BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a ...BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.展开更多
Industrial waste management constitutes a major challenge for sustainable development. This study aims to transform hardened cement waste stored in cement warehouses and in real estate construction sites into paving s...Industrial waste management constitutes a major challenge for sustainable development. This study aims to transform hardened cement waste stored in cement warehouses and in real estate construction sites into paving stones. This innovative solution will contribute to the protection of the environment and the reduction of inert industrial waste. To do this, paving stones based on hardened cement have been developed and characterized. The raw materials were subjected to physical and mechanical characterization tests. The hardened cement aggregates previously crushed with the 5/15 granular class were used as substitutes to replace the natural 5/15 aggregates in the hardened paving stones at contents ranging from 0 to 100%. The mechanical characterization results on the raw material showed that the hardened cement aggregate is made from lightweight aggregates. On the prepared mortar, in the fresh state, the Abrams cone slump test showed an increase in the quantity of waste water with the increase in the content of hardened cement aggregate. In the hardened state, physical (porosity, absorption and dry density) and mechanical (compression, splitting traction, 3-point bending traction and wear) characterization tests were carried out at periods of 7, 14 and 28 days of maturation in water on the cobblestones. These results show that the substitution of natural aggregates by hardened cement aggregates in increasingly large proportions leads to an improvement in compressive, flexural, splitting and wear resistance. In addition, the incorporation of hardened cement aggregate considerably slows down the mechanical degradation of the paving stones. They can, therefore, be used in road and interior or exterior floor coverings.展开更多
BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited....BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.展开更多
Gallbladder stones,a prevalent biliary tract disease,have multifactorial etiologies including metabolic,genetic,and environmental factors.Emerging evidence su-ggests that hematological disorders,particularly those inv...Gallbladder stones,a prevalent biliary tract disease,have multifactorial etiologies including metabolic,genetic,and environmental factors.Emerging evidence su-ggests that hematological disorders,particularly those involving hemolysis or impaired erythropoiesis,may play a significant role in the formation of gallblad-der stones,predominantly pigment stones.This review explores the pathophysio-logical mechanisms linking hematological disorders,such as hemolytic anemias,myeloproliferative disorders,and hematological malignancies,with gallbladder stone development.We also examine the influence of treatments for hemato-logical conditions,such as blood transfusions and chemotherapy,on gallstone risk.Additionally,this article discusses the clinical implications of gallbladder stones in patients with hematological disorders,including diagnostic challenges,management strategies,and surgical considerations.By providing a compre-hensive overview of current knowledge,this review aims to highlight the need for further research into the interplay between hematological disorders and gall-bladder stones,potentially improving preventive and therapeutic strategies in these patient populations.展开更多
Objective:This study aims to develop a drug controlled-release system based on nano-hydrogel technology for stone dissolution and evaluate its dual efficacy in synchronously dissolving calcium oxalate stones and inhib...Objective:This study aims to develop a drug controlled-release system based on nano-hydrogel technology for stone dissolution and evaluate its dual efficacy in synchronously dissolving calcium oxalate stones and inhibiting uropathogenic Escherichia coli.Methods:A pH-responsive chitosan(CS)-sodium alginate(SA)-hydrogel microsphere loaded with potassium sodium hydrogen citrate and fosfomycin(CS/SA@PSHC@CS@F)was constructed using ionic cross-linking.In vitro stone dissolution experiments were conducted to determine drug release kinetics and stone mass reduction rate under different pH environments,and the antibacterial activity against E.coli ATCC 25922 was evaluated using the plate counting method.A rat model of kidney stone combined with infection was established.Stone volume changes were quantified via micro-CT,urinary interleukin-6(IL-6)and tumor necrosis factorα(TNF-α)levels were measured by ELISA,and renal tissue inflammation was scored via histopathological evaluation.Results:The 24-hour cumulative release rate of CS/SA@PSHC@CS@F at pH 5.8 reached 92.3%±4.1%,significantly higher than at pH 7.4(31.2%±3.7%,P<0.01).At 72 h,the mass reduction rate of calcium oxalate stones in CS/SA@PSHC@CS@F was 68.9%±5.2%,significantly higher than that of the PSHC+F mixture(P<0.01).Antibacterial experiments confirmed that the inhibition rate of biofilm colonies by CS/SA@PSHC@CS@F could reach 82.4%±6.7%,compared to 58.2%±5.3%for F,with a statistically significant difference(P<0.01).Animal experiments showed that the stone volume reduction rate in the CS/SA@PSHC@CS@F group was62.3%±8.1%,higher than that in the PSHC+F group,and the decrease in urinary IL-6 level after administration was more significant,while there was no significant difference in TNF-αlevel compared with the other two groups(P>0.05).The renal tissue inflammation score decreased to 2(1,2)points,showing a significant reduction compared with the other two groups(P<0.05).Conclusion:The novel controlled-release system designed in this study achieves targeted drug release in the stone infection microenvironment through the ion exchange mechanism,simultaneously enhancing stone dissolution efficiency and antibacterial effect,thereby providing a new drug delivery strategy for the treatment of urinary stones combined with infection.展开更多
Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of co...Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of common bile duct(CBD)stones.Methods:This retrospective study was conducted at Bishan Hospital of Chongqing Medical University between January 2018 and August 2022.Patients with native papillae who underwent endoscopic treatment for CBD stones were recruited and divided into four groups according to Haraldsson's classification of papillae(typesⅠ-Ⅳ).Univariate and multivariate logistic regression analyses were used to identify risk factors for difficult cannulation and post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Results:A total of 596 patients with CBD stones were enrolled.The proportion of patients with typeⅠpapilla was the highest(n=231,38.8%),followed by typeⅢpapilla(n=175,29.4%),typeⅣpapilla(n=101,16.9%)and typeⅡpapilla(n=89,14.9%).Difficult cannulation occurred in 188 of 596 patients(31.5%),with most cases occurring in those with typeⅢpapilla(71/175,40.6%,P=0.020).Multivariate logistic analysis revealed that age[odds ratio(OR)=1.034,95%confidence interval(CI):1.021–1.047,P<0.001],typeⅢpapilla(OR=2.255,95%CI:1.439–3.535,P<0.001),gallbladder in situ(OR=2.486,95%CI:1.346–4.590,P=0.004),and CBD diameter<10 mm(OR=1.600,95%CI:1.049–2.441,P=0.029)were risk factors for difficult cannulation.The total incidence of PEP was 10.9%.Compared with the other types of papillae,the rate of PEP was the highest in those with typeⅠpapilla(15.2%,P=0.030).Multivariate analysis demonstrated that PEP was associated with difficult cannulation(OR=1.811,95%CI:1.044–3.143,P=0.035)and white blood cells(WBCs)<10×10~9/L(OR=2.199,95%CI:1.051–4.600,P=0.036).Conclusions:The endoscopic appearance of the major papilla is an important factor that influences both biliary cannulation and outcomes.TypeⅢpapilla is more frequently difficult to cannulate in the endoscopic treatment of CBD stones.展开更多
