肾结石患者血清中纳米细菌的分离与培养

目的分离培养肾结石患者血清中纳米细菌,探讨纳米细菌感染与肾结石发病之间的关系。方法取40例肾结石患者血清,经0．22μm滤膜过滤后,用RPNI 1640细胞培养基于37℃,5％CO2环境中培养,用显微摄影技术记录结果;以40例健康成人血清为对照。结果22例（55％）肾结石患者血清、8例（20％）对照血清中分离到纳米细菌。经X^2检验,差异具有显著性（P〈0．05）。结论肾结石患者血清中纳米细菌检出率高于正常人血清,提示纳米细菌感染与肾结石发生可能有关。     

Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography

AIM: To describe characteristics of a poorly expandable (PE) common bile duct (CBD) with stones on endoscopic retrograde cholangiography.METHODS: A PE bile duct was characterized by a rigid and relatively narrowed distal CBD with retrograde dilatation of the non-PE segment. Between 2003 and 2006, endoscopic retrograde cholangiography (ERC) images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Center in Chang Gung Memorial Hospital. Patients with characteristic PE bile duct on ERC were identified from the database. Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS: A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study. The median patient age was 45 years (range, 20 to 92 years); 66.7% of the patients were men. The diameters of the widest non-PE CBD segment, the PE segment, and the largest stone were 14.3 ± 4.9 mm, 5.8 ± 1.6 mm, and 11.2 ± 4.7 mm, respectively. The length of the PE segment was 39.7 ± 15.4 mm (range, 12.3 mm to 70.9 mm). To remove the CBD stone(s) completely, mechanical lithotripsy was required in 25 (83.3%) patients even though the stone size was not as large as were the difficult stones that have been described in the literature. The stone size and stone/PE segment diameter ratio were associated with the need for lithotripsy. Post-ERC complications occurred in 4 cases: pancreatitis in 1, cholangitis in 2, and an impacted Dormia basket with cholangitis in 1. Two (6.7%) of the 28 patients developed recurrent CBD stones at follow-up (50 ± 14 mo) and were successfully managed with therapeutic ERC.CONCLUSION: Patients with a PE duct frequently require mechanical lithotripsy for stones extraction. To retrieve stones successfully and avoid complications, these patients should be identified during ERC.     

Gall Stone Ileus with Acute Kidney Injury—A Case Report

Abstract

Gall stone ileus is a rare serious complication of cholelithiasis. We report a case of cholecystoduodenal fistula presenting as gall stone ileus with acute kidney injury which was managed successfully.     

A review of treatment options for bile duct stones

Introduction: Approximately 10–15% of bile duct stones cannot be treated using conventional stone removal techniques. For difficult common bile duct stones (CBDS), various endoscopic techniques have been developed. This review covers technical tips and endoscopic treatments including Endoscopic retrograde cholangiopancreatography (ERCP), particularly under Endoscopic ultrasound (EUS) guidance.

Areas covered: Literatures about endoscopic treatment for bile duct stone were searched in Pub Med. As novel methods, EUS-guided approaches have also been reported, although long-term results and prospective evaluation are not yet sufficient. Large stones may need fragmentation prior to removal, to prevent stone impaction. To perform fragmentation, mechanical lithotripsy, extracorporeal shock wave lithotripsy or laser lithotripsy techniques are available.

Expert commentary: Despite the fact that most bile duct stones can be treated using endoscopic techniques, endoscopists should remind to be able to select the temporary biliary stenting or percutaneous transhepatic cholangiodrainage as an option.     

巨大膀胱尿酸性结石1例报告并文献复习

膀胱结石是临床常见病、多发病,但本例患者膀胱结石长到如此巨大且为纯尿酸性极为罕见,经治疗后好转出院.现将病例及巨大膀胱尿酸性结石的形成、特点、危害、防治总结如下,以提高临床医生的重视程度.     

Medium and long-term complications difference between laparoscopic transcystic common bile duct exploration versus endoscopic sphincterotomy against choledocholithiasis: A protocol for systematic review and meta-analysis

Background:Common bile duct stone (CBDS) is typically manifested with abdominal pain, chills, fever, and jaundice. Laparoscopic transcystic common bile duct exploration (LTCBDE) and endoscopic sphincterotomy (EST) are currently the main minimally invasive methods for the treatment of CBDS. However, there are few studies about the differences of medium and long-term complication after EST or LTCBDE. Therefore, we will conduct a meta-analysis and systematic review to systematically evaluate the difference of medium and long-term complications between EST and LTCBDE against CBDS.Methods:Randomized controlled trials of EST or LTCBDE against CBDS will be searched in several English and Chinese databases with the following vocabularies: “laparoscopic transcystic common bile duct exploration,” “endoscopic sphincterotomy,” “choledocholithiasis,” “common bile duct stone” until December, 2020. Two reviewers will independently conduct the literature extraction, risk of bias assessment, and statistical analysis.Results and Conclusions:The study will help to systematically evaluate the difference of medium and long-term complication between EST and LTCBDE against CBDS.OSF Registration number:DOI 10.17605/OSF.IO/5U7SA.     

经十二指肠镜括约肌切开胆总管结石的处理(附168例报告)

目的：采用各种方法处理不同大小的胆总管结石。方法：于1986年3月至1996年9月经内镜括约肌切开（EST）治疗胆总管结石168例，其中单颗结石63例，2颗结石56例，3颗以上结石49例，最多一例8颗结石，结石的直径为5～25mm不等。结果：165例（98．2％）切开成功，3例失败。161例（95．8％）结石排出，其中96例（59．6％）结石自然排入肠道，57例（35．4％）采用网篮或气囊取出结石，6例（3．7％）采用碎石网篮碎石后排出，2例（1．2％）经震波碎石后排出。术后出现胃肠道出血1例（0．6％），胰腺炎1例（0．6％），胆管炎3例（1．8％）。48例术后行胃肠钡餐检查，43例胆道内无钡剂返流，2例胆道内有积气，3例有钡剂返流入胆道，但无临床症状。结论：EST是目前治疗胆管结石的重要手段之一。     

The evaluation and management of urolithiasis in the ED: A review of the literature

Background

Urolithiasis is a common condition in the U.S. Patients frequently present to the emergency department (ED) for care, including analgesia and treatments to facilitate stone passage.