目的 尿蛋白是肾功能受损的重要指标,评价肾结石患者术前尿蛋白阳性对其PCNL术后肾功能早期受损的判断价值.方法 对武警河南省总队医院96例肾结石患者采用PCNL治疗,监测术前尿蛋白、肾功能指标(Cr、Bun、GFR),及术后尿蛋白、尿微量蛋白(α1-MG、NAG、β2-MG、TRF、UmA1b、IgG)和肾功能指标,对检测数据和各指标阳性率进行统计分析.结果 肾结石患者术前尿蛋白阳性与术后血清Cr、Bun无相关(P＞0.05),但是,随着尿蛋白的增加,术后GFR有下降趋势(P＜0.05).术后TRF、UmA1b和IgG阳性率高于α1-MG、NAG和β-MG的阳性率,差异有统计学意义(P＜0.05).结论 术前中、重度蛋白尿肾结石患者术后肾功能受损更显著,适合诊断肾结石患者术后早期肾功能损伤程度.肾结石患者行PCNL术对肾小球功能损害高于肾小管功能损伤.

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：探讨泌尿外科老年患者术后下肢活动依从性的影响因素。方法选取我院2014年3月—2015年10月收治的泌尿外科老年患者42例为研究对象，随机均分为对照组和观察组，对照组实施常规护理，观察组在常规护理的基础上实施干预护理，采用问卷调查评估2组患者的依从性。结果观察组患者术后下肢活动依从性明显高于对照组，2组比较差异具有统计学意义（P<0.05）。结论根据泌尿外科老年患者的具体情况，在常规护理的基础上实施干预护理，制定合适患者的计划，能有效提高患者对下肢活动的依从性。

目的 探讨标准肾镜下B型超声引导气压弹道联合超声碎石术治疗复杂上尿路结石的方法及疗效.方法 回顾性分析标准肾镜下B型超声引导气压弹道联合超声碎石术治疗复杂上尿路结石5610例患者的临床资料.结果 所有患者均成功建立F24经皮肾镜通道,平均手术时间62min,术中失血量50～400ml,结石一期取净率91.2(5112/5610),术中、术后均未发生严重并发症.结论 标准肾镜下B型超声引导气压弹道联合超声碎石术治疗复杂上尿路结石安全、有效、在治疗复杂上尿路结石方面有良好的应用价值.

Objective:To evaluate the clinical effects of Ho∶YAG laser lithotriptor with flexible ureteroscope in the treatment of upper urinary tract calculi.Method:Three hundred and nine cases of upper urinary tract calculi were treated with Ho∶YAG laser lithotriptor through flexible ureteroscope.Among them were 228patients with renal calculi and 81patients with upper ureteral calculi.Stone diameter was 0.8-3.0cm,averaging 1.6cm.Re- sult:All the operative procedures were successful.The stone-free rate was 83.5%(258/309).Mean operation du- ration was 50(range,30-90)mins.Mean postoperative hospital stay was 5(range,2-8)days.The stone-free rate was 91.9%(284/309)two weeks later on KUB.No ureteral perforations or pyonephrosis occurred.Conclusion: Ho∶YAG laser lithotripsy through flexible ureteroscope is a safe,effective treatment for upper urinary tract cal- culi.

Objective:To investigate the value of percutaneous drainage of the hematoma and local application of urokinase to treat subcapsular renal hematoma resulted from percutaneous nephrolithotomy.Method:Percutaneous drainage of the hematoma was undertaken to treat 16 patients with subcapsular renal hematoma,then 30,000 U urokinase was injected into subcapsular renal hematoma and reserved 24 hours every other 2 or 3 days.Result: The ratio of the residual hematomo volume comparing to that of pre-therapy was from 1/19to 1/56in 30-35 days CT scan through the treatment of percutaneous drainage of the hematoma and local application of urokinase.In 16 patients,followed up for 12 years the complications of active bleeding,infection and hypertension were not found.Conclusion:Percutaneous drainage of the hematoma and local application of urokinase to treat subcapsular renal hematoma are potentially method to treat subcapsular renal hematoma resulted from percutaneous nephrolithotomy.

