Objective:To explore the clinical safety and efficacy of 4.8 F visual micro-percutaneous nephrolithotomy for the treatment of renal microlithiasis of aircrew.Methods:From March 2017 to September 2021, 4.8 F visual micro-percutaneous nephrolithotomy were performed to treat renal microlithiasis of 28 cases in Armed Police Forces Hospital of Henan, which underwent flexible ureteroscopy without success, it was difficult to place the guide sheath because of ureteral stricture in 19 cases, or no stones were found in 9 cases. Then, retrograde surgical method was perfromed and patients were placed in lithotomy position, then turned to the prone position to complete the operation.Results:All 28 cases were operated successfully in one stage. Mean operative time was (18.5±6.5) min. Hemoglobin decreased by 1.2-3.5 g/L, with an average of (2.6±0.5) g/L, 2 hours after operation. One patient had postoperative severe gross hematuria, after expectant treatment the patient got better. Followed up 3 days after operation, there was no serious complication such as pleural effusion, perirenal effusion or peripheral organ injury. All patients discharged average was (3.6±0.7) d after operation. Followed up 1 month after operation, the renal CT showed no residual stones. Followed up 3 and 6 month after operation, color Doppler ultrasonography showed no recurrence of stones.Conclusion:4.8 F visual micro-percutaneous nephrolithotomy-treatment is safe and effective in the treatment of renal microlithiasis of aircrew, especially when flexible ureterosopic lithotripsy fails, it can be tried.

目的:观察体外冲击波碎石术(ESWL)联合排石通淋汤与盐酸坦索罗辛缓释胶囊治疗泌尿系结石湿热蕴结证的临床疗效.方法:选择86例泌尿系结石湿热蕴结证患者,采用随机数字表法分为观察组和对照组各43例.2组均给予ESWL治疗,对照组术后服用盐酸坦索罗辛缓释胶囊治疗,观察组术后给予排石通淋汤联合盐酸坦索罗辛缓释胶囊治疗,2组均治疗2周,随访3个月.比较2组临床疗效、症状消失时间、不良反应发生率、复发率.结果:治疗后,观察组治愈率97.67％,高于对照组83.72％,差异有统计学意义(P＜0.05).观察组结石排尽、腰痛消失及肉眼血尿消失时间均短于对照组(P＜0.05).观察组不良反应发生率2.33％,与对照组4.65％比较,差异无统计学意义(P＞0.05).观察组复发率4.76％,低于对照组19.44％,差异有统计学意义(P＜0.05).结论:ESWL联合排石通淋汤与盐酸坦索罗辛缓释胶囊治疗泌尿系结石湿热蕴结证临床效果显著,可有效缩短结石排尽及症状消失时间,降低复发率,提高结石排尽率,安全性好.

目的:研究前列腺癌患者根治术后首次血清前列腺特异性抗原(Prostate-specific antigen,PSA)水平及其影响因素.方法:选取我院2018年11月至2021年1月收治的110例前列腺癌患者,比较手术前及手术6 w后首次血清PSA水平;根据患者手术6w后PSA水平分为PSA<0.2 ng?mL-1组和PSA≥0.2 ng?mL-1组,采用Logistic回归模型分析影响前列腺癌患者根治术后首次血清PSA水平的独立危险因素.结果:患者术后血清PSA水平明显低于术前;吸烟史、Gleason评分、病理分期、有无淋巴结清扫、术前有无电切为影响前列腺癌患者根治术后首次PSA水平的单因素(P<0.05).Logistic回归模型分析显示:Gleason评分(8～10分)、病理分期(进展期)、有无淋巴结清扫(有)、术前有无电切(有)为影响前列腺癌患者根治术后首次PSA水平的独立危险因素(P<0.05).结论:前列腺癌患者根治术后首次血清PSA水平普遍下降,其中Gleason评分、病理分期、有无淋巴结清扫、术前有无电切为影响其首次PSA水平的独立危险因素.

