残余胆囊结石6例诊治分析

目的 探讨残余胆囊结石的原因、诊治及预防.方法 回顾性分析绍兴市人民医院2016年10月至2019年12月收治的6例残余胆囊结石患者的临床诊治经过,分析其发生原因,探讨诊治方法及预防措施.结果 6例残余胆囊结石患者中,2例行腹部B超检查,其中1例证实为残余胆囊结石;所有患者行腹部增强CT检查,均证实为残余胆囊结石;3例...     

ESWL治疗输尿管石街的研究

目的：总结分析输尿管石街ESWL的技巧与方法,旨在提高其单纯ESWL的成功率。方法：将117例输尿管石街分为粉末型（26例）,蛇头型（72例）,石块型（19例）。不同类型的石街按不同治疗方法处理。结果：①粉末型石街长度≤5cm 21例,仅药物对症排石治疗2周排净13例,4周排净8例;长度〉5cm5例,ESWL一次2周排净3例,4周排净2例。②蛇头型石街72例,其中ESWL一次2周排净38例,4周排净22例,3个月排净5例,有7例2周复查时行第二次ESWL,2～4周复查均排净。③石块型石街19例,ESWL一次2周排净3例,4周排净4例,3个月排净5例;其中有7例2周复查时行第二次ESWL,4周复查排净3例,4例行第三次ESWL,2例2个月排净,1例3个月复查排净,1例历时半年排净。上述117病例中有9例出现患侧肾绞痛或（和）发热、明显肉眼血尿,予抗炎解痉等对症治疗或感染控制后即予ESWL,症状均缓解或消失,余病例均无严重并发症。结论：ESWL治疗输尿管石街具有清除率高、损伤少、安全性高、并发症少、可重复治疗等优点,对于碎石机性能较好、ESWL技术成熟的医疗单位,尤其对于无腔内微创治疗条件的医院,目前仍可作为首选的治疗方法。     

Near-infrared fluorescence guided laparoscopic cholecystectomy in the spectrum of complicated gallstone disease

ICG fluorescence (ICGF) guidance during laparoscopic cholecystectomy (LC) is gaining wider acceptance. While the accruing data largely addresses ICGF guidance during LC in patients with uncomplicated gallstone disease (UGS) and acute cholecystitis, there is a paucity of data related for complicated gall stone disease (CGS) such as choledocholithiasis, bilio-enteric fistula, remnant gall bladder, etc. The purpose of this study was to evaluate the role of ICGF during LC in the spectrum of CGS with state of the art 4 chip camera system. Retrospective review from a prospectively maintained database of all patients who underwent ICGF guided LC during the period June 1^st, 2019 till December 30^th, 2021 formed part of the study. Clinical profile and findings on ICGF during LC for CGS were studied. The data was studied to evaluate the potential roles of ICGF during LC for CGS. Of 68 patients, there were 29 males and 39 females. Among them were 32 and 36 in the uncomplicated and complicated gallstone disease groups, respectively. ICGF showed CBD visualization in 67(98.5%) and cystic duct in 62(91%). ICGF guidance helped in management of CGS, prior to, during and after completion of LC. It had novel application in patients undergoing CBD exploration. In our small series of patients with CGS, ICGF guidance enabled a LC and laparoscopic subtotal cholecystectomy in 94% and 6% of patients respectively. The study highlights potential roles and advantages with ICGF guided laparoscopic management for CBD stones, bilioenteric fistula, completion cholecystectomy and cystic duct stones. Large scale multicenter prospective studies are required to clarify the role of ICGF in the wide spectrum of CGS.     

输尿管支架在肾移植中的应用

肾移植术后易发生输尿管狭窄、尿漏等泌尿系统并发症,严重影响移植肾功能,甚至导致移植肾丢失。输尿管支架在肾移植中发挥着重要作用,其通过促进肾移植术后尿液从肾脏流入膀胱,减轻输尿管内压力,降低早期泌尿系统并发症的发生风险,但也可能造成尿路感染、支架相关并发症和BK病毒感染等不利影响。因此临床医师需要灵活把握输尿管支架移除指征。本文对肾移植领域输尿管支架的应用、可能带来的不利影响及移除时机做一综述,旨在为肾移植术后输尿管支架相关的临床决策提供参考。     

腹腔镜胆总管探查T管引流术治疗急性重症胆管炎

目的探讨腹腔镜胆总管探查T管引流术(laparoscopic common bile duct exploration with T tube drainge,LCTD)治疗急性重症胆管炎(acute cholangititis of severe type,ACST)的可行性和安全性,探讨LCTD治疗ACST时的手术适应证、手术时机的选择、手术要点和注意事项。方法回顾分析2009年1月至2017年10月中航工业西安医院肝胆外科采用LCTD治疗的27例ACST病人临床资料。结果 27例ACST病人均顺利完成LCTD手术,无中转开腹。术后发生胆漏1例,肺梗死1例,胆总管结石复发并再次发生ACST1例,二次行LCTD而治愈。结论 ACST是急危重症病人,需要早期手术干预,只要病例选择适当,手术时机选择合理,LCTD应用于ACST是安全可行的,并且具有创伤小、恢复快的优点。     

微创经皮肾镜钬激光碎石治疗的肾结石患者手术配合要点及护理体会

目的:总结行微创经皮肾镜钬激光碎石(MPCNL)治疗的肾结石患者手术配合要点及护理体会。方法:根据不同护理方案将106例行MPCNL治疗的肾结石患者分为研究组和对比组,各53例。对比组给予常规护理,研究组给予优质手术配合及护理,比较两组护理效果。结果:研究组首次取石成功率、护理满意度评分均优于对比组,差异有统计学意义(...     

前尿道憩室合并结石5例报告

目的　总结前尿道憩室合并结石的诊断治疗体会。方法　对 5例前尿道憩室合并结石行手术治疗后进行回顾性分析。结果　 4例行尿道憩室切除尿道修补术 ,取出全部结石 ,1例行尿道憩室造口术 ,取出结石 ,3个月后行尿道成形术。结论　尿道平片 +尿道造影简单可靠。手术应视具体情况选择方法