BACKGROUND Intrahepatic and extrahepatic bile duct stones(BDSs)have a high rate of residual stones,a high risk of recurrence,and a high rate of reoperation.It is very important to take timely and effective surgical in...BACKGROUND Intrahepatic and extrahepatic bile duct stones(BDSs)have a high rate of residual stones,a high risk of recurrence,and a high rate of reoperation.It is very important to take timely and effective surgical intervention for patients.AIM To analyze the efficacy,postoperative rehabilitation,and quality of life(QoL)of patients with intra-and extrahepatic BDSs treated with endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic papillary balloon dilation(EPBD)+laparoscopic hepatectomy(LH).METHODS This study selected 114 cases of intra-and extrahepatic BDSs from April 2021 to April 2024,consisting of 55 cases in the control group receiving laparoscopic common bile duct exploration and LH and 59 cases in the observation group treated with ERCP+EPBD+LH.Efficacy,surgical indicators[operation time(OT)and intraoperative blood loss(IBL)],postoperative rehabilitation(time for body temperature to return to normal,time for pain relief,and time for drainage to reduce jaundice),hospital stay,medical expenses,and QoL[Gastrointestinal Quality of Life Index(GIQLI)]were comparatively analyzed.Further,Logistic regression analysis was conducted to analyze factors influencing the QoL of patients with intra-and extrahepatic BDSs.RESULTS The data demonstrated a higher overall effective rate in the observation group compared to the control group(P=0.011),together with notably reduced OT,less IBL,shorter body temperature recovery time,pain relief time,time for drainage to reduce jaundice,and hospital stay(all P<0.05).The postoperative GIQLI of the observation group was more significantly increased compared to the control group(P<0.05).The two groups demonstrated no marked difference in medical expenses(P>0.05).CONCLUSION The above indicates that ERCP+EPBD+LH is effective in treating patients with intra-and extrahepatic BDSs,which is conducive to postoperative rehabilitation and QoL improvement,with promising prospects for clinical promotion.展开更多
BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modifie...BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.展开更多
The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the risi...The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the rising global prevalence of these conditions,understanding their interconnections is essential.The study emphasizes the importance of shared risk factors,such as obesity,type 2 diabetes,dyslipidemia,and oxidative stress,and calls for multidisciplinary screening strategies.This approach would improve patient outcomes and reduce the socio-economic burden.While the study contributes valuable insights from a Chinese population,further research across diverse populations is necessary to validate and extend these findings globally.Ultimately,the research underscores the need for integrated prevention programs to better manage these interconnected diseases and improve health outcomes.展开更多
Pancreatic duct stones(PDS)pose substantial therapeutic challenges owing to their tendency to induce recurrent pain and discomfort via mechanical irritation and ductal obstruction,resulting in a marked decline in pati...Pancreatic duct stones(PDS)pose substantial therapeutic challenges owing to their tendency to induce recurrent pain and discomfort via mechanical irritation and ductal obstruction,resulting in a marked decline in patients’quality of life.The pathogenesis of pancreatic duct calculi remains incompletely understood due to its multifactorial and intricate nature.Advances in minimally invasive endoscopic interventions have broadened the available treatment modalities for PDS.This review summarizes current perspectives on the mechanisms driving stone formation alongside evolving therapeutic strategies.展开更多
Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and ...Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.展开更多
Objective:Several therapeutic modalities for the prevention of calcium oxalate(CaOx)stones have been studied,but only a select few of these modalities have been incorporated into the American Urological Association gu...Objective:Several therapeutic modalities for the prevention of calcium oxalate(CaOx)stones have been studied,but only a select few of these modalities have been incorporated into the American Urological Association guidelines.Our study aimed to organize and interrogate existing research that may be promising for CaOx prevention.Methods:A literature search was conducted using MEDLINE and Embase from inception to November 16,2022.Our study population included adults with or without a history of CaOx kidney stones.Studies in which patients were treated with pharmacotherapies,herbal supplements,or uncategorized research chemicals that are not included in the current American Urological Association guidelines for preventing CaOx stones were included.Nonoriginal research was excluded.Results:Out of the 6155 identified articles,38 were included in the final analysis.The five distinct categories of interventions for stone prevention were“medications”,“herbal supplements”,“food and macronutrients”,“micronutrients”,and“enzymes and probiotics”.Modalities that were found to reduce known urinary risk factors were tolvaptan,cranberry juice,magnesium citrate,oxalate-degrading enzyme ALLN-177,and malic acid.Prophylaxis that reduced stone formation were sodium-glucose cotransporter-2 inhibitors,eicosapentaenoic acid,ethane-1-hydroxy-1,1-disphosphonate.Therapies that reduced urinary risk factors and stone formation were Phyllanthus niruri,rice bran,and magnesium hydroxide.Conclusion:Several of the identified therapies may provide prophylactic benefits for CaOx stone formation and may be useful for inclusion in guidelines for kidney stone prevention.展开更多
While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasibl...While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasible.Percutaneous cystolitholapaxy is a safe,effective,minimally invasive alternative for diverse indications,including patients with benign prostatic hyperplasia,urethral stricture disease,closed bladder neck,continent catheterized channel,or other urinary diversion.In this article,we review the indications for and advantages of percutaneous cystolitholapaxy and describe our step-by-step technique for this procedure,including representative imaging and favored equipment.We also discuss preoperative and postoperative considerations,management of potential complications,strategies to optimize clinical outcomes and patient safety,and comparisons with transurethral approaches.Finally,we report outcomes from our institutional series of percutaneous cystolitholapaxy cases to highlight the safety and efficacy of the procedure.展开更多