Objective:To evaluate the clinical efficacy and safety of using the F4.8 Visual Puncture Micro-percutaneous nephrolithotomy to treat the female distal calculi associated with stricture.Methods:From June 2017 to December 2019, 32 female patients with distal ureteric calculi associated with stricture, aged(35.0±10.3) years ( range from 16 to 75 years)old, were enrolled into this retrospective study. They were diagnosed by colour doppler ultrasound, IVU(intravenous Urography), or CT, et al. The average stone size was (13.0±3.6)mm in diameter(range from 3 to 20 mm), and the stone obstruction duration was from 2 to 35 days, with average of(5±17) days. Twenty-seven cases were on the unilateral ureter and 5 cases were on the bilateral ureters. There were 17 cases undergoing ESWL 2 weeks before. Six cases of stone diameter less than 6 mm were administered medical therapy for more than 7 days. All the 32 case underwent ureteroscopic lithotripsy but failed because of the ureter stricture. They all suffered from hydronephrosis, with the diameter of renal collecting system from 15 to 45 mm, with(23±15)mm on average. The lithotomy position was taken, and the F4.8 Visual Micro-percutaneous nephrolithotomy using 0.9% Sodium chloride was applied to enter into ureter through urethra. There were 21 cases of ureter orifice stricture, including 8 cases associated with avulsion or perforation, 9 cases associated with intramural ureter abnormality and stricture, the zebra guidewire being failed to enter. The F4.8 Visual Micro-percutaneous nephrolithotomy cooperated with water pressure modulation was used to flush and open the ureter orifice and intramural ureter for entering. Holmium lase was used for lithotripsy. Two cases stone were infective and obstructed seriously. F4.8 Visual Micro-percutaneous nephrolithotriptor entered the ureter and destroyed the stones, and the stone fragments were discharged. Stone migrated upward and escaped occurred in 1 case, then the zebra guidewire was indwelled and ureteroscope was used for lithotripsy successfully. All cases were indewelled F4.7 doubld-J tube and urethral catheter after operation.Result:All the 32 patients underwent lithotripsy successful by one-stage. The operation time was 15-43 min [averaged (35.0±8.7)min]. All patients were recovered and discharged 4-7(averaged 5.3) days after operation. Three patients occured fever, T>38.5℃, and they recovered by using sensitive antibiotics according to the blood and urine culture. No severe complications occurred, such as ureteral perforation or extravasation. All patients were reviewed by ultrasound and KUB 3 days after operation, finding 24 cases with stone free, and 8 cases of a little residual stone, with the stone free rate of 75%. One month later, ultrasound and IVU was performed, and no residual stone was detected, with the stone free rate of 100%. The hydronephrosis alleviated by varying degrees. The diameter of the renal collecting system was from 0 to 35 mm, with(12±9)mm on average. The IVU showed the ureter was unobstructed. Conclusions:The F4.8 Visual Micro-percutaneous nephrolithotomy is safe and effective for the female distal calculi associated with stricture, when routine ureteroscopic lithotripsy failed.

目的 探讨超声引导下针状可视肾镜联合钬激光处理直径1.0～2.5 cm肾盏憩室结石的临床疗效.方法 全身麻醉成功后输尿管镜下在患侧放置F5输尿管导管,并留置F18三腔尿管固定.改行俯卧位,在超声引导、显示器直视下,针状可视肾镜进入目标盏,留置硬导丝,应用扩张套件从F8逐号扩张至F14,连接F8可视肾镜碎石清石系统,550μm钬激光光纤将结石粉碎并吸出.若憩室盏颈口难以寻及,沿输尿管导管逆行推注10％亚甲蓝,找到盏颈口后用钬激光将盏颈口切开,顺行置入F6输尿管支架管.结果 36例均一次碎石取石成功.手术时间33～65 min,平均47.5 min.术后血红蛋白下降0.6～1.9 g/L,平均1.35 g/L.1例术中第1天出现发热,体温38.5℃,积极抗感染后体温恢复正常.6例术后出现肉眼血尿,尿管引流液呈暗红色,给予对症止血、卧床及膀胱冲洗后血尿逐渐停止,均无需输血.术后住院4～6 d,平均5.2 d.术后6、12个月复查肾脏CT,36例肾脏结石无复发,清石率100.0％(36/36).结论 针状可视肾镜治疗肾盏憩室结石安全、有效.

Objective:To evaluate the clinical safety and efficacy of using the visual puncture micro-percutaneous nephrolithotomy to treat the mid and distal calculi in children.Methods:From May 2017 to December 2019, 25 children patients with mid and distal ureteric calculi were enrolled into this retrospective study. There were16 males and 9 femals (age range from 2 to 12 years) who were diagnosed by colour doppler ultrasound, CTU, et al. The average stone size was (12±6) mm in diameter (range from 5 to 21 mm). 23 cases got stones in the unilateral ureter and 2 cases in the bilateral ureters, 10 cases in the mid ureter, 15 cases in the distal ureter. 6 cases received ESWL and 3 cases received ureteroscopic lithotripsy, but they were failed. In the lithotomy position, the visual puncture micro-percutaneous nephrolithotomy linked with 0.9% sodium chloride was applied to enter into ureter through urethra. Holmium laser was used for lithotripsy.Result:All the 25 patients were operated successful onestage. The operation time was 15-50 min (32±10) min. All patients were recovery and discharged from hospital 4-7 (6) days later. No calculi moved up and escaped. Serious irritative symptoms of bladder occurred in 2 patients who recovered after pulled out the catheter. Fever (T>38.5℃) occurred in 2 patients who, and they became normal by changed sensitive antibiotic. No severe complications such as ureteral perforation and extravasation occurred. All patients were rechecked by ultrasound and KUB 3 days later, the stone clearance rate was 88%. One month later ultrasound was rechecked, no stone was residual, the stone clearance rate was 100%.Conclusion:As a worth promoting treatment for the mid and distal calculi in children, the visual puncture micro-percutaneous nephrolithotomy is safe, minimally invasive, and effective.

