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经输尿管软镜钬激光治疗盆腔异位肾伴结石一例

医护合作-快速康复模式在经输尿管镜钬激光碎石术中的应用及效果评价

目的 探讨医护合作-快速康复模式在经输尿管镜钬激光碎石手术中的临床应用及效果的评价。 方法 将 2015 年 10 月—2016 年 3 月入住的 166 例输尿管结石患者随机分为对照组和试验组各 83 例，对照组按传统方法进行住院治疗及围手术期护理，试验组按照医护合作-快速康复模式进行诊治及护理，包括门诊评估、术前检查的完善、麻醉评估、流程办理、家庭护理的注意事项、围手术期的饮食活动指导和疼痛管理、健康保健等。比较两组患者的住院时间、住院费用、术后并发症、术后首次进食时间和满意度的差异。 结果 试验组患者住院时间[（22.46±0.89）h]少于对照组[（76.46±0.75）h]，住院费用[（8 275.21±789.45）元]低于对照组[（12 859.11±1 047.54）元]，并发症发生率[10.8%（9/83）]低于对照组[41.0%（34/83）]，患者满意度[（99.87±5.12）%]高于对照组[90.66±5.95）%]，差异均有统计学意义（P<0.05）。 结论 医护合作-快速康复模式应用于输尿管镜钬激光碎石手术，能充分利用医疗资源，促进医患关系协调，缩短患者的住院日，减少患者的住院费用，降低术后并发症的发生，促进术后康复，早日恢复患者的正常生活。

腹腔镜下经胆道镜钬激光碎石治疗难治性胆管结石

目的探讨腹腔镜下经胆道镜钬激光碎石治疗难治性胆管结石的可行性和疗效。 方法回顾性分析我院2009年6月至2014年12月期间18例腹腔镜下经胆道镜钬激光碎石治疗难治性胆管结石（无法在内镜下乳头括约肌切开取石术取出者）的临床资料。 结果成功手术18例，手术时间60～200 min，平均130 min。一次性取净结石16例，2例女性患者分别有四川、安徽生活居住史，术后造影在左、右肝管内再次发现絮状结石，予熊去氧胆酸口服，随访至今，其中1例结石消失，另外1例仍有结石表现。术后均无胆管出血、胆瘘、胆管狭窄等并发症发生。 结论对于难治性的胆管结石，腹腔镜下经胆道镜钬激光碎石治疗是一种安全、有效的方法。

Efficacy and safety of transurethral bipolar plasmakinetic prostatectomy versus holmium laser enucleation of the prostate for treatment of benign prostatic hyperplasia: a systematic review

ObjectivesTo systematically evaluate the efficacy and safety of the transurethral bipolar plasmakinetic prostatectomy (TUPKP) versus holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of TUPKP and HoLEP for treatment of BPH from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, the meta-analyses were performed by using RevMan 5.3 software.ResultsA total of 9 RCTs involving 784 patients were included. The results of meta-analyses showed that, in efficacy outcomes, TUPKP was superior to HoLEP in Qmax at 48 months, and was inferior to HoLEP in PVR at 3 months, Qmax in 60 and 72 months, and IIEF-5 at 48 and 72 months. No significant association was found between two groups in Qmax from 1 to 36 months, IPSS from 1 to 72 months, prostate volume, PVR from 6 months, IIEF-5 from 1 to 24 months, QoL at 1 to 36 months, and resected prostate weight. As for safety, TUPKP was superior to HoLEP in operation time, while inferior to HoLEP in blood loss during procedure, hospital stay, catheterization period, bladder irrigation period, irrigation fluid, massive hemorrhage and hematuresis. No significant association was observed between two groups in serum sodium decrease, hemoglobin decrease, PSA, postoperative urine retention, blood transfusion, cystospasm, temporary incontinence, urinary tract infection, TURS, epididymitis, temporary difficulty in urination, urinary tract irritation syndrome, reoperation, retrograde ejaculation, urinary incontinence, ED and urethrostenosis.ConclusionsCurrent evidence shows that the efficacy and safety of TUPKP and HoLEP for treatment of BPH are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Endoscopic reverse biliary tract stent placement via choledochus in treatment of situs inversus totalis complicated with choledocholithiasis

ObjectiveTo summarize experience of endoscopic reverse biliary tract stent placement via choledochus in treatment of situs inversus totalis complicated with choledocholithiasis.MethodThe clinical data of one patient with situs inversus totalis complicated with choledocholithiasis in the Department of Tumor Surgery of Lanzhou University Second Hospital were retrospectively analyzed.ResultsThe ERCP was failed at the first admission, followed by the cholecystectomy plus choledocholithotomy plus T-tube drainage, the stones were removed. Two months later, choledochoscopy revealed multiple choledocholithiasis, then the holmium laser lithotripsy and bile duct stent placement was performed at the secondary admission, the postoperative recovery was good, it had been more than 2 months after the surgery, no stone recurrence occurred.ConclusionEndoscopic reverse biliary tract stent placement via choledochus is feasible, which can be used as an option for treatment of patient with situs inversus totalis complicated with choledocholithiasis.