BACKGROUND In recent years,the use of ultrafine choledochoscopy has gradually increased in the treatment of cholelithiasis.However,stone incarceration and residual spasm of the sphincter of Oddi may be inevitable when...BACKGROUND In recent years,the use of ultrafine choledochoscopy has gradually increased in the treatment of cholelithiasis.However,stone incarceration and residual spasm of the sphincter of Oddi may be inevitable when an ultrafine choledochoscope is used alone.AIM To investigate the safety and feasibility of ultrafine choledochoscopy combined with low-dose atropine in the treatment of Oddi intersphincter stones.METHODS Seventeen patients with Oddi intersphincter stones were retrospectively analyzed.The perioperative clinical data and follow-up information were collected.RESULTS Among the 17 patients,3 were male and 14 were female.The mean age was 40.6±13.9 years,and the mean diameter of the common bile duct was 7.8±1.3 mm.All patients successfully underwent Oddi intersphincter stone removal using a combination of ultrafine choledochoscopy and low-dose atropine.No serious complications,such as postoperative hemorrhage,pancreatitis or bile leakage occurred in the 17 patients.During the one-year follow-up,none of the patients experienced stone recurrence.CONCLUSION Ultrafine choledochoscopy combined with low-dose atropine is safe and feasible for the treatment of Oddi intersphincter stones.展开更多
Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral...Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.展开更多
BACKGROUND There remain controversies regarding the surgical treatment of extrahepatic bile duct stones(EHBDSs)in clinical practice.AIM To explore the curative effect of laparoscopic cholecystectomy(LC)plus common bil...BACKGROUND There remain controversies regarding the surgical treatment of extrahepatic bile duct stones(EHBDSs)in clinical practice.AIM To explore the curative effect of laparoscopic cholecystectomy(LC)plus common bile duct exploration(CBDE)for the surgical treatment of EHBDSs and to analyze the risk factors that affect postoperative stone recurrence.METHODS Eighty-two patients with EHBDSs admitted between March 2017 and March 2023 were selected.Among them,patients treated with open choledocholithotomy plus LC or open cholecystectomy(OC)were set as the control group(n=40),and those treated with LC plus CBDE served as the observation group(n=42).The surgical outcomes of the two groups were compared,the surgical complications and Gas-trointestinal Quality of Life Index(GIQLI)scores were counted,and the one-year prognostic recurrence was recorded.Independent factors for postoperative re-currence were determined using univariate and multivariate analyses.RESULTS The two groups were comparable in the stone residual rate(P>0.05).The ope-ration time(P<0.05),intraoperative bleeding(P<0.05),and total complication rate(P=0.005)were lower in the observation group than in the control group.The observation group exhibited a marked increase in the GIQLI score,which was higher than the control group(P<0.05).A lower one-year recurrence rate was determined in the observation group vs the control group(P=0.027).Sphincter of Oddi dysfunction[odds ratio(OR)=5.712,P=0.007]and the treatment scheme of open choledocholithotomy plus LC or OC(OR=6.771,P=0.008)were the independent risk factors for one-year recurrence in patients after surgery.CONCLUSION LC plus CBDE for patients with EHBDSs can reduce stone residuals,intraoperative bleeding,complications,and postoperative recurrence.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal.Additionally,ursodeoxycholic acid(UDCA)can dissolve choles...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal.Additionally,ursodeoxycholic acid(UDCA)can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concen-tration in bile.Despite these treatment options,there are still patients who experience stone recurrence.The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People’s Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected.According to the post-ERCP treatment plan,100 patients were classified into UDCA(n=47)and control(n=53)groups.We aimed to assess the clinical efficacy and rate of relapse in the two patient populations.We then collected information(basic demographic data,clinical characteristics,and serum biochemical indicators)and determined the factors contributing to relapse using logistic regression analysis.Our secondary goal was to determine the effects of UDCA on liver function after ERCP.Compared to the control group,the UDCA group demonstrated a higher clinical effectiveness rate of 92.45%vs 78.72%(P<0.05).No significant differences were observed in liver function indices,including total bilirubin,direct bilirubin,gamma-glutamyl transpeptidase,alanine aminotransferase,alkaline phosphatase,and aspartate aminotransferase,between the two groups before treatment.After treatment,all liver function indices were significantly reduced.Comparing the control vs UDCA groups,the UDCA group exhibited significantly lower levels of all indices(55.39±6.53 vs 77.31±8.52,32.10±4.62 vs 45.39±5.69,142.32±14.21 vs 189.63±16.87,112.52±14.25 vs 149.36±15.36,122.61±16.00 vs 171.33±22.09,96.98±10.44 vs 121.35±11.57,respectively,all P<0.05).The stone recurrence rate was lower in the UDCA group(13.21%)in contrast with the control group(44.68%).Periampullary diverticula(OR:6.00,95%CI:1.69-21.30),maximum stone diameter(OR:1.69,95%CI:1.01-2.85),stone quantity>3(OR:4.23,95%CI:1.17-15.26),and positive bile culture(OR:7.61,95%CI:2.07-27.91)were independent factors that influenced the relapse of common bile duct stones after ERCP(P<0.05).Furthermore,postoperative UDCA was identified as a preventive factor(OR:0.07;95%CI:0.08-0.09).CONCLUSION The intervention effect of UDCA after ERCP for common bile duct stones is adequate,providing new research directions and references for the prevention and treatment of stone recurrence.展开更多
BACKGROUND Bile duct stones(BDSs)may cause patients to develop liver cirrhosis or even liver cancer.Currently,the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory,and there...BACKGROUND Bile duct stones(BDSs)may cause patients to develop liver cirrhosis or even liver cancer.Currently,the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory,and there is a risk of postoperative complic-ations.AIM To compare the clinical effects of dual-modality endoscopy(duodenoscopy and laparoscopy)with those of traditional laparotomy in the treatment of intra-and extrahepatic BDSs.METHODS Ninety-five patients with intra-and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected;45 patients in the control group were treated by traditional laparotomy,and 50 patients in the research group were treated by dual-modality endoscopy.The following factors were collected for analysis:curative effects,safety(incision infection,biliary fistula,lung infection,hemobilia),surgical factors[surgery time,intraoperative blood loss(IBL)volume,gastrointestinal function recovery time,and length of hospital stay],serum inflammatory markers[tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-8],and oxidative stress[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),and advanced protein oxidation products(AOPPs)].RESULTS The analysis revealed markedly better efficacy(an obviously higher total effective rate)in the research group than in the control group.In addition,an evidently lower postoperative complication rate,shorter surgical duration,gastrointestinal function recovery time and hospital stay,and lower IBL volume were observed in the research group.Furthermore,the posttreatment serum inflammatory marker(TNF-α,IL-6,and IL-8)levels were significantly lower in the research group than in the control group.Compared with those in the control group,the posttreatment GSH-Px,SOD,MDA and AOPPs in the research group were equivalent to the pretreatment levels;for example,the GSH-Px and SOD levels were significantly higher,while the MDA and AOPP levels were lower.CONCLUSION Dual-modality endoscopy therapy(duodenoscopy and laparoscopy)is more effective than traditional laparotomy in the treatment of intra-and extrahepatic BDSs and has a lower risk of postoperative complications;significantly shortened surgical time;shorter gastrointestinal function recovery time;shorter hospital stay;and lower intraop-erative bleeding volume,while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.展开更多
