Objective To evaluate effects of flush fluid of different temperatures on pain, comfort and adverse reactions in patients receiving choledochoscopy via T tube for residual bile duct stones. Methods Patients who underwent choledochoscopy were divided into the experimental group ( 36℃ saline was used as flush fluid) and control group ( room temperature saline was used as flush fluid) randomly. Pain degree, comfort degree, procedure time, the total amount of flush fluid, infusion speed and adverse reactions were recorded and analyzed. Results A total of 100 cases were included, 50 cases in each group. There was no significant difference between the two groups in their education level, working condition, operation methods, T-tube size, necessity for lithotripsy, procedure time, total amount of flush fluid and infusion speed (all P>0. 05). The pain scores were 1. 0(1. 00, 2. 00) and 2. 0(1. 00, 3. 25) (Z=-2. 158,P=0. 031) and the comfort scores were 6. 0(5. 00, 7. 25) and 5. 0(2. 00, 6. 00) (Z=-3. 384,P=0. 001) in the experimental group and the control group, respectively. There was significant difference in the change rate of heart rate during and before procedure between the two groups (-4. 07％± 10. 76％ VS 0. 30％± 10. 23％, P=0. 046) . The incidence of postoperative diarrhea in the experimental group and the control group was 6％( 3/50) and 22％ ( 11/50 ) , respectively (χ2=5. 316, P=0. 021 ) . Conclusion 36℃ saline flush can reduce pain scores, improve comfort degree and reduce the incidence of postoperative diarrhea after procedure in patients undergoing choledochoscopy via T tube.

Co-occurrence of renal cell carcinoma with two different histology is very rare. Here we present a 61-year-old gentleman with right renal mass in clinics. The diagnosis was right renal cell carcinoma by two different enhanced mass showing on CT scan. Right laparoscopic nephrectomy was performed. Pathology showed that one mass was papillary renal cell carcinoma, the other was clear cell renal cell carcinoma. No recurrence or metastasis was found during 36 months of follow up.