目的 评估急诊输尿管镜钬激光碎石术在治疗输尿管下段结石伴轻度尿脓毒血症过程中的安全性和有效性.方法 选取我院2015年9月至2020年9月期间收治的输尿管下段结石伴轻度尿脓毒血症的患者124例,将其随机分为输尿管镜组(n=55)与支架管置入组(n=69).比较两组的手术时间、白细胞和体温恢复正常的时间、住院时间和围术期并发症.结果 与支架管置入组患者比较,急诊输尿管镜组患者的手术时间(含碎石时间)[(44.60±8.69)min v s(22.22±6.71)min,P<0.01)]延长,但白细胞计数和体温恢复正常的时间、围术期并发症比较,差异无统计学意义(P>0.05),且总住院时间明显缩短[(6.70±1.60)d vs.(14.32±2.14)d,P<0.01)].结论 对继发于输尿管下段结石的泌尿系感染伴有轻度尿脓毒血症的患者,急诊输尿管镜钬激光碎石术是一种安全、有效的治疗方法,住院时间缩短,值得临床推广.

目的 评估不同麻醉方式对输尿管镜置镜效果的影响.方法 选取2018年9月至2021年3月期间收治的95例输尿管结石患者为研究对象,均行输尿管镜钬激光碎石术,根据所应用的麻醉方式,将患者分为三组:全凭静脉麻醉组(全麻组)33例,腰麻组31例,硬膜外麻组31例.记录并分析三组患者输尿管碎石通道建立时间、碎石时间、结石清除率、并发症发生率.结果 全麻组的碎石通道建立时间为(185.99±52.17)s,明显低于腰麻组的(308.06±98.25)s和硬膜外麻组的(358.22±115.58)s(P<0.01);全麻组的术中并发症发生率(6.1％)明显低于腰麻组(25.8％)和硬膜外麻组(29.0％)(P<0.05);三组的碎石时间、结石清除率和术后并发症发生率比较,差异均无统计学意义(P>0.05).结论 全麻可以缩短输尿管镜钬激光碎石术中的输尿管碎石通道建立时间,减少术中并发症发生率,值得临床推广.

目的 比较三种不同的消毒方式对经直肠前列腺穿刺活检后感染性并发症的影响.方法 选取荆州市第三人民医院2015年10月至2020年10月收治的451例需行前列腺穿刺活检的患者为研究对象,穿刺前所有患者均经过严格的肠道准备及针对性的抗生素预防感染.根据消毒方式不同,将患者分为三组:Ⅰ组(165例)使用1％聚维酮碘消毒肛周,Ⅱ组(116例)在Ⅰ组消毒方法上加0.5％聚维酮碘100 ml灌肠,Ⅲ组(170例)在Ⅱ组消毒方法上加0.5％聚维酮碘棉球消毒直肠、肛管.记录并分析三组患者术后的感染性并发症、非感染性并发症的发生率及平均住院时间.结果 Ⅰ、Ⅱ、Ⅲ组的术后感染性并发症发生率分别为21.82％、15.52％和5.88％,Ⅲ组的感染性并发症的发生率显著低于Ⅰ组和Ⅱ组,Ⅲ组患者的平均住院时间最短,差异有统计学意义(P<0.05).术后非感染性方面,除了急性尿潴留Ⅲ组的发生率低于Ⅱ组(P<0.05),其他项目三组之间的差异无统计学意义(P>0.05).结论 使用1％聚维酮碘消毒肛周皮肤、0.5％聚维酮碘灌肠加0.5％聚维酮碘棉球手动消毒直肠肛管黏膜的综合消毒方法能减少前列腺穿刺活检术后感染性并发症发生率,缩短住院时间,值得临床推广.