BACKGROUND Renal stones ranging 20–40 mm are very common in China.Although no largesample clinical studies have confirmed the clinical efficacy and safety of this method,there is also a lack of comparative data with ...BACKGROUND Renal stones ranging 20–40 mm are very common in China.Although no largesample clinical studies have confirmed the clinical efficacy and safety of this method,there is also a lack of comparative data with traditional treatment.AIM To investigate the clinical efficacy of flexible ureteroscopy(FURS)and percutaneous nephrolithotomy(PCNL)by postoperative stone clearance and changes in soluble vascular cell adhesion molecule 1(sVCAM-1)and kidney injury molecule 1(KIM-1)levels in patients with large kidney stones(>2 cm in diameter).METHODS This single-center observational study was performed at a Chinese hospital between January 1,2021,and October 30,2023.All 250 enrolled patients were diagnosed with large kidney stones(>2 cm)and divided into a FURS group(n=145)and a PCNL group(n=105)by the surgical method.The FURS group was treated with flexible ureteroscopy and the PCNL group was treated with percutaneous nephrolithotomy.The operation time,time to palinesthesia,intraoperative blood loss,drop in hemoglobin,length of hospital stay,stone clearance rate,and complications were recorded in the two groups.Preoperative and postoperative serum sVCAM-1 levels,erythrocyte sedimentation rate(ESR),urine KIM-1 levels,preoperative and postoperative pain visual analog scale(VAS)and Wisconsin Stone Quality of Life Questionnaire(WISQOL)scores were also documented.RESULTS All 250 eligible patients completed the follow-up.There were no significant differences in baseline characteristics between the two groups(P>0.05).The operation time in the FURS group was significantly greater than that in the PCNL group.The time to ambulation,intraoperative blood loss,decrease in hemoglobin,and length of hospital stay were significantly lower in the FURS group than in the PCNL group.The FURS group also had a significantly higher stone clearance rate and a lower incidence of postoperative complications.There was no significant difference in antibiotic use between the groups.Postoperative serum sVCAM-1 levels,urine KIM-1 levels,and VAS scores were lower in the FURS group than in the PCNL group,but postoperative ESR and WISQOL scores were greater in the FURS group than in the PCNL group.CONCLUSION FURS demonstrated superior clinical efficacy in treating large kidney stones(>2 cm in diameter)compared PCNL.It not only improved the postoperative stone clearance rate and reduced complications and recovery time but also positively affected serum SCM-1,ESR,and urine KIM-1 levels,subsequent improvement of patient quality of life.展开更多
BACKGROUND For intrahepatic duct(IHD)stones,laparoscopic liver resection(LLR)is currently a reliable treatment.However,the current LLR difficulty scoring system(DSS)is only available for patients with hepatocellular c...BACKGROUND For intrahepatic duct(IHD)stones,laparoscopic liver resection(LLR)is currently a reliable treatment.However,the current LLR difficulty scoring system(DSS)is only available for patients with hepatocellular carcinoma.AIM To explore the development of a DSS for IHD stone patients with LLR and the validation of its reliability.METHODS We used clinical data from 80 patients who received LLR for IHD stones.Forty-six of these patients were used in multiple linear regression to construct a scoring system.Another 34 patients from different centers were used as external validation.The completeness of our DSS was then evaluated in patients with varying degrees of surgical difficulty based on documented surgical outcomes in the study group of patients.RESULTS The following five predictors were ultimately included and scored by calculating the weighted contribution of each factor to the prediction of operative time in the training cohort:Location of stones,number of stones≥3,stones located in the bile ducts of several grades,previous biliary surgery less than twice,distal bile duct atrophy.Subsequently,the data set was validated using a DSS developed from the variables.The following variables were identified as statistically significant in external validation:Operative time,blood loss,intraoperative transfusion,postoperative alanine aminotransferase,and Clavien-Dindo grading≥3.These variables demonstrated statistically significant differences in patients with three or more grades.CONCLUSION Patients with IHD stones have varying degrees of surgical difficulty,and the newly developed DSS can be validated with external data to effectively predict risks and complications after LLR surgery.展开更多
文摘BACKGROUND Pancreaticobiliary maljunction(PBM)is a rare congenital abnormality in pancreaticobiliary duct development.PBM is commonly found in children,and it often leads to acute pancreatitis and other diseases as a result of pancreaticobiliary reflux.Roux-en-Y choledochojejunostomy is a common surgical method for the treatment of PBM,but there are several associated complications that may occur after this operation.CASE SUMMARY The patient,a 12-year-old female,was hospitalized nearly 20 times in 2021 for recurrent acute pancreatitis.In 2022,she was diagnosed with PBM and underwent laparoscopic common bile duct resection and Roux-en-Y choledochojejunostomy in a tertiary hospital.In the first year after surgery,the patient had more than 10 recurrent acute pancreatitis episodes.After undergoing abdominal computed tomography and other examinations,she was diagnosed with“residual bile duct stones and recurrent acute pancreatitis”.On January 30,2024,the patient was admitted to our hospital due to recurrent upper abdominal pain and was cured through endoscopic retrograde cholangiopancreatography.CONCLUSION This article reports a case of a child with distal residual common bile duct stones and recurrent acute pancreatitis after Roux-en-Y choledochojejunostomy for PBM.The patient was cured through endoscopic retrograde cholangiopancreatography.
文摘Industrial waste management constitutes a major challenge for sustainable development. This study aims to transform hardened cement waste stored in cement warehouses and in real estate construction sites into paving stones. This innovative solution will contribute to the protection of the environment and the reduction of inert industrial waste. To do this, paving stones based on hardened cement have been developed and characterized. The raw materials were subjected to physical and mechanical characterization tests. The hardened cement aggregates previously crushed with the 5/15 granular class were used as substitutes to replace the natural 5/15 aggregates in the hardened paving stones at contents ranging from 0 to 100%. The mechanical characterization results on the raw material showed that the hardened cement aggregate is made from lightweight aggregates. On the prepared mortar, in the fresh state, the Abrams cone slump test showed an increase in the quantity of waste water with the increase in the content of hardened cement aggregate. In the hardened state, physical (porosity, absorption and dry density) and mechanical (compression, splitting traction, 3-point bending traction and wear) characterization tests were carried out at periods of 7, 14 and 28 days of maturation in water on the cobblestones. These results show that the substitution of natural aggregates by hardened cement aggregates in increasingly large proportions leads to an improvement in compressive, flexural, splitting and wear resistance. In addition, the incorporation of hardened cement aggregate considerably slows down the mechanical degradation of the paving stones. They can, therefore, be used in road and interior or exterior floor coverings.
