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超声诊断输尿管结石伴输尿管瘘一例

微通道经皮肾输尿管镜联合气压弹道碎石术在基层医院的应用分析

目的探讨微通道经皮肾输尿管镜联合气压弹道碎石取石术（mini-PCNL）在基层医院的应用疗效和安全性。 方法对2010年3月－2013年3月收治的108例上尿路结石患者采用mini-PCNL予以治疗，并就手术方式、手术时间、结石清除率等情况进行分析表述。 结果107例患者成功在B型超声引导下建立经皮肾穿刺通道，1例肾下盏结石因肾脏大出血改开放手术行肾部分切除术，3例患者术中建立通道后出血较多安置肾造瘘管后行二期手术。手术时间为20～190 min，平均（78.0±40.1）min，结石总清除率78.5%，其中输尿管上段结石单次清除率100.0%、肾结石单次清除率70.1%。术中平均出血量（105.0±45.6）mL，无胸膜、腹腔脏器、结肠损伤；平均住院7～14 d。 结论mini-PCNL治疗上尿路结石具有较高的结石清除率、良好的安全性，同时具有术后恢复快、费用适中等优点，值得在基层医院推广应用。

Clinical Comparision of the Effects of Two Different Anesthesia for Surgery of Pediatric Ureteral Calculi

摘要:目的:分析与比较七氟醚吸入麻醉和丙泊酚静脉复合麻醉应用于三聚氰胺致婴幼儿输尿管结石手术的麻醉效果。方法:60例输尿管结石患儿随机分为七氟醚(Sev)组(n=30)和丙泊酚(Pro)组(n=30)。观察并记录诱导时间、气管内插管时间、苏醒时间、拔除气管插管时间、PACU滞留时间。记录麻醉诱导和苏醒期的不良反应。另外记录两组病人诱导前、插管前、插管后3 min、5 min、15 min、30 min时点的血压、心率、脉搏血氧饱和度(SPO2)。结果:七氟醚组诱导时间(63.2±6.9)s长于丙泊酚组(38.2±12.7)s,七氟醚组拔除气管插管时间(11.9±4.7)min短于丙泊酚组(15.6±8.2)min,两组相比有统计学意义(Plt;0.05)。七氟醚组躁动发生率53.3%显著高于丙泊酚组13.3%(Plt;0.01)。七氟醚组在插管前、插管后各时点的血压、心率与诱导前相比,差异无统计学意义(Pgt;0.05),丙泊酚组插管前、插管后3 min、5 min与诱导前相比血压、心率显著降低(Plt;0.05),与同时间点七氟醚组相比血压显著降低(Plt;0.05)。结论:两种麻醉方法均可安全有效用于婴幼儿输尿管结石手术,七氟醚组血流动力学更平稳,但躁动发生率较高。Abstract: Objective: To analyze and compare sevoflurane with propofol for anesthesia in infants with Melamineinduced ureteral stone surgery. Methods: Sixty infants who were to undergo Melamineinduced ureteral stone surgery were randomly divided into sevoflurane (Sev) group (n=30) and propofol (Pro) group (n=30). Observe and record the induction of anesthesia time, intubation time, awakening time, time to extubation, time to stay at PACU. Record adverse effects during induction of anesthesia and the awake period. In addition, recorded BP, HR, SPO2 of two groups before induction and intubation, after 3min、5min、15min、30min　after intubation. Results: Induction time ［（63.2 ± 6.9） s］ in sevoflurane group was longer than propofol group ［(38.2±12.7） s］,but extubation time ［（11.9 ± 4.7） min］ was shorter than propofol group ［(15.6 ± 8.2） min］, there was significantly different between two groups (Plt;0.05). The incidence of restlessness in sevoflurane group 53.3% was significantly higher than propofol group 13.3% (Plt;001). In sevoflurane group the BP, HR before intubation compare with after intubation has no significant difference (Pgt;0.05). Compared with before induction,the BP, HR before induction, after intubation 3 min, 5 min, decreased significantly (Plt;0.05) in propofol group.when compared the same point with sevoflurane group, blood pressure decreased significantly (Plt;0.05). Conclusion: Both propofol and sevoflurane can be used effectively and safely for anesthesia of ureteral calculi stone surgery in pediatric. The hemodynamics is more stable but restlessness is more common in sevoflurane group.