经尿道高功率钬激光前列腺汽化术护理

【摘要】　目的　加强经尿道高功率钬激光前列腺汽化术各环节的护理配合，防止发生电切综合征。　方法　通过对2007年10月-2009年1月36例行经尿道高功率钬激光前列腺汽化术患者资料回顾，总结该手术护理配合要点及体会。　结果　36例均顺利完成手术，术中患者生命体征平稳，无一例出现电切综合征。　结论　经尿道高功率钬激光前列腺汽化术是一种安全可靠的治疗前列腺增生的微创手术方法，护理在各个环节的密切配合是保证手术成功的必要条件。

Safety and effectiveness of transurethral holmium laser enucleation of the prostate versus transurethral plasma kinetic enucleation of the prostate in the treatment of benign prostatic hyperplasia: a systematic review

ObjectiveTo evaluate the safety and clinical efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) versus transurethral plasma kinetic enucleation of the prostate (PKEP) in the treatment of benign prostate hyperplasia (BPH).MethodsRandomized controlled trials of HoLEP versus PKEP in the treatment of BPH published between January 2000 and March 2021 were searched in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP database, and Wanfang database. Operative duration, estimated intraoperative blood loss, average duration of urinary catheterization, average duration of bladder irrigation, average length of hospital stay, and postoperative complications were used as safety evaluation indicators. Postoperative International Prostatic Symptomatic Score (IPSS), postoperative maximum urinary flow rate (Qmax), postoperative quality of life (QoL), and postvoid residual (PVR) were used as effective evaluation indicators.ResultsA total of 14 randomized controlled trials were included in this study, with a total of 1 478 patients (744 in the HoLEP group and 734 in the PKEP group). The results of the meta-analysis showed that the intraoperative blood loss in the HoLEP group was less than that in the PKEP group [weighted mean difference (WMD)=−25.95 mL, 95% confidence interval (CI) (−31.65, 20.25) mL, P=0.025], the average duration of urinary catheterization [WMD=−10.35 h, 95%CI (−18.25, −2.45) h, P=0.042], average duration of bladder irrigation [WMD=−10.28 h, 95%CI (−17.52, −3.04) h, P=0.038], and average length of hospital stay [WMD=−1.24 d, 95%CI (−1.85, −0.62) d, P=0.033] in the HoLEP group were shorter than those in the PKEP group, and the incidence of postoperative complications [risk ratio=0.70, 95%CI (0.56, 0.87), P=0.047] and 6-month postoperative Qmax [WMD=−0.89 m/s, 95%CI (−1.74, −0.05) m/s, P=0.037] in the HoLEP group were lower than those in the PKEP group. However, there was no significant difference in the operative duration, 3-month postoperative IPSS, 3-month postoperative Qmax, 3-month postoperative QoL, 3-month postoperative PVR, 6-month postoperative IPSS, 6-month postoperative QoL, or 6-month postoperative PVR between the two groups (P>0.05).ConclusionsIn the treatment of BPH, the effectiveness of HoLEP does not differ from that of PKEP, but HoLEP is safer. The conclusions of this study need to be verified in more precisely designed and larger sample-sized multi-center randomized controlled trials.

Treatment of Acute Renal Failure Induced by Upper Ureteric Obstruction with Ureterorenoscope

目的:探讨急性上尿路梗阻性肾功能衰竭的治疗方法。方法:采用输尿管镜检查,酌情钬激光碎石,放置双J管内引流治疗32例急性上尿路梗阻性肾功能衰竭患者。结果:术后患者血清BUN、SCr均明显下降,尿量不同程度恢复,结石排净率90.6%(29/32)。结论:对于上尿路结石梗阻性急性肾功能衰竭的患者,急诊输尿管镜下钬激光碎石,疗效确切,创伤小,可同时处理双侧输尿管结石。

泌尿外科腔内钬激光手术的护理体会

【摘要】　目的　分析总结泌尿外科腔内钬激光手术的护理要点，以指导护理。　方法　2009年6月－2010年12月，对400例行腔内钬激光手术患者在术前术中认真做好仪器参数设置及检查、体位摆放、病情观察、并发症预防等各项护理工作。　结果　400例手术均成功，手术配合效果满意，无因术中护理不当造成患者意外损伤、设备光纤意外损坏等情况发生。　结论　泌尿外科腔内钬激光手术配合专业性强，护理人员应熟知钬激光工作原理、正确设置钬激光参数，以确保患者安全。

Therapeutic Effect of Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy in Treating Renal Calculi

ObjectiveTo evaluate the therapeutic efficacy of flexible ureteroscopic holmium laser combined with lithotripsy in treating renal calculi. MethodsWe retrospectively analyzed the data of 78 patients from August 2012 to February 2014 who underwent flexible ureteroscopic holmium laser lithotripsy in our hospital. Among them, calculi were located at the upper or middle calyx in 41 patients, at the lower calyx in 27, at the renal pelvis in 6, and at multiple calyxes in 4. The diameter of the stones ranged from 0.8 to 2.0 cm with a mean of 1.4 cm. The stones were fragmentized by using 200 μm holmium laser fiber. A follow-up by renal CT scan was done 4 weeks after the procedure to evaluate the rate of the stone clearance. ResultsThe calculi were detected in 76 patients (97.4%, 76/78). The success rate in one-session procedure was 94.9% (74/78). After 4 weeks, the total stone-free rate was 97.4% (74/76). The mean operative time was 30 minutes (20-55 minutes). The mean hospital stay of the patients was 3 days (2-6 days). Two cases were found to have lower back pain combined with fever and cured by anti-inflammatory treatment. Naked eye hematuria disappeared in our cases after operation for 1 to 2 days. Seventy-four cases were followed up from 4 to 16 months with a median time of 8 months and no recurrence was detected. ConclusionThe flexible ureteroscopic holmium laser lithotripsy is a safe and effective mini-invasive therapy for patients with renal calculi, with a high discovery rate of stones, high success rate, high evacuation rate, few severe complications, short hospital stay and sustainable treatment.