文摘BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.
文摘Gallbladder stones,a prevalent biliary tract disease,have multifactorial etiologies including metabolic,genetic,and environmental factors.Emerging evidence su-ggests that hematological disorders,particularly those involving hemolysis or impaired erythropoiesis,may play a significant role in the formation of gallblad-der stones,predominantly pigment stones.This review explores the pathophysio-logical mechanisms linking hematological disorders,such as hemolytic anemias,myeloproliferative disorders,and hematological malignancies,with gallbladder stone development.We also examine the influence of treatments for hemato-logical conditions,such as blood transfusions and chemotherapy,on gallstone risk.Additionally,this article discusses the clinical implications of gallbladder stones in patients with hematological disorders,including diagnostic challenges,management strategies,and surgical considerations.By providing a compre-hensive overview of current knowledge,this review aims to highlight the need for further research into the interplay between hematological disorders and gall-bladder stones,potentially improving preventive and therapeutic strategies in these patient populations.
文摘Objective:This study aims to develop a drug controlled-release system based on nano-hydrogel technology for stone dissolution and evaluate its dual efficacy in synchronously dissolving calcium oxalate stones and inhibiting uropathogenic Escherichia coli.Methods:A pH-responsive chitosan(CS)-sodium alginate(SA)-hydrogel microsphere loaded with potassium sodium hydrogen citrate and fosfomycin(CS/SA@PSHC@CS@F)was constructed using ionic cross-linking.In vitro stone dissolution experiments were conducted to determine drug release kinetics and stone mass reduction rate under different pH environments,and the antibacterial activity against E.coli ATCC 25922 was evaluated using the plate counting method.A rat model of kidney stone combined with infection was established.Stone volume changes were quantified via micro-CT,urinary interleukin-6(IL-6)and tumor necrosis factorα(TNF-α)levels were measured by ELISA,and renal tissue inflammation was scored via histopathological evaluation.Results:The 24-hour cumulative release rate of CS/SA@PSHC@CS@F at pH 5.8 reached 92.3%±4.1%,significantly higher than at pH 7.4(31.2%±3.7%,P<0.01).At 72 h,the mass reduction rate of calcium oxalate stones in CS/SA@PSHC@CS@F was 68.9%±5.2%,significantly higher than that of the PSHC+F mixture(P<0.01).Antibacterial experiments confirmed that the inhibition rate of biofilm colonies by CS/SA@PSHC@CS@F could reach 82.4%±6.7%,compared to 58.2%±5.3%for F,with a statistically significant difference(P<0.01).Animal experiments showed that the stone volume reduction rate in the CS/SA@PSHC@CS@F group was62.3%±8.1%,higher than that in the PSHC+F group,and the decrease in urinary IL-6 level after administration was more significant,while there was no significant difference in TNF-αlevel compared with the other two groups(P>0.05).The renal tissue inflammation score decreased to 2(1,2)points,showing a significant reduction compared with the other two groups(P<0.05).Conclusion:The novel controlled-release system designed in this study achieves targeted drug release in the stone infection microenvironment through the ion exchange mechanism,simultaneously enhancing stone dissolution efficiency and antibacterial effect,thereby providing a new drug delivery strategy for the treatment of urinary stones combined with infection.
文摘Background:The endoscopic appearance of the major duodenal papilla influences biliary cannulation and complications.This study aimed to investigate the role of major duodenal papillae in the endoscopic treatment of common bile duct(CBD)stones.Methods:This retrospective study was conducted at Bishan Hospital of Chongqing Medical University between January 2018 and August 2022.Patients with native papillae who underwent endoscopic treatment for CBD stones were recruited and divided into four groups according to Haraldsson's classification of papillae(typesⅠ-Ⅳ).Univariate and multivariate logistic regression analyses were used to identify risk factors for difficult cannulation and post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Results:A total of 596 patients with CBD stones were enrolled.The proportion of patients with typeⅠpapilla was the highest(n=231,38.8%),followed by typeⅢpapilla(n=175,29.4%),typeⅣpapilla(n=101,16.9%)and typeⅡpapilla(n=89,14.9%).Difficult cannulation occurred in 188 of 596 patients(31.5%),with most cases occurring in those with typeⅢpapilla(71/175,40.6%,P=0.020).Multivariate logistic analysis revealed that age[odds ratio(OR)=1.034,95%confidence interval(CI):1.021–1.047,P<0.001],typeⅢpapilla(OR=2.255,95%CI:1.439–3.535,P<0.001),gallbladder in situ(OR=2.486,95%CI:1.346–4.590,P=0.004),and CBD diameter<10 mm(OR=1.600,95%CI:1.049–2.441,P=0.029)were risk factors for difficult cannulation.The total incidence of PEP was 10.9%.Compared with the other types of papillae,the rate of PEP was the highest in those with typeⅠpapilla(15.2%,P=0.030).Multivariate analysis demonstrated that PEP was associated with difficult cannulation(OR=1.811,95%CI:1.044–3.143,P=0.035)and white blood cells(WBCs)<10×10~9/L(OR=2.199,95%CI:1.051–4.600,P=0.036).Conclusions:The endoscopic appearance of the major papilla is an important factor that influences both biliary cannulation and outcomes.TypeⅢpapilla is more frequently difficult to cannulate in the endoscopic treatment of CBD stones.
文摘BACKGROUND Intrahepatic and extrahepatic bile duct stones(BDSs)have a high rate of residual stones,a high risk of recurrence,and a high rate of reoperation.It is very important to take timely and effective surgical intervention for patients.AIM To analyze the efficacy,postoperative rehabilitation,and quality of life(QoL)of patients with intra-and extrahepatic BDSs treated with endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic papillary balloon dilation(EPBD)+laparoscopic hepatectomy(LH).METHODS This study selected 114 cases of intra-and extrahepatic BDSs from April 2021 to April 2024,consisting of 55 cases in the control group receiving laparoscopic common bile duct exploration and LH and 59 cases in the observation group treated with ERCP+EPBD+LH.Efficacy,surgical indicators[operation time(OT)and intraoperative blood loss(IBL)],postoperative rehabilitation(time for body temperature to return to normal,time for pain relief,and time for drainage to reduce jaundice),hospital stay,medical expenses,and QoL[Gastrointestinal Quality of Life Index(GIQLI)]were comparatively analyzed.Further,Logistic regression analysis was conducted to analyze factors influencing the QoL of patients with intra-and extrahepatic BDSs.RESULTS The data demonstrated a higher overall effective rate in the observation group compared to the control group(P=0.011),together with notably reduced OT,less IBL,shorter body temperature recovery time,pain relief time,time for drainage to reduce jaundice,and hospital stay(all P<0.05).The postoperative GIQLI of the observation group was more significantly increased compared to the control group(P<0.05).The two groups demonstrated no marked difference in medical expenses(P>0.05).CONCLUSION The above indicates that ERCP+EPBD+LH is effective in treating patients with intra-and extrahepatic BDSs,which is conducive to postoperative rehabilitation and QoL improvement,with promising prospects for clinical promotion.
