Objective To access the therapeutic efficacy of newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage for severe acute cholangitis caused by choledocholithiasis.Methods Data o...Objective To access the therapeutic efficacy of newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage for severe acute cholangitis caused by choledocholithiasis.Methods Data of 26 patients were retrospectively analyzed,who were admitted into the intensive care unit(ICU),Zhongda Hospital,Southeast University,due to choledocholithiasis induced by severe acute cholangitis and underwent cholangioscope-assisted bedside one-stage lithotomy and biliary drainage from June 2020 to February 2022.Clinical outcomes were analyzed.Results The time interval from disease onset to endoscopic intervention was 36.2±15.5 hours,with 7.2±4.9 hours from ICU admission to endoscopic intervention.Technical success rate was 100.0%in one-stage stone removal and biliary drainage.Except for one mild pancreatitis,no other complications occurred.Acute physiology and chronic health evaluation(APACHE)II and sequential organ failure assessment(SOFAs)cores prior to endoscopic intervention were 25.2±6.6 and 11.9±3.5,respectively.APACHE II scores at day 1,3,and 7 after endoscopic intervention were 21.7±6.5,17.2±6.8 and 12.7±7.7,respectively,and SOFA scores were 10.6±2.9,8.4±3.0 and 5.4±3.7,respectively,all of which were lower than those before operation(P<0.001).The length of ICU stay and total hospitalization was 9.7±5.0 days and 12.8±4.5 days,respectively.In-hospital mortality occurred in 3(11.5%)patients.According to a 6-month follow-up,one patient died of pneumonia,and another died of acute myocardial infarction.No acute cholangitis re-occurred in those survivors.Conclusion Newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage demonstrate significant improvements in prognosis,highlighting its safety in managingsevere acute cholangitis.展开更多
The prevalence of urolithiasis has been observed to increase during last decades. Kidney stones over 2 cm in diameter are the common urologic problem. European and American Associations of Urology has published guidel...The prevalence of urolithiasis has been observed to increase during last decades. Kidney stones over 2 cm in diameter are the common urologic problem. European and American Associations of Urology has published guidelines on Urolithiasis and presented the most effective tools to treat large stones. On the other hand many experienced endourologic centres choose other modalities from their armamentarium. All treatment methods are characterized by their efficacy and safety which are usually inversely proportional. It is crucial for patients and physicians to find a golden mean. Percutaneous lithotripsy is still considered treatment of choice with more than 95% efficacy. Less invasive retrograde intrarenal surgery is also less effective, but burdened with lower complication rate. Extracorporeal shockwave lithotripsy is feasible in paediatric patients with acceptable stone free rates. Open surgery(pylolithotomy and anatrophic nephrolithotomy) are almost obsolete techniques. All methods have their pros and cons. Physicians should share decisions regarding treatment modalities with patients.展开更多
BACKGROUND Meralgia paresthetica(MP)is an entrapment mononeuropathy of the lateral femoral cutaneous nerve(LFCN).Although structural abnormalities in nerve tissues can be confirmed using ultrasonography,this is not ro...BACKGROUND Meralgia paresthetica(MP)is an entrapment mononeuropathy of the lateral femoral cutaneous nerve(LFCN).Although structural abnormalities in nerve tissues can be confirmed using ultrasonography,this is not routinely performed.CASE SUMMARY Herein,we present the case of a 52-year-old woman who developed MP after laparoscopic gynecological surgery.The patient was referred to our clinic from an obstetrics and gynecology clinic with symptoms of numbness and a tingling sensation in the left anterolateral thigh,which developed after surgery performed 5 mo earlier.Tests were performed to assess the disease status and determine the underlying causes.Ultrasonographic examination revealed an anatomical variation,where the left LFCN was entrapped within the inguinal ligament.This case suggests that performing ultrasonographic examination before and after surgery in the lithotomy position could help prevent MP.CONCLUSION This case demonstrates the value of ultrasonography in detecting anatomical variation and diagnosing persistent MP.Ultrasonography should be considered an adjunct to electromyography for optimal MP management.Further,this case would help other clinicians determine patient prognosis and decide on targeted treatment strategies.展开更多
Objective: to investigate the value of self-made negative pressure aspirator combined with ureteroscopic lithotripsy (URL) in the treatment of upper urinary calculi. Methods: 178 patients with upper urinary calculi we...Objective: to investigate the value of self-made negative pressure aspirator combined with ureteroscopic lithotripsy (URL) in the treatment of upper urinary calculi. Methods: 178 patients with upper urinary calculi were divided into two groups according to different treatment methods, 89 cases in each group. Patients in the control group were treated with conventional URI, and patients in the observation group were treated with self-made negative pressure suction device combined with URI. The surgical indicators, complications and therapeutic effects of patients in the two groups were observed. Results: the renal pressure, operation time, postoperative hospital stay, intraoperative blood loss, WBC count, neutrophil percentage, PCT value and CRP value in the observation group were significantly lower than those in the control group (P < 0.01), and the differences were statistically significant (P < 0.05). The primary stone clearance rate in the observation group was higher than that in the control group (P < 0.05), and the intraoperative stone escape rate, postoperative fever incidence and postoperative septic shock incidence in the observation group were significantly lower than those in the control group (P < 0.05), with statistically significant differences. Conclusion: the self-made negative pressure suction device combined with URL can significantly reduce the intraoperative calculus escape rate and the incidence of septic shock, and can significantly improve the primary calculus clearance rate with good effect.展开更多
