Objective To study the feasibility of percutaneous nephrolithotripsy(PCNL) combined with ureteroscopic pneumatic lithotripsy for ureteral stone street.Methods Since March 2008 to October 2011,27 patients were diagnosed with ureteral stone street in our hospital by B-ultrasonography,KUB and CT 3D reconstruction.PCNL was performed on all the patients after the stones were pushed up to the renal pelvis or upper ureter by ureteroscopic pneumatic technique.Results Among the patients,one-session success was achieved in 23 patients,and two-session success was in 3.The other patient was converted to percutaneous nephrostomy drainage,for the lower end of the ureter was closed.A follow-up for 3 to 12 months was achieved in 19 patients(mean,6 months),8 of them showed no hydronephrosis,7 had mild hydronephrosis,and the other 4 had moderate hydronephrosis;no patient had hemorrhage,ureteral obstruction or recurrent renal calculi during the follow-up.Conclusion PCNL combined with ureteroscopic pneumatic lithotripsy is safe and effective for ureteral stone street.

Objective To investigate the efficacy and safety of anterograde and retrograde ureteroscopy in treating complicated upper ureteral calculi.Metbods Ninety patients with complicated upper ureteral calculi were treated by anterograde and retrograde ureteroscopy,including transurethral ureteroscopy supplemented with pneumatic lithotripsy and push stones,and percutaneous ureteroscopy supplemented with high-pressure water jetting stone removal.Results The first time success rate of lithotripsy for 90 cases of ureteral calculi was 94％ (85/90).None of the patient had complications,such as significant hemorrhage,urethral false passage,perforation,or urinary tract infections,and no blood transfusion treatment was required.Conclusions The treatment of complicated upper ureteral calculi by anterograde and retrograde ureteroscopy has the advantages of minor injury,safe surgery,convenient stone removal and low residual stone rate,which is worthy of further promotion.

目的探讨输尿管镜在经尿道前列腺电切术后膀胱颈挛缩治疗中的应用。方法 2005年1月至2012年1月收治的经尿道前列腺电切术后膀胱颈挛缩患者25例进行总结。结果本组25例患者手术时间30～75min,平均52min。一次手术治愈23例,治愈率92%。结论输尿管镜在前列腺电切术后膀胱颈挛缩治疗中应用,具有进镜顺利,视野清晰,节约手术时间,减少误伤和出血等优点。

目的:探讨经皮肾镜治疗肾结石合并肾盂旁囊肿的临床应用价值。方法:回顾性分析6例肾结石合并肾盂旁囊肿患者采用经皮肾镜技术同时治疗肾结石和肾盂旁囊肿的临床资料。结果:6例患者手术均1次成功,术后复查无结石残留。出院后3个月、6个月、1年、2年随访,患者无囊肿复发。结论:经皮肾镜治疗肾结石合并肾盂旁囊肿,具有安全、经济、微创、恢复快等优点,值得推广应用。

目的:探讨输尿管镜手术中输尿管开口寻找困难的原因及相应对策。方法:回顾性总结分析2007年8月-2011年8月收治的380例输尿管结石患者施行输尿管镜手术中出现的25例输尿管开口寻找困难病例,针对不同情况,采用辅助水冲,更换导丝,穿刺,注射药物,电切等方法,帮助寻找开口。结果:25例手术均获成功,手术时间50~127min,平均75min。结论:遇到输尿管开口寻找困难的情况,通过耐心细致地寻找开口,配合冲水、换用导丝,采用穿刺、注射、电切等方法,均有助与手术取得成功。

Objective To discuss the efficacy of transurethral electrovaporization of the prostate(TUEVP) combined with percutaneous bladder pneumatic lithotripsy(PBPL) for patients with benign prostate hyperplasia(BPH) complicated with bladder stones.Methods Since January 2008 to January 2011,we performed TUEVP combined with PBPL on totally 33 patients with BPH complicated with bladder stones.The weight of the prostate ranged from 50 to 80 g,and the size of the stones was 2.5-5.0 cm in diameter.Results The procedures were completed in all the cases in one session without blood transfusion.No patients developed tranurethral resection syndrome or severe infection after the operation.Re-examination at one week postoperation showed no residual stones by KUB.The mean hospital stay of this series was 9 days(ranged from 7 to 12 days).One-month postoperative maximum urinary flow rate was 18-26 ml/s with a mean of 20 ml/s.Conclusions TUEVP plus PBPL is effective,safe,and minimally invasive for patients with BPH and bladder stones.The operation and recovery time of the procedure are short.

