目的 观察物理振动排石机在上尿路结石体外冲击波碎石术(ESWL)后的临床应用效果.方法 选取240例行ESWL治疗的上尿路结石患者,随机分为观察组和对照组,各120例.所有患者均接受ESWL治疗,术后观察组接受体外物理振动排石(EPVL)联合常规排石治疗,对照组接受常规排石治疗.比较两组患者术后排石效果及并发症情况.结果 观察组患者当日排石率显著高于对照组,且术后1周、2周和4周净石率均高于对照组(均P ＜0.05).两组术后并发症发生率比较差异无统计学意义(P＞0.05).结论 上尿路结石行ESWL的患者术后采用EPVL治疗,可促进结石碎块排出,提高净石率,值得临床推广应用.

目的 探讨输尿管软镜狄激光碎石术(FURL)联合超微通道经皮肾镜碎石清石术(SMP)治疗上尿路结石患者的疗效及安全性评估.方法 选取2018年2月至2019年5月就诊的上尿路结石患者150例,按照随机数字表法分为试验组与对照组,每组75例.对照组给与SMP治疗,试验组给与FURL联合SMP治疗,观察并记录患者一般情况,包括手术时间、肾造瘘管留置时间、住院时间、术后血红蛋白下降值、结石清除率.检测手术前与手术后3个月患者肾功能[尿素、肌酐、β2-微球蛋白(β2-MG)],检测术前与术后24、48、72 h尿液中肾损伤因子-1(KIM-1)值,评估术前1 d、术后1、3、7 d应激功能,术后随访3个月,观察术后并发症的发生情况.结果 试验组住院时间、结石清除率、肾造瘘管留置时间、术后血红蛋白下降值小于对照组,手术时间长于对照组,差异均有统计学意义(P<0.05).2组治疗前血清尿素、肌酐、β2-MG值差异无统计学意义(P>0.05),经治疗后尿素、肌酐、β2-MG值均升高,试验组小于对照组(P<0.05).术前2组患者尿液KIM-1水平均差异无统计学意义(P>0.05),试验组患者术后24、48、72 h的KIM-1水平显著低于对照组(P<0.05).术前2组患者血清皮质醇、去甲肾上腺素、肾上腺素差异无统计学意义(P>0.05),术后2组患者血清皮质醇、去甲肾上腺素、肾上腺素均上升(P<0.05),且试验组皮质醇、去甲肾上腺素、肾上腺素水平大于同时间点对照组值(P<0.05).2组不良反应发生率比较,差异无统计学意义(P>0.05).结论FURL联合SMP缩短患者住院时间短,减少术后出血量和肾造瘘留置时间,提高结石清除率,对肾功能和肾的损伤小,应激反应小,术后并发症少,安全性和经济学效益高.

目的 探讨经尿道输尿管镜钬激光治疗婴儿输尿管囊肿的临床效果.方法 对5例输尿管囊肿患儿采用经尿道输尿管镜下钬激光囊肿切开术,并随访观察疗效.结果 5例患儿均一次治愈,无明显并发症.术后随访0.5～2.0年,均未见输尿管囊肿复发,复查肾积水好转,无膀胱输尿管反流;3例患儿合并肾结石排出.结论 经尿道输尿管镜钬激光婴儿输尿管囊肿切开术是一种安全、有效的微创治疗方法.

目的 评价组合式输尿管软镜钬激光碎石术治疗肾结石的临床效果.方法 回顾分析我院2012年1 1月-2013年5月采用组合式输尿管软镜钬激光碎石术治疗肾结石患者47例.结石位于肾中、上盏8例,肾下盏16例,肾盂20例,多肾盏结石3例.结石直径5.0 ～30.0(16.0 ±4.0)mm.硬膜外麻醉下,探及结石后使用200μm光纤,0.8～1.0 J/15～20Hz(12 ～20W)功率钬激光将结石击碎.术后常规留置5～6F双J管.术后3d内尿路平片(KUB)评价碎石效果;术后4周B超或KUB评价结石排净率.结果 本组47例中,结石探及率91.5％ (43/47);单次碎石成功率93.2％ (41/44);手术时间65～ 155(125±16)min.结论 组合式输尿管软镜钬激光碎石术治疗肾结石疗效确切、并发症少,是一种安全、有效的方法.

