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"Director Xu, if the stone still can't be removed, you will cut off my kidney!" At the first meeting, Lao Shi (pseudonym) handed a thick stack of medical records and imaging materials to Xu Li, chief physician of the Department of Urology of Run Shaw Hospital affiliated to Zhejiang University School of Medicine, and said quite disheartened. Xu Li asked the chief physician about his medical history while calming his emotions.
It turned out that more than a year ago, Lao Shi from Xinchang found a right kidney stone in the local hospital, and the doctor recommended surgery. Lao Shi's son was very filial and took Lao Shi to a city in Jiangsu where he lived, and took Lao Shi to the best local hospital for treatment. But the family did not expect that this "clear stone" road would take more than a year as soon as it was gone.
There have been 6 surgeries and cost nearly 100,000 yuan
The stones are endless
For more than a year, Lao Shi traveled to major hospitals in Jiangsu and Zhejiang provinces, and experienced 6 operations without taking stones to relieve the pain. Old Shi lover said that every time the operation, the doctor always said that the stones had been broken, and she had also seen a lot of rubble taken from Lao Shi's body, but there were still so many stones after a review.
After experiencing many surgical blows and long-term medical pain, and spending 10,000 or 20,000 yuan on treatment costs for each hospitalization, Lao Shi was very depressed and even desperate. After inquiring from many family members, he came to the Department of Urology of Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine and found Xu Li as the chief physician.
After Carefully inquiring about the medical history and checking the information for the chief physician, Xu Li found that the old shi's stone was the most complex staghorn stone in the kidney stone.
This is a special type of kidney stone, which, as the name suggests, fills the kidney pelvis and renal calyx of the kidney like the horns of a reindeer. Due to the complexity of stones and the difficulty of stone retrieval, staghorn stones are still one of the clinical difficulties in urology.
Commonly used treatment methods include percutaneous nephrolithotomy, ureteral soft microscopic lithotripsy, and open or laparoscopic nephrectomy.
Xu Li explained to the chief physician that Lao Shi had previously received routine ureteral soft mirror lithotripsy treatment. Compared with other stone surgery methods, ureteral soft mirror lithotripsy does not require surgery and punching, and the operation is performed through the urethra, which is less traumatic and less technically difficult, and has been widely carried out in hospitals at all levels in recent years.
However, ureteral soft mirror lithotripsy also has its limitations, and experts at home and abroad agree that ureteral soft mirrors should treat stones with a length and diameter of less than 2 cm. Individual successful cases of ureteral soft microscopy for the treatment of large kidney stones require multiple surgeries and staging treatment.
However, after so many times of ureteral soft mirror lithotripsy, Lao Shi's right kidney is still full of stones, what is the reason for this?
Xu Liwei analyzed for the chief physician that there are many reasons such as large stones, hard texture, and ureteral conditions of patients. The stones are so hard that they cannot be powdered under the laser, and can only be broken into gravel (the powder is easier to excrete with the urine); while the old history's ureter conditions are not good, and the gravel-like rubble cannot be discharged smoothly. At the same time, the antlers are filled with renal pelvis, renal calyx, and there are many gravel stones, although some have been taken out after several surgeries, there are still many left in the body.
Individual differences in kidney stones are large
Minimally invasive technology and personalization concepts
Accurately review the "stone" situation
When choosing a treatment regimen for kidney stones, doctors need to fully consider the patient's specific situation, the efficacy of various treatments, the incidence of complications, and other factors.
The preferred treatment for staghorn kidney stones is percutaneous nephrolithotomy, in short, a hole in the kidney that breaks the stone and removes it from that hole. This kind of surgery often requires multi-channel surgery, the operation is complex, the possibility of surgical trauma is large, and the technical requirements of doctors are higher, which makes many doctors prohibitive.
For the case of laoshi, simple ureteral soft mirror lithotripsy has been shown to be ineffective in treatment, but if you choose traditional percutaneous nephrolitoscopic surgery, considering that the stones in the kidneys of laoshi are all gravel, scattered in different positions of the kidneys, it is bound to hit multiple holes to form multiple channels, which is very damaging to the kidneys and easy to bleed heavily.
Schematic diagram of nephrolitoscopic multichannel surgery for percutaneous nephrolithotomy
After comprehensive measurement, Xu Li finally chose a double-mirror combination surgery of percutaneous nephrolitoscopy (single channel) and ureteral soft mirror for the chief physician, internationally known as Endoscopic combined intrarenal surgery (ECIRS) surgery. This scheme combines the advantages of two surgical methods, using soft mirrors to observe and treat renal calyx stones that cannot be treated by nephrochroscopy, reduce puncture channels, reduce the incidence of damage and complications to the renal calyx, and improve the success rate and stone-free rate of lithotripsy.
The operation successfully removed the stones for Lao Shi and naturally saved his kidneys.
Gravel removed from Old Shi's body
Old Shi's family sent thanks
Xu Liwei, chief physician, said that although kidney stones are very common diseases, individual differences are very large, and it is necessary to choose the most suitable treatment method according to the specific situation of patients, and avoid repeated treatment experiences such as old history as much as possible.
It is understood that the Urology Department of Zhejiang University Shaw Hospital leads the province in the annual diagnosis and treatment volume of urinary tract stones and the amount of surgery, and has rich experience in the diagnosis and treatment of urinary tract stones. The department is equipped with almost all the advanced lithotripsy equipment currently available clinically, can carry out various types of urinary tract stone surgery, and has always advocated the minimally invasive technology and individualized concept of urinary tract stone treatment.
Source: Department of Urology, Run Run Shaw Hospital
Original works, reprinted please indicate the source and source
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