目的 评估不同温度的灌注液对输尿管镜钬激光碎石术手术效果的影响.方法 选取2018年3月至2020年11月我院收治的144例需要接受输尿管镜钬激光碎石术的输尿管结石患者为研究对象,将其随机分为常温等渗盐水灌注组(n=75)和38℃等渗盐水灌注组(n=69).记录并比较两组患者的手术时间、体温变化、结石上移率、手术并发症发生率、结石清除率、二期手术或体外碎石率.结果 38℃等渗盐水灌注组患者的手术时间为(35.70±9.11)min,明显短于常温等渗盐水灌注组的(42.88±8.75)min,差异有统计学意义(P<0.05).38℃等渗盐水灌注组患者的体温变化、结石上移率、手术并发症发生率、结石清除率、二期手术或体外碎石率均明显低于常温等渗盐水灌注组,差异有统计学意义(P<0.05).结论 与常温等渗盐水相比,在输尿管镜手术中使用38℃等渗盐水灌注可以明显改善输尿管的松弛度,降低手术并发症发生率,预防结石上移,且不增加患者的住院费用,值得临床推广.

目的:剖析腹腔镜下非萎缩性肾实质切开取石术治疗鹿角形肾结石的临床效果.方法:选取2016年1月—2017年12月期间我院收治60例鹿角形肾结石患者临床资料,予以回顾性分析.60例患者均采用腹腔镜下非萎缩性肾实质切开取石术进行治疗.观察分析其结石有效清除率、并发症发生率以及术后肾功能改善情况.结果:术后3d进行复查,结石有效清除率(Ⅰ期)为90.00％,并发症发生率为8.33％.术后6个月进行回访,患者患侧肾脏GFR(肾小球滤过率)、SCr(血清肌酐)明显低于术前,差异有统计学意义(P＜0.05).结论:腹腔镜下非萎缩性肾实质切开取石术治疗鹿角形肾结石具有结石清除率高、术后并发症发生率低以及肾脏功能改善良好等显著优势,可提升鹿角形肾结石整体治疗水平,减少鹿角形肾结石患者痛苦,值得予以学习.

目的 研究孤立肾结石患者应用腹腔镜联合纤维胆道镜治疗的效果及临床价值.方法 选取医院2018年1月—2019年1月收治的60例孤立肾结石患者,将其按照随机数字表法分为对照组与观察组,各组30例.对照组实施传统经皮切开手术治疗,观察组实施腹腔镜联合纤维胆道镜治疗.对比两组患者前后VAS疼痛评分与各项手术指标.结果 观察组在实施腹腔镜联合纤维胆道镜的治疗下,患者手术时间、住院时间、术后自主排尿时间均显著短于对照组,术中出血量显著少于对照组,差异具有显著性(P<0.05);术前,两组患者VAS评分无显著性差异(P>0.05);术后6 h、12 h、24 h观察组VAS评分均显著低于对照组,差异具有显著性(P<0.05).结论 针对孤立性肾结石患者对其实施腹腔镜联合纤维胆道镜治疗,可有效缓解患者术后疼痛程度,优化各项手术指标,促进患者预后康复,值得临床借鉴实施.

目的:探讨钬激光碎石和气压弹道碎石治疗老年输尿管结石的效果及安全性.方法:将笔者所在医院2015年4月-2018年4月收治的100例老年输尿管结石患者随机分为对照组和观察组,每组50例.观察组行输尿管镜钬激光碎石术,对照组行输尿管镜气压弹道碎石术,观察两组碎石成功率、并发症发生率.结果:观察组碎石成功率高于对照组,并发症发生率低于对照组,差异均有统计学意义(P<0.05).结论:输尿管镜钬激光碎石术治疗老年输尿管结石,碎石成功率更高,并发症更少,值得临床推广.