文摘BACKGROUND Common bile duct stones pose a high risk of recurrence or disease progression if not promptly treated.However,there is still no optimal treatment approach.AIM To investigate the clinical efficacy of modified pancreatic duct stent drainage in endoscopic retrograde cholangiopancreatography(ERCP)for treating common bile duct stones.METHODS This retrospective study included 175 patients with common bile duct stones treated at Taizhou Fourth People’s Hospital between January 1,2021,and November 30,2023.The patients were divided into three groups-the modified pancreatic duct stent drainage group(59 cases),the nasobiliary drainage group(58 cases),and the standard biliary drainage group(58 cases).Preoperative general clinical data,laboratory indicators,and the visual analog scale(VAS)at two time points(24 hours before and after surgery)were compared,along with postoperative complications across the three groups.RESULTS Serum levels of aspartate aminotransferase,alanine aminotransferase,alkaline phosphatase,gamma-glutamyltransferase,total bilirubin,direct bilirubin,Creactive protein,and amylase were significantly lower in the modified pancreatic duct stent drainage group and the standard biliary drainage group than those in the nasobiliary drainage group(P<0.05).However,no statistically significant differences were observed in white blood cells,hemoglobin,or neutrophil levels among the three groups(P>0.05).The standard biliary drainage group had significantly lower VAS scores[(4.36±1.18)points]than those for the modified pancreatic duct stent drainage group[(4.92±1.68)points](P=0.033),and the nasobiliary drainage group[(5.54±1.24)points](P=0.017).There were no statistically significant differences in complication rates across the three groups(P>0.05).CONCLUSION Compared to standard biliary drainage and nasobiliary drainage,the modified pancreatic duct stent used during ERCP for patients with bile duct stones significantly reduced hepatocyte injury,improved liver function parameters,alleviated inflammation and pain,enhanced patient comfort,and demonstrated superior safety.
文摘The recent study exploring the bidirectional associations between gallstone disease,non-alcoholic fatty liver disease,and kidney stone disease highlights a critical concern in chronic disease management.Given the rising global prevalence of these conditions,understanding their interconnections is essential.The study emphasizes the importance of shared risk factors,such as obesity,type 2 diabetes,dyslipidemia,and oxidative stress,and calls for multidisciplinary screening strategies.This approach would improve patient outcomes and reduce the socio-economic burden.While the study contributes valuable insights from a Chinese population,further research across diverse populations is necessary to validate and extend these findings globally.Ultimately,the research underscores the need for integrated prevention programs to better manage these interconnected diseases and improve health outcomes.
基金Supported by the National Natural Science Foundation of Gansu province,No.22JR11RA023。
文摘Pancreatic duct stones(PDS)pose substantial therapeutic challenges owing to their tendency to induce recurrent pain and discomfort via mechanical irritation and ductal obstruction,resulting in a marked decline in patients’quality of life.The pathogenesis of pancreatic duct calculi remains incompletely understood due to its multifactorial and intricate nature.Advances in minimally invasive endoscopic interventions have broadened the available treatment modalities for PDS.This review summarizes current perspectives on the mechanisms driving stone formation alongside evolving therapeutic strategies.
文摘Objective:Medical expulsive therapy(MET)is a suitable option for facilitating stone expulsion in patients with distal ureteral stones.This meta-analysis was conducted to compare efficacy and safety of monotherapy and combination therapy with tamsulosin,silodosin,and tadalafil on stone expulsion rate(SER)and stone expulsion time(SET),as well as their comparative safety,numbers of colic pain episodes,and need for analgesics.Methods:Randomized controlled trials were retrieved by searching PubMed,Scopus,and Web of Science up to November 27,2023.Hand-searching was also conducted in Google Scholar to find additional records.Papers in English that compared the safety and efficacy of at least two of the above agents in adults with distal ureteral stones≤10 mm were included.Results:In total,27 studies were identified(six studies through database searches and 21 through checking reference lists and hand-searching in Google Scholar).More than half of them(n=15,56%)were conducted in India.The SER significantly improved with silodosin compared with tamsulosin(odds ratio[OR]2.24,p<0.001),whereas the difference in SET was non-significant.Tadalafil achieved a significantly higher SER compared with tamsulosin(OR 1.42,p=0.042)without any difference in SET.Subgroup analysis of 5-and 10-mg doses of tadalafil showed no significant difference in SER or SET.We found no significant difference in need for analgesics(mean difference(MD−53.73,p=0.2)or the mean number of colic episodes(MD−0.42,p=0.060)between tadalafil and tamsulosin.SER or SET was not significantly different between silodosin and tadalafil.Tadalafil plus tamsulosin led to a significantly higher SER(OR 1.87,p<0.001)and SET(MD−2.99,p=0.002)compared with tamsulosin,without any significant difference in adverse effects.Conclusion:Compared with tamsulosin,SER significantly improved with silodosin,tadalafil,and the combination of tadalafil plus tamsulosin.Meanwhile,the difference in SET was only significant between tadalafil plus tamsulosin versus tamsulosin.It appears that tadalafil and silodosin have similar efficacy in SET and SER.All medical expulsive therapies had comparable safety.
文摘Objective:Several therapeutic modalities for the prevention of calcium oxalate(CaOx)stones have been studied,but only a select few of these modalities have been incorporated into the American Urological Association guidelines.Our study aimed to organize and interrogate existing research that may be promising for CaOx prevention.Methods:A literature search was conducted using MEDLINE and Embase from inception to November 16,2022.Our study population included adults with or without a history of CaOx kidney stones.Studies in which patients were treated with pharmacotherapies,herbal supplements,or uncategorized research chemicals that are not included in the current American Urological Association guidelines for preventing CaOx stones were included.Nonoriginal research was excluded.Results:Out of the 6155 identified articles,38 were included in the final analysis.The five distinct categories of interventions for stone prevention were“medications”,“herbal supplements”,“food and macronutrients”,“micronutrients”,and“enzymes and probiotics”.Modalities that were found to reduce known urinary risk factors were tolvaptan,cranberry juice,magnesium citrate,oxalate-degrading enzyme ALLN-177,and malic acid.Prophylaxis that reduced stone formation were sodium-glucose cotransporter-2 inhibitors,eicosapentaenoic acid,ethane-1-hydroxy-1,1-disphosphonate.Therapies that reduced urinary risk factors and stone formation were Phyllanthus niruri,rice bran,and magnesium hydroxide.Conclusion:Several of the identified therapies may provide prophylactic benefits for CaOx stone formation and may be useful for inclusion in guidelines for kidney stone prevention.