目的探讨经皮肾镜取石术并发出血的原因及防治措施。方法回顾性分析2007年6月～2011年6月收治的500例次经皮肾镜取石术临床资料,发生大出血8例。结果 8例出血病人中,采用保守疗法5例,超选择性介入栓塞3例,出血停止,均治愈出院。结论充分认识经皮肾镜取石术出血的原因,术前准备充分、术中规范操作,术后准确判断出血原因及积极治疗,对经皮肾镜取石术出血的防治有重要意义。

Objective:using nephroscopic joint vaporization cutting mirror outer sheath pneumatic treatment of large bladder calculi.Methods:using vaporization cutting F26 mirror established outer sheath,nephroscopic belt F24,metal scabbard bladder channel inserted on nephroscopic lithotripsy treatment under pressure trajectory 56 cases,large bladder calculi of operation efficiency analysis.Results:the 56 cases,54 cases of surgical success,2 cases of urethral stricture couldn't cut into F26 vaporization mirror outer sheath turn bladder made fistula nephroscopic lithotripsy treatment under pressure trajectory bladder calculi.Conclusion:nephroscopic joint vaporization cutting mirror outer sheath pneumatic therapy greatly improve operation efficiency of bladder calculi,greatly shorten the time of surgery,is a kind of natural channel and minimally invasive surgery,rapid recovery.

我院2005-02～2007-02对32例前列腺增生患者行经尿道前列腺汽化电切术,术中应用膀胱穿刺双通道微造瘘预防经尿道电切综合征(TURS),效果满意.现报告如下.

目的 探讨经皮肾穿刺微造瘘术的新方法.方法 使用中心静脉穿刺包行经皮肾穿刺微造瘘术,并把中心静脉导管作为造瘘管,观察穿刺的可行性、成功率、并发症及优缺点.结果 25例患者穿刺均获成功,无并发症发生.结论 在经皮肾穿刺微造瘘术中应用中心静脉导管,具有经济、方便、实用的特点.

我院2004-10～2006-10行经尿道前列腺电切术(transurethral resection of prostate,TURP)治疗前列腺体积巨大(>75 g)的良性前列腺增生(benign prostatic hypertrophy,BPH)患者25例,术中应用膀胱微造瘘术预防经尿道电切综合征(transurethral resection syndrome,TURS),效果满意,现报告如下.

目的探讨腹腔镜胆总管切开取石,胆总管I期缝合的可行性及其微创的临床价值。方法腹腔镜下完成手术32例,其中胆总管I期缝合、免置T管17例,胆总管切开探查取石、胆总管置T管引流15例,中转开腹胆总管切开取石T管引流2例。术前B超明确诊断胆总管结石31例,1例术前B超诊断可疑,行核磁共振水成像确诊胆总管下段结石。结果所有患者均治愈。手术中无副损伤,手术后无胆漏及其他并发症发生。手术时间(90.00±210.0)m in。术中出血量(50±20)mL。术后第1天病人即可进食,2~3 d下床活动,术后5~7 d出院。结论腹腔镜下胆总管切开、纤维胆道镜取石后行胆总管I期缝合免置T管,是一疗效好、安全性大的微创手术方法。

目的探讨纤维胆道镜在后腹腔镜输尿管切开取石术中的应用价值。方法对8例输尿管中上段结石患者行后腹腔镜输尿管切开取石术,术中联合使用纤维胆道镜观察、取石。结果8例手术均获成功,手术时间60～120min,平均100min,随访3-12个月,B超、KUB、IVU证实患侧肾积水改善,未见结石残留。结论后腹腔镜输尿管切开取石术中联合使用纤维胆道镜提高了寻找结石速度,避免了结石残余,同时可发现并处理输尿管内其他病变,是一种值得推广的方法。

目的:探讨前列腺增生症合并膀胱结石的微创治疗方法。方法:回顾性分析2002年3月-2005年10月我院应用电切镜联合腹腔镜治疗前列腺增生症合并膀胱结石的临床资料,利用腹腔镜器械碎石、取石后再用电切镜行经尿道前列腺电气化切除术。结果:30例均一次成功,取石率100%。无膀胱黏膜损伤,术后排尿通畅,随访3~6个月,IPSS评分降至8分以下,无结石残留。结论:利用电切镜联合腹腔镜治疗前列腺良性增生合并膀胱结石具有方法可靠、创伤小、费用低、术后患者恢复快等优点,值得推广。

对我院2005-03～2006-03应用腹腔镜联合膀胱镜三孔打结法行阑尾切除术30例分析如下.

目的探讨经尿道前列腺电切术致尿道狭窄的预防措施。方法对150例诊断为前列腺良性增生症患者行尿道前列腺电切术,术中采用多种措施,预防术后尿道狭窄。结果本组150例患者中,发生尿道狭窄5例,发生率为3.3%,较文献报告明显降低。结论采取多种预防措施,可以明显降低术后尿道狭窄的发生率。

我科从1992年5月至2001年5月,应用胆囊管部引流术治疗复杂胆囊疾患(良性)25例,效果理想,报告如下.