目的 探讨超声引导下针状可视肾镜钬激光碎石联合排石颗粒治疗直径1.0～2.0 cm无积水肾下盏结石的临床疗效.方法 我院2018年1～8月采用针状可视肾镜联合钬激光碎石术治疗50例无积水肾下盏结石,全身麻醉后输尿管镜下患侧放置F4.8输尿管支架管及F18双腔尿管,膀胱灌注后改俯卧位,在超声定引导、显示器直视下,将针状可视肾镜进入肾下盏,用200μm钬激光光纤,功率0.8 J/10 Hz,将结石粉末化,碎石后加压注水将碎石颗粒冲至肾盂.结果 所有患者均一次性碎石成功,手术时间20～58 min,平均42 min.术后第1天血红蛋白下降0.6～1.3 g/L,平均0.96 g/L.术后发热1例,体温39.0℃,经抗感染、地塞米松磷酸钠注射液后体温恢复正常;术后疼痛5例,给予止痛药物对症止痛后好转;术后出现肉眼血尿8例,未做特殊处理,嘱患者多饮水、休息后好转,均无需输血.术后住院2～6 d,平均3 d.术后第2天复查腹部平片,6例术后碎石已完全排出,其余44例口服排石颗粒,适当倒立体位排石,1个月后复查腹部平片,42例结石完全排出,术后1个月结石清除率96.0％(48/50).术后6个月随访:50例复查彩超,48例双肾未见明显异常,2例右侧肾下盏3～5 mm小结石.结论 超声引导下针状可视肾镜钬激光碎石联合排石颗粒治疗直径1.0～2.0 cm无积水肾下盏结石安全、有效,结石清除率高.

肾盏憩室是肾实质内覆盖移行上皮细胞的囊腔,经狭窄的盏颈与肾盂或肾盏相通,憩室无分泌功能,但尿液可反流入憩室内。肾盏憩室结石首先由Rayer于1841年描述,可为多发性,位于肾的任何部位,但肾上盏更易受累及。常规治疗方式包括开放手术、体外冲击波碎石术、经皮肾镜取石术（percutaneous nephrolithotom,PCNL）及腹腔镜肾楔形切除术 [1] 。随着输尿管软镜在上尿路结石治疗中的增

目的探讨经皮椎体成形术治疗骨质疏松性脊柱压缩性骨折的临床疗效及并发症。方法随访老年骨质疏松脊柱压缩性骨折患者21例,男5例,女16例,年龄61~82岁,平均72岁,21例36椎行经皮椎体成形术(PVP),术前及术后3 d进行疼痛视觉类比评分(VAS)和活动能力评分;随访期间观察患者疼痛缓解及生活能力状况,并分析骨水泥渗漏、邻椎骨折、临近器官损伤等并发症。结果手术全部成功,术后早期疼痛明显缓解,VAS评分术后3 d(2.5±0.6)较术前(7.5±0.7)明显下降(P<0.01);活动能力评分术后3 d(1.2±0.4)较术前(2.4±0.6)明显改善(P<0.01)。随访6~26个月(平均16个月);4例发生周围椎体骨折;3例发生骨水泥渗漏。患者对治疗效果满意。结论经皮椎体成形术是一种治疗老年骨质疏松性椎体压缩性骨折的微创手术,能够有效缓解骨质疏松性椎体骨折引起的疼痛,维持椎体稳定性,恢复椎体的高度,是一种简单、安全、有效的新方法。

目的探讨切开复位内固定对Pilon骨折的治疗结果。方法应用切开复位内固定治疗Pilon骨折48例,按Puedi-Allgower分类:Ⅱ型30例,Ⅲ型18例。结果48例均获得随访,时间6～36个月。按Teeny踝关节评分标准,优22例、良16例、可7例、差3例。结论关节面的解剖复位,坚强的内固定,踝关节早期功能锻炼是Pilon骨折治疗取得良好疗效的关键。

目的探讨应用钩板治疗肩锁关节脱位的疗效。方法对41例肩锁关节脱位患者应用钩板固定。结果41例获得随访,时间6～36个月,无一例发生再脱位和钩板断裂松动情况。结论锁骨钩板治疗肩锁关节脱位,手术创伤小,操作简便,术后可早期活动,值得在基层医院推广。