly lower (P＜0.05). Conclusions OxF are successively screened from healthy adults. Daily administration of 108 CFU OxF can safely and effectively reduce the urinary oxalic acid excretion, prevent the formation of calcium oxalate crystals and inhibit the formation of stones in kidneys of rats.     

输尿管封堵器联合气压弹道碎石治疗输尿管结石的临床研究

目的探讨输尿管封堵器联合气压弹道碎石在输尿管结石治疗中的临床疗效。方法将该院收治的78例输尿管结石患者随机分为观察组40例和对照组38例,对照组采用气压弹道碎石术,观察组采用输尿管封堵器联合气压弹道碎石术。对比两组患者手术疗效、手术时间、住院时间、血尿时间以及治疗后BUN、Cr水平变化和两组患者不良反应发生情况。结果两组一次性碎石率比较χ2=5.5038(P=0.0190);两组1个月结石排净率比较χ2=8.6771(P=0.0032);两组需再次手术患者例数比较χ2=11.9114(P=0.0006);两组有效患者例数比较χ2=14.4866(P=0.0001)。两组患者手术时间比较t=7.9142(P=0.0000);两组患者住院时间比较t=6.0797(P=0.0000);两组患者血尿时间比较t=5.2690(P=0.0000);两组BUN水平比较t=1.3569(P=0.1788);两组Cr水平比较t=4.3967(P=0.0000)。两组患者术后恶心、呕吐例数比较χ2=6.7818(P=0.0092);两组患者术后发热例数比较χ2=8.2611(P=0.0041);两组患者术后血尿例数比较χ2=8.6771(P=0.0032);两组患者术后肾绞痛例数比较χ2=14.5142(P=0.0001)。结论输尿管封堵器联合气压弹道碎石治疗输尿管结石,能提高碎石成功率,值得临床上广泛应用。     

Percutaneous transhepatic Laser lithotripsy for intrahepatic cholelithiasis

PurposeTo report the technical success, complications and long-term outcomes of patients with intrahepatic cholelithiasis not amenable to endoscopic retrograde cholangiopancreatography (ERCP) who were treated with percutaneous transhepatic biliary Laser lithotripsy (PTBLL).Patients and methodsA retrospective review of 12 patients who underwent PTBLL for intrahepatic cholelithiasis was performed. There were 5 men and 7 women with a mean age of 46 ± 18 (SD) years (range: 23–75 years). PTBLL was performed when stone clearance using ERCP had previously failed or was not appropriate due to unfavourable anatomy or the presence of multiple stones or a large stone. Percutaneous biliary access into intrahepatic ducts was obtained if not already present and lithotripsy was performed using a HolmiumYAG 2100 nM Laser. Patients files were analyzed to determine the technical success, complications and long-term outcomes.ResultsEleven patients (11/12; 92%) had a history of previous hepatobiliary surgery and nine (9/12; 75%) had multiple stones confirmed on preprocedure imaging. A 100% success rate in fragmenting the target stone(s) was achieved and 11/12 patients (92%) had successful first pass extraction of target stone fragments. Two patients (2/12; 17%) required repeat lithotripsy. One patient (1/12; 8%) experienced a major complication in the form of cholangitis. Of patients with long-term follow-up, 4/10 (40%) had recurrence of intrahepatic calculi with a mean time interval of 31 months (range 3–84 months).ConclusionFor patients with intrahepatic biliary calculi not amenable to ERCP, PTBLL provides an effective and safe alternate treatment.