文摘While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasible.Percutaneous cystolitholapaxy is a safe,effective,minimally invasive alternative for diverse indications,including patients with benign prostatic hyperplasia,urethral stricture disease,closed bladder neck,continent catheterized channel,or other urinary diversion.In this article,we review the indications for and advantages of percutaneous cystolitholapaxy and describe our step-by-step technique for this procedure,including representative imaging and favored equipment.We also discuss preoperative and postoperative considerations,management of potential complications,strategies to optimize clinical outcomes and patient safety,and comparisons with transurethral approaches.Finally,we report outcomes from our institutional series of percutaneous cystolitholapaxy cases to highlight the safety and efficacy of the procedure.
基金Supported by Health Research Program of Anhui,No.AHWJ2023A30034.
文摘BACKGROUND In recent years,the use of ultrafine choledochoscopy has gradually increased in the treatment of cholelithiasis.However,stone incarceration and residual spasm of the sphincter of Oddi may be inevitable when an ultrafine choledochoscope is used alone.AIM To investigate the safety and feasibility of ultrafine choledochoscopy combined with low-dose atropine in the treatment of Oddi intersphincter stones.METHODS Seventeen patients with Oddi intersphincter stones were retrospectively analyzed.The perioperative clinical data and follow-up information were collected.RESULTS Among the 17 patients,3 were male and 14 were female.The mean age was 40.6±13.9 years,and the mean diameter of the common bile duct was 7.8±1.3 mm.All patients successfully underwent Oddi intersphincter stone removal using a combination of ultrafine choledochoscopy and low-dose atropine.No serious complications,such as postoperative hemorrhage,pancreatitis or bile leakage occurred in the 17 patients.During the one-year follow-up,none of the patients experienced stone recurrence.CONCLUSION Ultrafine choledochoscopy combined with low-dose atropine is safe and feasible for the treatment of Oddi intersphincter stones.
文摘Objective We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.Methods We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021.The primary outcome was a stone-free rate with one session within 30 days,defined as no residual stones without auxiliary treatment.The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success.Furthermore,we compared the outcomes using propensity score matching.Results Ninety-eight patients underwent the intravenous urography use protocol(Group I),and the remaining 636 patients underwent the non-intravenous urography protocol(Group N).Stone-free rates with one session within 30 days were 38%and 32%in groups I and N,respectively(p=0.3).No statistical differences were observed in the conversion rate to ureteroscopy(p=0.3)or complication rate(p=0.7)between Group I and Group N.One patient who developed skin redness was considered a complication of the contrast medium.Propensity score matching examined 88 matched pairs.Treatment success was obtained in 31(35%)patients in Group I and 33(38%)patients in Group N(p=0.9)within 30 days with one session.Conclusion Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.
文摘BACKGROUND There remain controversies regarding the surgical treatment of extrahepatic bile duct stones(EHBDSs)in clinical practice.AIM To explore the curative effect of laparoscopic cholecystectomy(LC)plus common bile duct exploration(CBDE)for the surgical treatment of EHBDSs and to analyze the risk factors that affect postoperative stone recurrence.METHODS Eighty-two patients with EHBDSs admitted between March 2017 and March 2023 were selected.Among them,patients treated with open choledocholithotomy plus LC or open cholecystectomy(OC)were set as the control group(n=40),and those treated with LC plus CBDE served as the observation group(n=42).The surgical outcomes of the two groups were compared,the surgical complications and Gas-trointestinal Quality of Life Index(GIQLI)scores were counted,and the one-year prognostic recurrence was recorded.Independent factors for postoperative re-currence were determined using univariate and multivariate analyses.RESULTS The two groups were comparable in the stone residual rate(P>0.05).The ope-ration time(P<0.05),intraoperative bleeding(P<0.05),and total complication rate(P=0.005)were lower in the observation group than in the control group.The observation group exhibited a marked increase in the GIQLI score,which was higher than the control group(P<0.05).A lower one-year recurrence rate was determined in the observation group vs the control group(P=0.027).Sphincter of Oddi dysfunction[odds ratio(OR)=5.712,P=0.007]and the treatment scheme of open choledocholithotomy plus LC or OC(OR=6.771,P=0.008)were the independent risk factors for one-year recurrence in patients after surgery.CONCLUSION LC plus CBDE for patients with EHBDSs can reduce stone residuals,intraoperative bleeding,complications,and postoperative recurrence.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal.Additionally,ursodeoxycholic acid(UDCA)can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concen-tration in bile.Despite these treatment options,there are still patients who experience stone recurrence.The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People’s Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected.According to the post-ERCP treatment plan,100 patients were classified into UDCA(n=47)and control(n=53)groups.We aimed to assess the clinical efficacy and rate of relapse in the two patient populations.We then collected information(basic demographic data,clinical characteristics,and serum biochemical indicators)and determined the factors contributing to relapse using logistic regression analysis.Our secondary goal was to determine the effects of UDCA on liver function after ERCP.Compared to the control group,the UDCA group demonstrated a higher clinical effectiveness rate of 92.45%vs 78.72%(P<0.05).No significant differences were observed in liver function indices,including total bilirubin,direct bilirubin,gamma-glutamyl transpeptidase,alanine aminotransferase,alkaline phosphatase,and aspartate aminotransferase,between the two groups before treatment.After treatment,all liver function indices were significantly reduced.Comparing the control vs UDCA groups,the UDCA group exhibited significantly lower levels of all indices(55.39±6.53 vs 77.31±8.52,32.10±4.62 vs 45.39±5.69,142.32±14.21 vs 189.63±16.87,112.52±14.25 vs 149.36±15.36,122.61±16.00 vs 171.33±22.09,96.98±10.44 vs 121.35±11.57,respectively,all P<0.05).The stone recurrence rate was lower in the UDCA group(13.21%)in contrast with the control group(44.68%).Periampullary diverticula(OR:6.00,95%CI:1.69-21.30),maximum stone diameter(OR:1.69,95%CI:1.01-2.85),stone quantity>3(OR:4.23,95%CI:1.17-15.26),and positive bile culture(OR:7.61,95%CI:2.07-27.91)were independent factors that influenced the relapse of common bile duct stones after ERCP(P<0.05).Furthermore,postoperative UDCA was identified as a preventive factor(OR:0.07;95%CI:0.08-0.09).CONCLUSION The intervention effect of UDCA after ERCP for common bile duct stones is adequate,providing new research directions and references for the prevention and treatment of stone recurrence.