Objective To investigate the calculi composition of patients with urinary calculi in Henan area and the clinical significance of preventing calculi recurrence with individualized method.Methods From August 2009 to July 2010,1050 patients in our hospital underwent extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy and percutaneous nephrolithotomy were set as the experimental group,all stone specimens were detected with the BRUKER TENSOR27 infrared spectroscopy for analysis of stone composition,and nurse on duty gave instructions according to the stone composition to prevent recurrence.From July 2008 to July 2009 1010 patients in our hospital underwent extracorporeal shock wave lithotripsy,ureteroscope and percutaneous nephrolithotomy were set as the control group,patients in the control group were not given calculi component analysis and these patients received general prevention guidance.The calculi recurrence was compared between two groups.Results Among 1050 cases in the experimental group,urinary calculi with single component accounted for 46.29％,of which calcium oxalate stones accounted for 44.95％.Calculi with mixed components accounted for 53.71％,mainly were calcium oxalate and carbonate apatite mixture components (30.48％).57 cases (5.43％) occurred urinary stone recurrence in the experimental group,while 177 cases(17.52％) in the control group.The difference had statistical significance.Conclusions Urinary calculi analysis has important clinical significance for understanding the causes and treatment of calculi as well as prevention of recurrence of calculi.

Objective To investigate the effect of down-regulation of sphingosine kinase 1(SphK1) on cell proliferation and cell migration of bladder carcinoma T24 cells.Methods SphK1 siRNA and nonsense siRNA were used to transfect bladder carcinoma T24 cells,which was divided into three groups:control group,nonsense siRNA group and SphK1 siRNA group.Expression of SphK1 protein was detected in three group T24 cells by Western blotting method.The changes of cell proliferation were analyzed by CCK-8 kit after transfection with SphK1 siRNA,and the changes of cell migration ability were detected by Boyden chamber.Expressions of cdk2,p21,MMP-2,and MMP-9 proteins were examined by Western blotting method.Results Expression of SphK1 protein in SphK1 siRNA group was lower than those in control group and nonsense siRNA group(P < 0.05).The result of cell proliferation demonstrated that compared with control group and nonsense siRNA group,cell proliferation in SphK1 siRNA group was obviously inhibited(P < 0.05),coupled with the elevation of p21 protein and decrease of cdk2 protein(P < 0.05).The number of cells migrated through membrane in SphK1 siRNA group was markedly lower than those in control group and nonsense siRNA group(P < 0.05),accompanied by the down-regulation of MMP-2 and MMP-9 proteins(P < 0.05).Conclusion SphK1 may play an essential role in the occurrence and development of bladder carcinoma,and its down-regulation mediated proliferation inhibition and cell migration decrease may be closely associated with the elevation of p21 expression and the decrease of cdk2,MMP-2 and MMP-9 proteins.

<正>马蹄肾是常见的肾脏畸形,常合并肾结石。开放手术创伤大、出血多,体外冲击波碎石术需多次碎石,且不易排出。近年来经皮肾镜手术逐渐成为主要治疗方法。2005年10月至2011年10月,我院采用肾镜下气压弹道及超声碎石清石术治疗马蹄肾肾结石患者35例,效果满意,现报告如下。

目的：探讨尿道损伤早期急诊内窥镜诊治效果。方法在尿道损伤早期,应用尿道镜、输尿管镜及膀胱镜诊治尿道损伤,恢复尿道连续性。结果36例尿道损伤早期经急诊内镜诊治处理,32例顺利成功,4例改开放手术。结论尿道损伤早期急诊内镜处理,创伤小,成功率高,恢复快,并发症少。

目的利用输尿管镜下气压弹道碎石联合膀胱镜下大力碎石钳碎石治疗膀胱大结石(结石直径大于3.0cm),探讨膀胱大结石微创治疗手段。方法先在输尿管镜下利用气压弹道碎石术将膀胱结石击碎至直径小于3.0cm以下,再换膀胱镜下大力碎石钳将结石颗粒进一步钳碎。结果 38例膀胱大结石均一次完全碎石成功并取出。结论两镜联合微创治疗膀胱大结石方法安全、手术时间短、不开刀、出血少、痛苦小、损伤轻、恢复快。