Objective To evaluate the effacacy of minimally invasive or micro-invasive percutaneous nephrolithotomy (MPCNL) in treating upper urinary calculi. Methods A retrospective analysis was performed on 2,724 patients received MPCNL in our depart-ment from January 2004 to December 2013. Results During the treatment, 2,835 kidneys were treated and MPCNL was performed for 3,078 times, including first stage procedures for 2,696 times (87. 59% ), secondary procedures for 357 times (11. 60% ) and third pro-cedures for 25 times (0. 81% ). Nephrolithotomy was performed in 2,786 cases (98. 27% ) via single tract, in 44 cases (1. 55% ) via double tracts and in 5 cases (0. 19% ) via triple tracts. After, 173 cases (6. 35% ) needed extracorporeal shock wave lithotripsy (ES-WL) and/ or flexible ureteroscope lithotripsy. The average operating time was (120. 4 ±50. 5)min. The stone-free rate after MPCNL was 91. 2% , and it was increased up to 94. 1% by adjunctive ESWL and/ or flexible ureteroscope lithotripsy. And the mean hospital stay was (10. 6 ±3. 2)days. Blood transfusion was performed in 61 cases (2. 24% ) including 8 cases (0. 29% ) that needed selective renal arte-rial embolization to achieve hemostasis. Other complications included 1 case (0. 04% ) of kidney rupture caused by nephrectomy, 1 case (0. 04% ) case of colon injury, and 5 cases (0. 18% ) of pleura injury. Septic shock happened in 28 cases (1. 03% ), one of which (0. 04% ) died. Another death was caused by pulmonary embolism seven days after operation. Conclusion MPCNL has the advantage of less invasion and complications and higher stone-free rate. The clinical experience in MPCNL demonstrates that it is safe, feasible, and efficient for managing upper urinary calculi.

Objective To investigate the effect and safety of minimally invasive percutaneous nephrolithotomy ( MPC-NL) in treatment of upper urinary tract calculi in children .Methods Retrospecitvely analyzed 39 cases(43 sides) with upper urinary tract calculi from January 2004 to April 2013 ,they were all received minimally invasive percutaneous nephrolithotomy with pneumatic lithotripsy(pneumatic lithotripsy and holmium laser ).Under the ipsilateral ureter retrograde ureteroscopy 4-6F indwelling ureteral catheter , puncture percutaneous renal target calyx established channels under B -type ultrasound guidance , pneumatic lithotripsy and holmium laser lithotripsy , X-ray films or B-type ultrasound were used to evaluate stone expulsion af-ter operation .Results One session MPCNL were successfully performed in all children .The operation time ranged from 50 to 143 (82.0 ±9.0) min, the stone clearance rate was 90.7%(39/43).Severe complications such as pneumothorax ,intraope-rative injury to adjacent organs did not occurred in all patients .Thirty-seven patients were followed up for 3-12 months,chil-dren with hydronephrosis were not aggravated , the kidney function is improved after operation , no complications occurred . Conclusion Minimally invasive percutaneous nephrolithotomy with fewer traumas , less complications , the stone clearance rate was high;it is safe and reliable to treat upper urinary tract calculi in children .

传统经皮肾镜的扩张通道较大,容易拉伤叶间血管或撕裂肾盏颈而致大出血,术后易出现尿外渗、肾周积液、感染、肾周血肿等并发症.针对传统经皮肾镜取石术(percutaneous nephrolithotripsy,PCNL)大通道、并发症多等不足,经过多年的临床实践,李逊等[1]提出了微创经皮肾镜取石术(minimally-invasive percutaneous nephrolithotripsy,MPCNL).

外科学是一门实践性很强的学科,具有实践性、应用性的学科特征,外科学实验课是培养医学生临床基本操作技能的主干课程.在教学中,我们采用讲授、示教、练习及考核相结合的教学法,收到了良好效果.大多数学员树立起正确的无菌观念,基本掌握了外科基本操作技能,为适应临床工作奠定了良好基础.现将外科学实验课教学方法及学员常见问题的处理介绍如下.

Objective To evaluate the clinical effect of holmium laser on the treatment of ureteral calculi.Methods We retrospectively analyzed the clinical data of 1210 patients with urethral calculi treated with holmium laser lithotripsy.Results The successful calculi-fragmenting rate was 97.7%(1 182/1 210) and the stone-free rate was 96.6%(1 169/1 210).The main complications were ureteral perforation in 9 and ureteral stenosis in 24.Conclusion Treatment of ureteral calculi by ureteroscopic holmium laser lithotripsy has been safe,effective and less invasive,and should be the first choice to patients with lower,middle and partial upper ureteral stones.

目的 总结输尿管镜钬激光碎石治疗输尿管结石的临床经验.方法 回顾分析1210例输尿管镜下使用钬激光治疗输尿管结石患者的资料.结果 本组病例碎石成功率97.7%(1182/1210),结石排尽率96.6%(1 169/1 210).主要并发症为输尿管穿孔9例,黏膜明显裂伤或黏膜下假道24例.结论 输尿管镜钬激光碎石术治疗输尿管结石具有微创、安全、高效等优点,可作为中下段和部分上段输尿管结石的首选治疗方法.