目的探讨无明显早期意识障碍的创伤性蛛网膜下腔出血临床特点,减少临床漏诊、漏治。方法分析24例无明显早期意识障碍的创伤性蛛网膜下腔出血患者的临床资料。结果 24例患者中恢复良好19例,中度伤残2例,昏迷状态1例,2例死亡。结论无明显早期意识障的颅脑外伤患者要严密观察,避免漏诊,及早诊治,降低患者致残率及病死率。
Objective To present experience on the diagnosis and treatment of female primary bladder neck obstruction(PBNO) with bellyache.Methods Clinical data are collected from 13 female patients with diagnosis of PBNO with bellyache from May 2001 to December 2008.All of these patients were identified by conventional urodynamics combined with cysto-urethrogaphy.After conservative treatment with the oral α1-receptor blocker failed,all patients accepted TURBN treatment.To value therapeutic effectiveness of TURBN for PBNO with bellyache,the dynamic parameters,such as preoperative and postoperative detrusor pressure at maximum flow,maximum flow rate,IPSS scores and quality of life scores,are compared and analyzed.Results One patient was lost to follow up,the 12 patients were followed up for 3 to 24 months.The follow-up evaluation in 10 cases included urodynamics,IPSS scores and quality of life scores while that in another 2 cases included only IPSS scores and quality of life scores.The preoperative and postoperative Qmax values in the 10 patients were(8.00±1.944)mL/s and(12.70±3.129)mL/s(P0.01).And Pdet-Qmax values were(6.70±2.497) kPa and(5.64±2.237) kPa(P0.01).IPSS scores in the pre-and post-operation of 12 patients were(15.92±5.42) and(10.42±6.07)(P0.01).Quality of life scores were(5.17±0.84) and(2.33±1.07)(P0.01).Conclusion Excluding urinary calculous or gut disease,combined urodynamics with cysto-urethrogaphy is an effective and accurate diagnostic way for female PBNO with bellyache.TURBN is safe and effective measure for female PBNO with bellyache refractory to previousα1-receptor blocker medication.
目的探讨湿润烧伤膏在尿道扩张治疗尿道外口狭窄的疗效。方法 随机将63例尿道外口狭窄患者分为治疗组33例与对照组30例,2组均采用常规治疗,治疗组在尿道扩张治疗中及治疗后应用湿润烧伤膏(MEBO)。结果对照组尿道扩张时的疼痛程度大于治疗组(P<0.006),对照组需要尿道扩张的次数多于治疗组(P<0.016)。结论湿润烧伤能有效缓解患者扩张治疗时疼痛、减少因尿道再狭窄需再次尿道扩张次数。
目的 探讨膀胱憩室癌的诊疗方法和临床特点.方法 7例均行手术治疗,分别行经尿道电切术、膀胱部分切除术或根治性膀胱全切术.结果 尿路上皮细胞癌5例,其中1例行经尿道膀胱憩室癌电切术,患者于术后3个月局部复发,再次行膀胱部分切除术,术后随访48个月,未见复发;1例于术后9个月局部复发,再次行根治性膀胱全切加输尿管皮肤造口术,术后2年死于肿瘤多器官转移;另3例尿路上皮细胞癌患者随访5年,未见肿瘤复发或转移.1例鳞癌者术后15个月死于呼吸衰竭.1例混合性癌患者术后21个月死于肿瘤多器官转移.结论 膀胱憩室癌的诊断以膀胱镜和CT等影像学检查为主,主要治疗手段是膀胱部分切除术或根治性膀胱全切术,必要时辅以放、化疗.
目的探讨输尿管下段结石误诊为尿潴留的原因及预防,减少临床误诊、误治。方法分析8例输尿管下段结石误诊为尿潴留的临床资料。结果输尿管下段结石7例,膀胱壁内段结石1例,均经药物和(或)ESWL治疗后痊愈。结论输尿管下段结石可以避免误诊为尿潴留。