基金Supported by 2021 Municipal Health Commission Scientific Research Project,No.WX21D482021 Municipal Health Commission Project,No.WZ21Q112022 Hubei Provincial Department of Science and Technology Project,No.2022CFB980.
文摘BACKGROUND Bile duct stones(BDSs)may cause patients to develop liver cirrhosis or even liver cancer.Currently,the success rate of surgical treatment for intrahepatic and extrahepatic BDSs is not satisfactory,and there is a risk of postoperative complic-ations.AIM To compare the clinical effects of dual-modality endoscopy(duodenoscopy and laparoscopy)with those of traditional laparotomy in the treatment of intra-and extrahepatic BDSs.METHODS Ninety-five patients with intra-and extrahepatic BDSs who sought medical services at Wuhan No.1 Hospital between August 2019 and May 2023 were selected;45 patients in the control group were treated by traditional laparotomy,and 50 patients in the research group were treated by dual-modality endoscopy.The following factors were collected for analysis:curative effects,safety(incision infection,biliary fistula,lung infection,hemobilia),surgical factors[surgery time,intraoperative blood loss(IBL)volume,gastrointestinal function recovery time,and length of hospital stay],serum inflammatory markers[tumor necrosis factor(TNF)-α,interleukin(IL)-6,and IL-8],and oxidative stress[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),and advanced protein oxidation products(AOPPs)].RESULTS The analysis revealed markedly better efficacy(an obviously higher total effective rate)in the research group than in the control group.In addition,an evidently lower postoperative complication rate,shorter surgical duration,gastrointestinal function recovery time and hospital stay,and lower IBL volume were observed in the research group.Furthermore,the posttreatment serum inflammatory marker(TNF-α,IL-6,and IL-8)levels were significantly lower in the research group than in the control group.Compared with those in the control group,the posttreatment GSH-Px,SOD,MDA and AOPPs in the research group were equivalent to the pretreatment levels;for example,the GSH-Px and SOD levels were significantly higher,while the MDA and AOPP levels were lower.CONCLUSION Dual-modality endoscopy therapy(duodenoscopy and laparoscopy)is more effective than traditional laparotomy in the treatment of intra-and extrahepatic BDSs and has a lower risk of postoperative complications;significantly shortened surgical time;shorter gastrointestinal function recovery time;shorter hospital stay;and lower intraop-erative bleeding volume,while having a significant inhibitory effect on excessive serum inflammation and causing little postoperative oxidative stress.
基金the Clinical Research Ethics Committees of Wuxi Taihu Hospital(Approval Number THH-YXLL-2021-0103).
文摘BACKGROUND Renal stones ranging 20–40 mm are very common in China.Although no largesample clinical studies have confirmed the clinical efficacy and safety of this method,there is also a lack of comparative data with traditional treatment.AIM To investigate the clinical efficacy of flexible ureteroscopy(FURS)and percutaneous nephrolithotomy(PCNL)by postoperative stone clearance and changes in soluble vascular cell adhesion molecule 1(sVCAM-1)and kidney injury molecule 1(KIM-1)levels in patients with large kidney stones(>2 cm in diameter).METHODS This single-center observational study was performed at a Chinese hospital between January 1,2021,and October 30,2023.All 250 enrolled patients were diagnosed with large kidney stones(>2 cm)and divided into a FURS group(n=145)and a PCNL group(n=105)by the surgical method.The FURS group was treated with flexible ureteroscopy and the PCNL group was treated with percutaneous nephrolithotomy.The operation time,time to palinesthesia,intraoperative blood loss,drop in hemoglobin,length of hospital stay,stone clearance rate,and complications were recorded in the two groups.Preoperative and postoperative serum sVCAM-1 levels,erythrocyte sedimentation rate(ESR),urine KIM-1 levels,preoperative and postoperative pain visual analog scale(VAS)and Wisconsin Stone Quality of Life Questionnaire(WISQOL)scores were also documented.RESULTS All 250 eligible patients completed the follow-up.There were no significant differences in baseline characteristics between the two groups(P>0.05).The operation time in the FURS group was significantly greater than that in the PCNL group.The time to ambulation,intraoperative blood loss,decrease in hemoglobin,and length of hospital stay were significantly lower in the FURS group than in the PCNL group.The FURS group also had a significantly higher stone clearance rate and a lower incidence of postoperative complications.There was no significant difference in antibiotic use between the groups.Postoperative serum sVCAM-1 levels,urine KIM-1 levels,and VAS scores were lower in the FURS group than in the PCNL group,but postoperative ESR and WISQOL scores were greater in the FURS group than in the PCNL group.CONCLUSION FURS demonstrated superior clinical efficacy in treating large kidney stones(>2 cm in diameter)compared PCNL.It not only improved the postoperative stone clearance rate and reduced complications and recovery time but also positively affected serum SCM-1,ESR,and urine KIM-1 levels,subsequent improvement of patient quality of life.
文摘BACKGROUND For intrahepatic duct(IHD)stones,laparoscopic liver resection(LLR)is currently a reliable treatment.However,the current LLR difficulty scoring system(DSS)is only available for patients with hepatocellular carcinoma.AIM To explore the development of a DSS for IHD stone patients with LLR and the validation of its reliability.METHODS We used clinical data from 80 patients who received LLR for IHD stones.Forty-six of these patients were used in multiple linear regression to construct a scoring system.Another 34 patients from different centers were used as external validation.The completeness of our DSS was then evaluated in patients with varying degrees of surgical difficulty based on documented surgical outcomes in the study group of patients.RESULTS The following five predictors were ultimately included and scored by calculating the weighted contribution of each factor to the prediction of operative time in the training cohort:Location of stones,number of stones≥3,stones located in the bile ducts of several grades,previous biliary surgery less than twice,distal bile duct atrophy.Subsequently,the data set was validated using a DSS developed from the variables.The following variables were identified as statistically significant in external validation:Operative time,blood loss,intraoperative transfusion,postoperative alanine aminotransferase,and Clavien-Dindo grading≥3.These variables demonstrated statistically significant differences in patients with three or more grades.CONCLUSION Patients with IHD stones have varying degrees of surgical difficulty,and the newly developed DSS can be validated with external data to effectively predict risks and complications after LLR surgery.
