目的 探讨经胆道镜联合钬激光碎石治疗肝内外胆管难取性结石的价值。方法 纤维胆道镜窥视下用钬激光碎石治疗肝内外胆管难取性结石29例，观察临床效果。结果 经1～3次胆道镜下钬激光碎石治疗，28例患者结石全部取尽，1例未完全取净，成功率为96.55%（28/29）； 近期无胆道出血、漏胆、黄疸等并发症发生。26例获得随访，随访时间6～20个月，平均13个月，未发现结石复发及胆管狭窄。结论 经胆道镜钬激光碎石是一种治疗肝内外胆管难取性结石简便、安全及有效的方法。
Objective To assess the safety and efficacy of holmium laser resection for superficial bladder cancer (HoLRBT) compared with electrocautery transurethral resection of bladder tumor (TURBT). Methods Such databases as MEDLINE, EMbase, CBM, and The Cochrane Library were searched by computer to include the randomized controlled trials (RCTs) about holmium laser and transurethral electroresection for treating superficial bladder cancer. Meta-analyses were performed by RevMan 5.0 software after the data were abstracted and the quality was evaluated. Results Nine RCTs involving 1 323 patients were included. The results of meta-analyses showed in comparison with the TURBT, there were significant differences in HoLRBT for less intraoprative bleeding volume (WMD= –6.04, 95%CI –6.90 to –5.19), shorter mean bladder irrigating time (WMD= –14.99, 95%CI –17.58 to –12.40), shorter time of indwelling urethral catheter (WMD= –2.46, 95%CI –3.59 to –1.34), fewer postoperative complications such as the obturator nerve reflex (OR=0.03, 95%CI 0.01 to 0.09), fewer events of bladder perforation (OR=0.12, 95%CI 0.05 to 0.31) and lower postoperative recurrence rate (OR=0.70, 95%CI 0.52 to 0.96). Conclusions The current evidence shows that HoLRBT is a feasible, safe, and effective alternative for the management of superficial bladder cancer because of few damages to bladder tissues and less operation bleeding.
Objective To access the efficacy and safety of Holmium laser prostatectomy technique compared to TURP. Methods We searched MEDLINE (1996 to 2004), EMBASE (1984 to 2004), The Cochrane Library (Issue 4, 2004), CNKI, VIP, CMCC and CBMdisc; and handsearched the relevant Chinese journals. Randomized controlled trials (RCT) were included. The quality of trials was evaluated and meta-analysis was performed. Non-randomized controlled trials were also included to evaluate the safety and efficacy. Results We found 4 randomized controlled trials. A total of 480 participants were in the trials ranging from 60 to 200. There was no statistical difference between the two techniques at 12 or 48 months follow-up in terms of quality of life (QOL) improvement（WMD=-0.19, 95%CI -0.81 to 0.44, Z=0.59, P=0.56; WMD=-0.30, 95%CI -0.90 to 0.30, Z=0.98, P=0.33); Qmax improvement（WMD=1.63 ml/s, 95%CI -0.32 to 3.59, Z=1.64, P=0.10; WMD=3.80 ml/s, 95%CI -1.36 to 8.96,Z=1.44, P=0.15); I-PSS or AUA (WMD=-0.06, 95%CI -1.01 to 0.89, Z=0.12, P=0.91; WMD=-1.40, 95%CI -3.91 to 1.11, Z=1.09, P=0.27) and the urethral stricture complication rate (RR=0.75, 95%CI 0.35 to 1.60, Z=0.74, P=0.46). However hospital stay was significantly shorter in the Holmium laser prostatectomy groups (total WMD=-24.89, 95%CI -28.56 to -21.21, Z=13.27, P＜0.000 01). We can not draw consistent conclusions in terms of blood loss according to the present data. One study indicated Holmium laser prostatectomy technique was more cost-effective than TURP. Conclusions In short period Holmium laser prostatectomy is as safe as TURP in terms of hospital stay, urethral stricture and blood loss complication. This new technique is as effiective as TURP in terms of I-PSS (AUA), Qmax and QOL. More RCTs and more long term follow-up is necessary.