文摘Objective To access the therapeutic efficacy of newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage for severe acute cholangitis caused by choledocholithiasis.Methods Data of 26 patients were retrospectively analyzed,who were admitted into the intensive care unit(ICU),Zhongda Hospital,Southeast University,due to choledocholithiasis induced by severe acute cholangitis and underwent cholangioscope-assisted bedside one-stage lithotomy and biliary drainage from June 2020 to February 2022.Clinical outcomes were analyzed.Results The time interval from disease onset to endoscopic intervention was 36.2±15.5 hours,with 7.2±4.9 hours from ICU admission to endoscopic intervention.Technical success rate was 100.0%in one-stage stone removal and biliary drainage.Except for one mild pancreatitis,no other complications occurred.Acute physiology and chronic health evaluation(APACHE)II and sequential organ failure assessment(SOFAs)cores prior to endoscopic intervention were 25.2±6.6 and 11.9±3.5,respectively.APACHE II scores at day 1,3,and 7 after endoscopic intervention were 21.7±6.5,17.2±6.8 and 12.7±7.7,respectively,and SOFA scores were 10.6±2.9,8.4±3.0 and 5.4±3.7,respectively,all of which were lower than those before operation(P<0.001).The length of ICU stay and total hospitalization was 9.7±5.0 days and 12.8±4.5 days,respectively.In-hospital mortality occurred in 3(11.5%)patients.According to a 6-month follow-up,one patient died of pneumonia,and another died of acute myocardial infarction.No acute cholangitis re-occurred in those survivors.Conclusion Newly-designed digital cholangioscope-assisted bedside one-stage lithotomy and biliary drainage demonstrate significant improvements in prognosis,highlighting its safety in managingsevere acute cholangitis.
文摘The prevalence of urolithiasis has been observed to increase during last decades. Kidney stones over 2 cm in diameter are the common urologic problem. European and American Associations of Urology has published guidelines on Urolithiasis and presented the most effective tools to treat large stones. On the other hand many experienced endourologic centres choose other modalities from their armamentarium. All treatment methods are characterized by their efficacy and safety which are usually inversely proportional. It is crucial for patients and physicians to find a golden mean. Percutaneous lithotripsy is still considered treatment of choice with more than 95% efficacy. Less invasive retrograde intrarenal surgery is also less effective, but burdened with lower complication rate. Extracorporeal shockwave lithotripsy is feasible in paediatric patients with acceptable stone free rates. Open surgery(pylolithotomy and anatrophic nephrolithotomy) are almost obsolete techniques. All methods have their pros and cons. Physicians should share decisions regarding treatment modalities with patients.
文摘BACKGROUND Meralgia paresthetica(MP)is an entrapment mononeuropathy of the lateral femoral cutaneous nerve(LFCN).Although structural abnormalities in nerve tissues can be confirmed using ultrasonography,this is not routinely performed.CASE SUMMARY Herein,we present the case of a 52-year-old woman who developed MP after laparoscopic gynecological surgery.The patient was referred to our clinic from an obstetrics and gynecology clinic with symptoms of numbness and a tingling sensation in the left anterolateral thigh,which developed after surgery performed 5 mo earlier.Tests were performed to assess the disease status and determine the underlying causes.Ultrasonographic examination revealed an anatomical variation,where the left LFCN was entrapped within the inguinal ligament.This case suggests that performing ultrasonographic examination before and after surgery in the lithotomy position could help prevent MP.CONCLUSION This case demonstrates the value of ultrasonography in detecting anatomical variation and diagnosing persistent MP.Ultrasonography should be considered an adjunct to electromyography for optimal MP management.Further,this case would help other clinicians determine patient prognosis and decide on targeted treatment strategies.
文摘Objective: to investigate the value of self-made negative pressure aspirator combined with ureteroscopic lithotripsy (URL) in the treatment of upper urinary calculi. Methods: 178 patients with upper urinary calculi were divided into two groups according to different treatment methods, 89 cases in each group. Patients in the control group were treated with conventional URI, and patients in the observation group were treated with self-made negative pressure suction device combined with URI. The surgical indicators, complications and therapeutic effects of patients in the two groups were observed. Results: the renal pressure, operation time, postoperative hospital stay, intraoperative blood loss, WBC count, neutrophil percentage, PCT value and CRP value in the observation group were significantly lower than those in the control group (P < 0.01), and the differences were statistically significant (P < 0.05). The primary stone clearance rate in the observation group was higher than that in the control group (P < 0.05), and the intraoperative stone escape rate, postoperative fever incidence and postoperative septic shock incidence in the observation group were significantly lower than those in the control group (P < 0.05), with statistically significant differences. Conclusion: the self-made negative pressure suction device combined with URL can significantly reduce the intraoperative calculus escape rate and the incidence of septic shock, and can significantly improve the primary calculus clearance rate with good effect.