膀胱平滑肌瘤是一种罕见的间叶组织来源良性肿瘤,华中科技大学同济医学院附属同济医院泌尿外科于2018年8月收治1例巨大膀胱平滑肌瘤患者,采用经尿道激光剜除术治疗,取得满意疗效,现报告如下. 患者,男,70岁,排尿中断伴下腹部胀痛3月余,伴有尿频、尿急症状,偶有肉眼血尿,血尿症状能自行缓解,无发热及腰痛.既往2年前因前列腺增生症行前列腺激光剜除术,术后恢复良好.入院体格检查及 PSA未见明显异常.全腹部增强CT提示膀胱尿道内口处见不规则团块状软组织密度影,突向膀胱腔内,边界可见散在高密度钙化灶,增强不均匀强化,大小约55 mm×46 mm ×62 mm ,腹膜后及盆壁未见肿大淋巴结影(图1). MRI平扫+DWI提示膀胱左前壁可见菜花样稍长T1 稍长 T2 信号,可见低信号"蒂"影,DWI弥散明显受限,肌层未见明显侵及,盆腔内未见肿大淋巴结(图2) .经尿道膀胱镜检查提示膀胱颈口可见巨大新生物,类圆形,表面光滑,基底部位于膀胱颈左上方,因肿瘤遮挡,双侧输尿管口无法窥及.膀胱镜病理活检:梭形细胞肿瘤,结合免疫组化,考虑平滑肌来源;免疫组化:EM A (+) ,DES (+) ,CaLdesmon(+) ,SDHB (+) ,SMA (弱+) ,ALK (散在+) ,CD117(－) ,CD34 (－) ,DOG1 (－) ,S‐100 (－) ,SOX10 (－) ,ST A T6 (－) ,PCK (－) ,GAT A‐3 (－) ,HMB45 (－) , MeLanA (－) ,Ki‐67 LI约5%.

目的 对比分析输尿管上段结石应用体外冲击波碎石术(ESWL)与经输尿管镜钬激光碎石术(URL)治疗的效果.方法 选取我院2017年10月—2019年1月收治的45例行URL的输尿管上段结石患者为URL组,以同期收治的50例行ESWL的输尿管上段结石患者为ESWL组.对比2组结石排净率以及并发症发生率.结果 URL组直径>1 cm的结石排净率显著高于ESWL组,差异具有显著性(P<0.05);URL组直径≤1 cm的结石排净率与ESWL组差异无统计学意义(P>0.05).2组患者术后并发症发生率对比无显著差异(P>0.05).结论 对于直径>1 cm的患者更适宜选用输尿管钬激光碎石术,直径≤1 cm的患者可选择体外冲击波碎石术,临床需结合患者的病情选择最佳治疗方式.

Objectives To evaluate the effect of tamsulosin,solifenacin and combined therapy for the prevention of double-Jstent related syndrome.Methods 128 cases were collected from March 2012 to January 2015,who were divided into four groups:group A(blank group) was deemed as blank control and not given any drugs,group B (tamsulosin group,given tamsulosin 0.2 mg once daily),group C (solifenacin group,given solifenacin 5 mg once daily) and group D (combination therapy group,given the two drugs at the same time) The adverse drug reactions were recorded in the treatment period.Overactive bladder symptoms score(OABSS),quality of life(QOL) and visuai analogue pain scale(VAS) were completed by all patients at first day,one week,two weeks after catheter removal and the first day after double-Jstent removal.Results Four groups completed clinical observation and removed double-Jstent after 30 days.There were no significant in the patients'characteristics before operation.The group B,group C and group D had a better OABSS,QOL and VAS than group A (P ＜ 0.05).The group D had a better effect than group B and group C (P ＜ 0.05).Conclusions Tamsulosin,solifenacin and combination therapy have similar effect to relieve double-Jstent related syndrome,combination therapy improved better than separate treatment.

Objectives To investigate the efficacy of hot-water hip bath combined with pelvic floor training (PFT) in the treatment of overactive bladder (OAB).Methods 197 cases with OAB were allocated to four groups according to registration order and gender:group A(simple medicine,solifenacin),group B(hot-water hip bath combined with solifenacin),group C(pelvic floor muscle training combined with solifenacin) and group D(hot-water hip bath combined with pelvic floor muscle training and solifenacin).After 8 weeks of treatment,estimate the effects of four groups according to voiding diary (the first three days and the last three days) and the OAB symptoms score card were estimated.Results The efficacy of the group B,group C and group D were more effective than group A.There was no significant difference in group B and group C.The efficacy of group D was better than group A,group B and group C obviously.Conclusions Hot-water hip bath with solifenacin is a potential therapy for OAB patients.A combination of hot-water hip bath and PFT with solifenacin can relieve the symptoms of OAB obviously.The clinical efficacy of the combination is better than the simple hip bath or PFT,worth clinical promotion.