【摘要】 目的 探讨微创经皮肾镜下钬激光碎石术治疗上尿路结石的方法及疗效。 方法 2007年9月-2010年10月在B型超声引导下应用微创经皮肾镜下钬激光碎石术治疗上尿路结石138例，其中肾鹿角形结石64例，单发肾盂、肾盏结石38例，双肾结石8例，输尿管上段结石28例，孤立肾结石2例。 结果 136例取石成功，其中95例一期取石成功（包括双通道取石5例），41例二期取石，2例因经皮肾穿失败改行开放手术取石。27例术后体外震波碎石治疗。平均结石清除率78.9%（109/138）。平均手术时间112 min，平均住院时间10 d，肾造瘘管平均留置时间4 d，双J管平均留置时间4周。5例因术中出血较多需输血。11例术后1周内出血较多，其中3例需要输血。12例出现尿外渗。7例术后出现高热（gt;39 ℃）。随访: 98例伴有肾积水，时间3~6个月，平均4个月，24例积水消失，68例积水减轻，6例无改善也无加重；22例残余结石随访4~9个月，平均6个月，6例结石增大，16例结石无变化；87例随访12个月无残余结石，7例结石复发。 结论 微创经皮肾镜下钬激光碎石术治疗上尿路结石创伤小，恢复快，并发症少，疗效满意。【Abstract】 Objective To discuss the method and the curative effect of minimally invasive percataneous nephrolithotomy (mini PCNL) with holmium laser in treating upper urinary tract calculi. Methods From September 2007 to October 2010, 138 patients with upper urinary tract calculi were treated with mini PCNL with holmium laser under the conduction by type-B ultrasonography. Of the 138 cases, 64 patients had staghorn calculi, 38 had single renal pelvis or renal calyx stones, eight had bilateral renal calculi, 28 had upper-ureteral calculi, and two had solitary kidney calculi. Results Successful stone removal was achieved in 136 cases, among which there were 95 cases of stage-one nephrolithotomy (double tracts were used in five cases) and 41 cases of sfage-two neploolithotomy. Two cases were changed to open operation due to failures of percutaneous nephrolithotory. Extracorporeal shock-wave lithotomy was used in 27 cases after operation. The average stone removal rate was 78.9% (109/138). The average operation time was 112 minutes. The average hospital stay was 10 days. The average nephrostomy tube stay was four days. The average double J tube stay was four weeks. Five patients needed blood transfusion in operations due to a large amount of blood loss. Eleven patients suffered from massive hemorrhage one week after operation and blood transfusion was performed in three patients. Urine exosmosis happened in 12 cases. And there were seven cases of high fever (gt;39 ℃) after operation. Follow-up was done for 98 patients accompanied by hydronephrosis for a time period ranged from three to six months averaging at four months. Hydronephrosis disappeared in 24 patients, alleviated in 68 cases, and did not change in six cases. Twenty-two cases of residual calculi were followed up for a period ranged from four to nine months averaging at six months. Enlarged calculi occurred in six cases and no change happened to the calculi in 16 cases. Eighty-seven patients without residual calculi were followed up for 12 months, and there were seven cases of reoccurrence. Conclusion Treatment of upper urinary tract calculi with minimally invasive percutaneous nephrolithotomy with holmium laser is a simple and safe method with little injury, quick recovery, few complications and satisfactory results.
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。
ObjectiveTo compare the clinical efficacy of transurethral plasmakinetic resection of bladder tumors (PKRBT) and holmium laser resection of bladder tumors (HOLBT), and discuss the effcacy, safety, indication, and complications of PKRBT for the treatment of bladder tumors compared with HOLBT. MethodsA hundred patients with bladder tumors were divided into two groups randomly, who were selected from patients in the Department of Urology of West China Hospital from March 2011 to March 2013. Among all the 100 cases, half of them were treated with PKRBT, and all others treated with HOBLT. The significant markers in both groups were recorded and evaluated, including the situation of before operation, during operation and after operation. The data recorded consisted of the general records of patients' medical background, concomitant disease, laboratory examination, and the position, amount, pathology of the tumor, total operative duration, the time of gross hematuria, the time of postoperative bladder irrigation and catheterization, the length of stay, postoperative complications and patients' conditions at month 3, 6, and 12 during the follow-up. ResultsAll operations were successfully performed, and there was no significant diTherences between the two groups in preoperative indexes (P>0.05). No abnormalities were detected in the postoperative laboratory examinations. The diTherences in operatative duration, time of bladder irrigation, duration of indwelling catheter, and postoperative length of stay between the two groups were not significant (P>0.05). But the mean time of gross hematuria was significantly shorter after operation in the HOLBT patients [(6.1±7.6) hours] than in those treated with PKRBT [(15.3±17.2) hours] (P<0.05). There was no significant diTherence between the two groups in the recurrence rate 3, 6, and 12 months after operation (P>0.05). ConclusionHOLBT can be used safely and effectively in treating bladder tumors, and it is easy for clinical manipulation. HOLBT is as effective and safe as PKRBT with similar adverse side-effect rate within and after operation.