Treatment of Renal Pelvic Calculi by Transurethral Ureteroscopic Pneumatic Lithotripsy

目的:探讨经尿道输尿管镜腔内气压弹道碎石治疗肾盂结石的疗效。方法:回顾分析7例肾盂结石经尿道输尿管镜腔内气压弹道碎石术式治疗的临床资料。结果:5例术后复查出现大小不等上尿路残余结石,分别予经皮肾镜碎石,经尿道输尿管镜碎石,体外振波碎石治疗后复查无残余结石。结论:肾盂结石经尿道输尿管镜腔内气压弹道碎石治疗需要根据结石的大小、形态及位置严格掌握适应症。

he Application of Retroperitoneoscopic Ureterolithotomy in Treatment of Impacted Stone of Upper Ureter (Reports of 58 Cases)

摘要:目的:探讨后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石的临床价值和技术要点。 方法:2006年12月至 2009年3月,对58例嵌顿性输尿管中上段结石采用后腹腔镜输尿管切开取石术,术中取石后于镜下直接置入双J管,间段缝合输尿管切口。 结果:58例手术均获成功,无中转开放手术,结石清除率100%。术后创腔引流液量少,3～5d拔除引流管,1周出院,术后3周膀胱镜下拔除双J管。随访1～27个月,B超复查显示肾积水明显好转或消失,无结石复发。 结论:后腹腔镜输尿管切开取石术治疗嵌顿性输尿管结石具有创伤小\疗效好、术后恢复快等特点,明显优于开放手术及其它手术,值得推广应用。Abstract: Objective: To summarize our experience and evaluate the outcome of retroperitoneal laparoscopic ureterolithotomy of the upper ureter impacted stone. Methods: Between December 2006 and March 2009, 58 patients underwent retroperitoneal laparoscopic ureterolithotomy of the upper ureter. After removal of the stones, the double J was put in and interrupted suture was performed for upper ureter. Results: Retroperitoneoscopic ureterolithotomy was successful in all patients, there was neither ureteral stricture nor recurrent calculus, the blood loss ranged from 510 mL, without urine leakage occurred.The mean hospital stay was 7 days, after 3 weeks double J was removed by cystoscopy. With 127 months followup, the hydronephrosis relieved and no recurrence of ureter calculus founded. Conclusion:Retroperitoneoscopic ureterolithotomy is a safe and effective minimally invasive operation, and worth to generalization.

经电切镜外鞘输尿管镜气压弹道碎石术治疗下尿路结石

【摘要】　目的　总结经电切镜外鞘输尿管镜气压弹道碎石术治疗下尿路结石的疗效。　方法　2009年10月－2010年4月，采用经电切镜外鞘输尿管镜直达结石部位，采用气压弹道碎石术治疗下尿路结石20例。其中男15例，女5例；年龄35~80岁，平均54岁。膀胱结石18例，后尿道（尿道膜部）结石2例，结石直径0.5~2.0 cm，均为单发。病程6 h~2年，平均15 d。　结果　20例均一次性成功碎石，碎石成功率100%。碎石时间15~45 min，平均27 min；术后住院时间2~6 d，平均3.7 d。术后无大出血、水中毒、感染等术后早期并发症。13例患者获随访，随访时间1~3个月，平均1.2个月。所有患者均未出现结石复发、尿道狭窄等并发症。　结论　经电切镜外鞘输尿管镜下气压弹道碎石术治疗下尿路结石疗效确切、微创，是一种治疗下尿路结石的安全方法。

Curative Effect of Flexible Ureteroscope with 200 μm Holmium Laser Lithotripsy in the Treatment of Medullary Sponge Kidney Calculi