目的 通过对126例膀胱过度活动症(OAB)患者的研究,探讨热水坐浴对OAB的治疗救果.方法 选取于2012年5月～2015年1月于我院就诊的OAB患者126例,将符合入选标准的患者分为两组:A组:热水坐浴联合索利那新组(实验组),B组:索利那新组(对照组).治疗疗程8w,通过比较患者治疗前后的膀胱过度活动症症状评分(OABSS)来评价两组患者的治疗效果.结果 两组患者治疗后OABSS均明显低于治疗前OABSS,P＜0.05;实验组活疗后的OABSS明显低于对照组治疗后的OABSS,P＜0.05.结论 热水坐浴联合索利那新可显著改善膀胱过度活动症症状,疗效明显优于单纯索利那新治疗,该方法简单、实用、廉价.

目的：总结大力碎石钳碎石加经尿道前列腺电切（ TURP）、经膀胱镜钬激光碎石加TURP、小切口开放取石加TURP三种手术方法治疗前列腺增生合并膀胱结石的临床效果。方法对118例前列腺增生合并膀胱结石患者分别采用大力碎石钳碎石加TURP术37例（ A组），经膀胱镜钬激光碎石加TURP术43例（ B组），小切口开放取石加TURP术38例（ C组）。对比和评价三种手术方式的临床疗效。结果 A、B、C三组在膀胱黏膜损伤率、膀胱穿孔改开放手术率、住院时间上，B组明显好于A组及C组；碎石取石操作时间上，B组碎石取石操作时间长于A组及C组。结论经膀胱镜钬激光碎石结合TURP治疗前列腺增生合并膀胱结石具有损伤小、疗效好、恢复快等优点，虽然结石较大时碎石取石时间延长，但手术并发症少，值得临床推广。

OBJECTIVE:To investigate the clinical effect of spermatic cord seal-up injection on acute epididymitis and its mechanisms.METHODS:A total of 120 cases of acute epididymitis were allocated to a trial group (n = 56), aged 18 - 78 (38.4 +/- 9.6) years, and a control group (n = 64), aged 14 -82 (41.3 +/- 7.2) years. The patients in the trial group were given seal-up injections of a mixture of lidocaine, gentamicin (or Amikacin) and dexamethasone into the spermatic cord, qd or bid, for 2 courses of 5 days each, with an interval of 3 to 5 days. Those in the control group were treated by intravenous drip of penicillin, qd, intramuscular injection of Streptomycin, bid, and oral medication of SMZCo (SMZ-TMP), bid, with the initial dose doubled. After less than 2 weeks of treatment, we compared the therapeutic effects between the two groups of patients.RESULTS:In the trial group, 53.6% of the patients were basically cured, 37.5% obviously improved and 91.1% improved (total rate of effectiveness). The average treatment time for the improved cases was (9.2 +/- 0.5) d. In the control group, 40.6% of the patients were basically cured, 31.2% obviously improved and 71.8% improved (total rate of effectiveness). The average treatment time for the improved cases was (12.8 +/- 0.7) d. There were significant differences between the two groups in the total rate of effectiveness and the average treatment time for the improved cases (P < 0.05).CONCLUSION:Spermatic cord seal-up injection for acute epididymitis deserves wide clinical application for its simple operation, good tolerance, short therapeutic course and high safety and efficacy.

目的 探讨经输尿管镜钬激光治疗输尿管结石并息肉增生的临床疗效.方法 回顾性分析38例采用输尿管镜钬激光治疗输尿管结石并息肉增生患者的临床资料.结果 一次性息肉切除并碎石成功31例;4例息肉切除时结石上移至肾盂内,术后1周行体外冲击波碎石治疗,效果良好;2例输尿管穿孔,留置双J管2个月后,二期输尿管镜手术成功.1例输尿管癌改开放手术治疗.37例随访半年,复查KUB+IVP显示输尿管通畅,未见明显结石残留.结论 输尿管镜钬激光治疗输尿管结石并息肉增生是一种安全、有效的治疗方法,具有创伤小、疗效好、并发症少等优点,值得临床推广.