Aim:To investigate the effect of silencing Pim-3 with small interfering RNA(siRNA)on cell proliferation and cell cycle of bladder carcinoma T24 cells.Methods:T24 cells were divided into 3 groups:untreated group,control siRNA group,and Pim-3 siRNA group.Pim-3 siRNA and control siRNA were utilized to transfect bladder carcinoma T24 cells by LipofectamineTM2000. Western blot was used to detect the protein expressions of Pim-3,Cyclin D1,Cdk2,and P21. CCK-8 kit and flow cytometry were used to examine cell proliferation and cell cycle, respectively.Results:The protein expressions of Pim-3,Cyclin D1,Cdk2,and P21 among the 3 groups had significant differences(F=32.506,49.573,23.079,44.758,P0.05). The expressions of Pim-3,Cyclin D1,and Cdk2 decreased and P21 increased in Pim-3 siRNA group(P0.05).The proliferation rate of T24 cells was obviously inhibited at 48,72,96 h after transfection with Pim-3 siRNA (F=50.067,132.504,277.389,P0.001).The percentage of G0/G1,S,and G2/M phases cells among the 3 groups had significant differences(F=107.970,20.039,66.872,P0.05).The percentage of G0/G1 phase of T24 cells in Pim-3 siRNA group was higher than those in untreated group and control siRNA group, whereas S and G2/M phases appeared the opposite result.Conclusion:Pim-3 may be a useful molecular target for therapy of bladder carcinoma.

Objective:To evaluate Clinical experience of B-ultrasound-guided Standard percutaneous nephrolithotomy and ureteroscopic combined pneumatic lithotripsy for treatment of upper urinary calculi.Methods:We retrospectively analyzed operative time,stone-free rate,complications and other clinical data of 1 120 patients with upper urinary calculi who underwent B-ultrasound-guided percutaneous nephrolithotomy and ureteroscopic combined pneumatic lithotripsy from Aug 2007 to Jan 2011.Results:The F24 percutaneous renal access was successfully established in all patients.the mean operative duration was 53 minutes,the intraoperative blood loss was 50-100 ml,The stone-free rate in Phase I was 91.2%(1 021/1 120),thirty-eight patients experienced transient postoperative fever that be improved with appropriate antibiotics treatment,three patients with postoperative hemorrhage underwent selective renal artery embolization,without pneumothorax,intestinal damage and other serious complications.Conclusions:B-ultrasound-guided Standard percutaneous nephrolithotomy and ureteroscopic treatment of upper urinary calculi is efficient,safe and low rate of residual stones.

目的观察标准肾镜下取石术中减少结石残留常用方法的效果,探讨其技巧。方法对1 870例上尿路结石患者行标准肾镜下超声联合气压弹道碎石清石术。采用术前认真分析影像资料,术中应用建立多个取石通道、肾镜联合输尿管镜反复寻找残留结石、B超术中动态观察肾脏及残留结石情况等方法,减少结石残留。结果1 870例中一期手术取净结石者1 706例(91.2%),残石率为8.8%。结论采用术前进行认真的影像分析及术中建立多个取石通道、联合输尿管镜检查、B超动态观察肾脏及结石的方法能有效减少标准肾镜下取石的残石率。

【Objiective】To explore the treatment of percutaneous nephrolithotripsy with pneumatic and ultrasonic cystolithotripsy for calculus pyonephrosis.【Methods】From October 2005 to February 2009,79 calculus pyonephrosis patients were treated with percutaneous nephrolithotripsy with pneumatic and ultrasonic cystolithotripsy. 【Results】79 patients were drained clearly,67 patient were lithotripsied completely one time. Only 12 patients accepted the second operation,4 patient accepted extracorporeal shock wave lithotripay. 74 patients renal function recovered,5 patients renal atrophy. 【Conclusions】Percurtaneous nephrolithotripsy with pneumatic and ultrasound cystolithotripsy treating for calculus pyonephrosis is a mini-trauma,effective,safe way.