ObjectiveTo investigate the clinical efficacy and safety of lithotripsy under flexible ureteroscope using 200 μm holmium laser for medullary sponge kidney stones. MethodsWe identified and retrospectively reviewed 10 patients who underwent flexible ureteroscopic lithotripsy for medullary sponge kidney calculi between January 2013 and July 2014. The remission of clinical symptoms and incidence of perioperative complications were observed. ResultsThe staged surgery was performed on 10 bilateral cases with one session for each kidney. The operative time of our cohort was 130-180 minutes. The postoperative average hemoglobin was not significantly reduced (110.6 g/L) as compared with preoperative average hemoglobin (116.8 g/L) (P>0.05). Two patients had fever after operation and temperatures became normal by anti-infection. The renal function and plain film of kidney-ureter-bladokr (KUB) and CT scan were rechecked for all cases on three months after operation. The kidney function in 3 cases of chronic renal failure was ameliorated to varying degrees. The postoperative average of serum creatinine (196.2 μmol/L) was reduced as compared with the preoperative average serum creatinine (385.7 μmol/L) (P<0.05). Six patients reported spontaneous discharge of residuary stones during three months after surgery. KUB and CT scan proved significant reduction of the loads of stones for all cases after operation. ConclusionFlexible ureteroscope with 200 μm holmium laser lithotripsy is a safe and effective treatment for medullary sponge kidney stones based on its effect on amelioration of symptom and renal function.

Development and prospect of tissue engineering in urology

Tissue engineering technology and stem cell research based on tissue engineering have made great progresses in overcoming the problems of tissue and organ damage, functional loss and surgical complications. Traditional method is to use biological substitute materials to repair tissues, while tissue engineering technology focuses on combining seed cells with biological materials to form biological tissues with the same structure and function as its own to repair tissue defects. The advantage is that such tissue engineering organs and tissues can solve the problem that the donor material is limited, and effectively reduce complications. The purpose of tissue engineering is to find suitable seed cells and biomaterials which can replace the biological function of original tissue and build suitable microenvironment in vivo. This paper mainly describes current technologies of tissue engineering in various fields of urology, and discusses the future trend of tissue engineering technology in the treatment of complex urinary diseases. The results of this study show that although there are relatively few clinical trials, the good results of the existing studies on animal models reveal a bright future of tissue engineering technology for the treatment of various urinary diseases.

输尿管软镜钬激光碎石治疗肾输尿管上段结石150例

目的 评价输尿管软镜钬激光碎石治疗肾输尿管上段结石的效果，探讨操作技巧。 方法 2010年9月－2014年9月行输尿管软镜钬激光碎石治疗的肾输尿管上段结石患者150例，结石直径为0.8～4.2 cm。早期患者均先置F5双J管2周，再行输尿管软镜碎石。自2014年起均采用直接一期输尿管软镜碎石，术后3～5 d及术后4周复查腹部X线片及CT，评价碎石及排石效果。 结果 输尿管软镜一次性进镜率98.7%（148/150）；碎石成功率98.7%（148/150）；结石清除率97.3%（146/150）；手术时间20～126 min，平均40 min。2例术后出现尿源性败血症，经治疗缓解。 结论 输尿管软镜钬激光碎石手术创伤小，恢复快，并发症发生率低，结石排净率高，是治疗肾输尿管上段结石安全有效的方法。

常规彩色多普勒超声组合拳法在输尿管非典型结石诊断中的实用价值

目的总结常规彩色多普勒超声组合拳法对输尿管非典型结石诊断的实用价值，提高彩色多普勒超声对其诊断水平。 方法对2008年10月－2014年12月178例输尿管非典型结石患者采用排除法，凸阵、线阵探头加压追踪检查，彩色多普勒超声闪烁伪像辅诊，必要时结合口服利尿剂饮水膀胱充盈聚焦检查，输尿管口射尿多普勒彩色信号观察法与采用腔内探头经阴道超声检查有机组合应用，以确定结石的存在。 结果输尿管非典型结石多比较小，患侧输尿管扩张及肾积水程度较轻；输尿管腹段结石5例，盆段结石29例，膀胱壁段结石144例；二维B型超声共检出132枚（74%，132/178），通过彩色多普勒超声观察结石后方闪烁伪像进一步明确检出170枚（96%，170/178），采用腔内探头经阴道超声检出6枚，2例通过适量饮水后对比观察双侧输尿管膀胱入口处喷尿现象，提示存在结石梗阻。 结论彩色多普勒超声联合多种探查方法诊断可提高输尿管非典型结石的显示率。