[Objective] To discuss the efficacy of down eight spelling transurethral electroresection for female bladder outline obstruction. [Methods] From January 2008 to January 2010, 49 patients with female bladder outline obstruction were enrolled. The patients were divided into two groups. The lighter-symptom group included 29 cases. The residual urine volume was no more than 100 mL and they had no upper urinary hydrocele. All the 29 cases were treated with drug. The heavier- symptom group included 20 cases. All of them had upper urinary hydrocele. And they were treated with electroresection. The mean maximum urinary flow rate ( Qmax ) and average of residual urine volume were compared between the two groups before and after treatment, the results were processed by SPSS13.0 software. [Results] 16 cases in drug-treated group were followed up for 3～24 months. The symptom of 12 cases was not severer and residual urine volume was decreased. The symptom of 4 cases increased. 17 cases in surgery-group made a quick recovery on the stage Ⅰ and other 3 on the stage Ⅱ. Twelve patients were followed up for 5～49 months. Comparing the two groups before and after treatment, the effect was more obvious in surgery-group (P <0.01). [Conclusions] The method of down eight spelling transurethral electroresection for female bladder outline obstruction is easy to learn, less bleeding ,safe ,and can be used repeatedly. It is worth to be popularized.

【Objective】To introduce a simpler and easier technique of inserting D-J tubes in retroperitoneal laparoscopic ureterolithotomy (RLU).【Methods】Access of retrograde ureteral catheter with cystoscope,in RLU, the stiff type guide wire was put through the end of D-J tube in advance, the proximal end of the slent was put down to the distal end of ureteral incision until the bladder (maintaining whole length of guide wire and connection promoting rod in vitro), and then continuously downward to near ureteral incision with the remaining 1 cm from incision ,in vitro removing built-in guide wire and operating to disconnect the promoting rod from the slent, the proximal end of D-J tube was drew up along the ureteral lumen with two elastic separating pliers until the pelvis.【Results】36 patients suffered from impacted upper ureteric calculi were operated by RLU between Mar.2008 and Mar. 2011. The mean D-J tubes implantation time was 4min, the mean operation time was 60min. The operation was successfully performed in all cases.【Conclusions】 As a kind of micro-insult operation for upperureteric calculi. RLU is very safe and effective. But it's hard to insert D-J tubes in surgery. Our method is more convenient and less time consuming obviously, and is convenient for training and promoting.

目的 探讨45°斜仰卧位经皮肾输尿管镜取石术治疗上尿路结石的方法 与效果.方法 对60例应用经皮肾输尿管镜治疗上尿路结石患者的临床资料进行回顾性分析.结果 60例患者均穿刺成功,其中50例行Ⅰ期取石,8例行Ⅱ期取石,2例行Ⅲ期取石,平均结石清除率90.18%.建立单通道取石55例,双通道取石5例.术后平均住院时间8d,肾造瘘管平均留置时间7.5d,术中术后有明显出血2例,2例术后出现尿外渗,调整肾造瘘管位置后治愈.结论 45°斜仰卧位经皮肾输尿管镜取石术治疗上尿路结石安全,有效,对患者创伤小,恢复快,结石清除率高,并发症少,疗效满意.

Objective To evaluate the safety and efficacy of extracorporeal shock-wave lithotripsy (ESWL) in children with upper urinary calculus.Methods From January 2009 to May 2011,20children with upper urinary calculi undertook ESWL in our department and their clinical data were reviewed.Results Various type of calculi could be seen in this study including renal pelvis calculi in 8cases,renal calyx calculi in 6 cases,single kidney with calculi in 2 cases,staghorn calculi in 2 cases,and ureter duplication with renal calculi in 2 cases,as well as ureteral calculi in 4 cases.Among them,single urinary calculi were found 13 cases; multiple urinary calculi could be seen in 7 cases.The satisfactory efficacy was achieved in 17 cases of patients (85％) in primary ESWL procedure and 3case of patients (15 ％) in secondary ESWL procedure.Conclusions ESWL is an effective and safe procedure in children with upper urinary calculus.

自1986年Newman等[1]首次报道ESWL成功治疗小儿尿路结石以来,体外冲击波碎石术(extracorporeal shock wacw lithotripay,ESWL)已成为临床上治疗儿童尿路结石的首选方法.我院于2009年1月至2011年5月采用美芝JT-ESWL-Ⅲ型碎石机治疗上尿路结石患儿20例,疗效满意.现报道如下.