2006年10月-2008年10月,我科使用输尿管镜下气压弹道碎石机治疗输尿管结石996例,取得满意效果,现将护理体会报道如下. 资料与方法 1.一般资料.本组996例,男581例,女415例,年龄7～79岁,平均年龄(42.3±11.5)岁,输尿管上段结石99例,中下段897例,右侧539例,左侧399例,双侧58例.结石横径3～15 mm,纵径5～23 mm.所有患者经KUB+IVU及B超检查确诊.手术操作时间10～75 min,平均32 min. 2.方法.患者在基础+局部浸润麻醉或持续硬膜外麻醉下取膀胱截石位,采用STORZF6-8输尿管硬镜或WolfF8.0-9.8输尿管硬镜,STOPZ气压弹道碎石机,50 ml注射器2具用于注水保持视野清晰.在电视监视下将输尿管硬镜经尿道进入膀胱,找到患侧输尿管开口后,直接进镜或在输尿管导管或斑马导丝的引导下进镜至输尿管腔内,用50 ml注射器向输尿管镜内缓慢注水,缓慢进镜至结石处,将气压弹道撞针由输尿管镜工作通道进入,将结石轻压在输尿管壁上,启动气压弹道碎石机用连续脉冲或单击方法将结石粉碎至3mm以下,注意勿损伤输尿管黏膜,较大的结石用Wolf异物钳取出,较小结石待自行排出,沿导丝推入F5D-J管置于输尿管内,退出输尿管镜,常规留置导尿管.

自2005年1月～2007年10月,笔者对523例复杂性上尿路结石患者行经皮肾镜碎石清石术治疗,取得满意疗效.经皮肾镜下使用EMSⅢ代碎石清石系统治疗肾结石具有操作小、手术时间短、出血少、恢复快等优点,可以使绝大多数患者避免开放手术.

目的 探讨经皮肾镜超声/气压弹道碎石术治疗复杂性肾、输尿管上段结石的围术期护理措施,总结护理经验.方法 采用经皮肾镜及目前国际最为先进的瑞士第三代气压弹道超声碎石机治疗复杂性肾及输尿管上段结石,以整体护理形式对200例患者进行观察及护理.结果 200例患者均Ⅰ期手术成功,结石残留率为3%,3个月结石排净率为100%;术中、术后未出现严重并发症,平均住院日(10±3)d.结论 合理完善的围术期护理是经皮肾镜取石术顺利进行和术后患者康复的重要条件.

【Objiective】 To explore the treatment of pneumatic and ultrasound cystolithotripsy and transurethral electrovaporization of the prostate (TUVP) for benign prostatic hyperplasia (BPH) and bladder calculus. 【Methods】From October 2005 to February 2008, Pneumatic and ultrasound cystolithotripsy and TUVP were used to treat 54 cases of BPH and bladder calculus. 【Results】53 patients received lithotripsy and stones were evacuated completely at one time, and then they accepted TUVP. Only 1 patient of bladder diverticula caculus was operated on. 【Conclusion】A combination of pneumatic and ultrasound cystolithotripsy and TUVP is a minimally-invasive, effective way to treat bladder calculus.

Objective To explore the efficacy of transurethral nephroscopic pneumatic lithotripsy combined with ultrasound lithotripsy for bladder calculus.MethodsBy using transurethral F20.8 nephroscope and EMS LithoCaster,we performed transurethral nephroscopic pneumatic lithotripsy and ultrasound lithotripsy on 69 patients with bladder calculus(63 men and 6 women)between October 2005 and May 2008.The diameter of the calculi was ranged from 1.5 to 6.0 cm.Among the patients,42 had one stone in the bladder,while 27 had multiple calculi.Fifty-five patients were complicated with BPH,14 had neurogenic bladder,and 4 showed bladder diverticulum with stones in situ.Pneumatic frequency was set at 8-12 Hz,and ultrasonic energy was 50%-60%.For the patients with BPH electrovaporization ablation was plused.ResultsAmong the 69 patients,68 were cured in one session.The mean operation time was 25 minutes(15 to 40 minutes).One patient was converted to open surgery because of rupture of the bladder during the procedure.No patient had urethral stricture,infection,or massive hemorrhage during the operation.Follow-up was available in 68 patients for 6 to 10 months(mean,9 months).During the period,no recurrent calculi was found by ultrasonography and X-ray.ConclusionTransurethral nephroscopic pneumatic lithotripsy combined with ultrasound lithotripsy is effective for bladder calculus.