目的 了解前列腺穿刺引导器穿刺活检标本与前列腺全切标本Gleason分级相关性.方法 收集69例经前列腺穿刺引导器穿刺活检确诊为前列腺癌患者的临床资料,对比26例接受前列腺根治术的Gleason评分与穿刺标本Gleason评分的符合情况.结果 69例确诊患者中,35例非手术治疗,8例转院或失访,26例接受前列腺根治术,穿刺标本与根治术Gleason评分相比,一致17例(65.4％),升级4例(15.4％),降级5例(1 9.2％),差异具有统计学意义(P＜0.05).结论 前列腺穿刺引导器穿刺活检Gleason评分与根治标本Gleason评分具有较好的一致性.经前列腺穿刺引导器穿刺活检标本Gleason评分对临床治疗方案的选择和预后判断具有重要参考价值.

目的:探讨微创经皮肾穿刺取石术(MPCNL)治疗孤立肾多发性结石在临床中的治疗效果;方法:选取2015年1月至2016年6月在东莞康华医院进行孤立肾多发性结石治疗的58例患者作为研究对象,将其随机分成观察组29例(MPCNL治疗)和对照组29例(开放式取石手术),对比两组的临床治疗效果;结果:经过不同的治疗后,两组在术中出血量、术后结石取净率、术后2个月结石排净率、并发症发生率等方面相比,差异均具有统计学意义(P＜0.05),但在手术时间方面相比,差异无统计学意义(P＞0.05);结论:MPCNL是一种新型的微创治疗方式,在手术过程中患者出血的概率小,并且结石的清除率高,对患者肾脏产生的影响较小,安全性高、实用性强.

目的 分析连续性肾脏替代治疗与间歇性血液透析治疗重症急性肾功能衰竭的临床效果.方法 选取我院2014年5月～2016年3月收治的46例重症急性肾功能衰竭患者,按照治疗方法的不同分为观察组和对照组,各23例.对照组采用间歇性血液透析治疗方法,观察组采用连续性肾脏替代治疗,比较两组的临床疗效.结果 观察组的总有效率为91.30％,高于对照组的73.91％,差异有计学意义(P＜0.05).观察组治疗后的BUN、SCr水平低于对照组治疗后,CCr水平高于对照组治疗后,差异有统计学意义(P＜0.05).观察组的1年生存率为82.61％,高于对照组的60.87％,差异有统计学意义(P＜0.05).结论 连续性肾脏替代治疗重症急性肾功能衰竭的效果确切,能够改善患者的临床症状,提高生存率,值得临床推广应用.

Objective To investigate the practical value of HD-3D organ model,printed by simultaneous imaging technology of the renal vessels and collecting system.Method The difficulties of the renal vessels and collecting system in simultaneous imaging technology were resolved by a selfdesigned imaging method.By the STL (a kind of data format) data,converted from the real-time 3D data of renal vessels and collecting system in simultaneous imaging,the 3D organ model for the clinical practice were printed successfully.Results In our investigation,the 3D organ model fitted the real organ exactly of 12 patients (with the ratio 1:1 between the data measured during the surgery and the 3D model on internal diameter of renal collecting system and vessels).Besides,the transparent material showed the 3D structures clearly on renal vessels,collecting system and lesions.Conclusions Our study indicates that it's feasible to print a HD-3D organ model of individual via simultaneous imaging of the renal vessels and collecting system technically.The 3D structures clearly show on renal vessels,collecting system and lesions.

Objective To study the factors of percutaneous nephrolithotomy treatment of postoperative renal function after solitary kidney stone patients.Methods Selected 54 cases of patients with solitary kidney stones and treated by percutaneous nephrolithotomy during December 2011 to December 2016 in Dongguan Kanghua Hospital.The estimated glomerular filtration rate (GFR) was calculated by modified modification of diet in renal disease (MDRD) equation for Chinese patients,and the MDRD equation for Chinese patients was generally regarded as an important method for the determination of GFR change in preoperative and postoperative renal function.Results The stone-free rat was 85.18％(46/54).The mean GFR reduced transiently on the first day after surgery,and the difference between the GFR of baseline level and first day after surgery was not statistically significant (P ＞0.05).The GFR level began to gradually return to baseline levels on the third day postoperatively,and tend to be stable on the thirtieth days after postoperatively.The age,gender,without urinary road infection,without proteinuria,without hypertension,the normal versus impaired renal function were not the factors of GFR changing after mPCNL.And the proteinuria (B =1.902,OR =4.744),urinary road infection (B =1.612,OR =5.248) and hypertension (B =1.495,OR =3.728) were the risk factors of solitary kidney stones.Conclusion For the first treated by percutaneous nephrolithotomy surgery surgery solitary kidney stone patients with renal cortical thickness thicker,hypertension,proteinuria,and urinary tract infections absence of preoperative renal function after surgery,the higher the probability of stable or improved situation,whereas postoperative renal function in patients deteriorate more.

目的：探讨高通量血液透析与普通血液透析对肾性骨病患者相关因子的影响。方法选取行维持性血液透析治疗的肾性骨病患者100例，随机分为高通量透析组和普通透析组，各50例。普通透析组采用普通血液透析治疗、高通量透析组采用高通量血液透析治疗，观察治疗前及治疗后2个月时血钙、磷、β2-微球蛋白、甲状旁腺素水平变化及不良反应。结果高通量透析组治疗后血钙较治疗前升高，血磷、β2-微球蛋白、甲状旁腺素较治疗前下降（P ＜0．01），两组治疗后比较，高通量透析组血钙高于普通透析组，血磷、β2-微球蛋白、甲状旁腺素均低于普通透析组（P ＜0．05或 P ＜0．01）；两组透析不良反应发生率比较，差异无统计学意义（P ＞0．05）。结论与普通血液透析相比，高通量血液透析能有效提高肾性骨病患者血钙水平，降低血磷、β2-微球蛋白、甲状旁腺素水平，透析不良反应未见明显增加。

目的:研究孤立肾经皮肾镜取石术的手术风险管理.方法:选取2013年6月至2016年3月东莞康华医院68例行孤立肾经皮肾镜取石术患者作为研究对象.采用数字法随机将两组患者分为观察组和对照组,各34例.观察组患者实施手术风险管理,对照组实施普通管理.对比观察两组的不良反应发生情况.结果:观察组与对照组的焦虑自评表(SAS)评分和抑郁自评表(SDS)评分在管理之后均得到明显调节,差异具有统计学意义(P＜0.05),观察组的降低程度明显优于对照组,差异具有统计学意义(P＜0.05).观察组出现大出血、感染性休克、败血症以及肾衰竭的几率均小于对照组,总发生率明显小于对照组,差异具有统计学意义(P＜0.05).观察组管理效果明显优于对照组,差异具有统计学意义(P＜0.05).结论:对孤立肾经皮肾镜取石术的手术风险进行评估,能够有效降低患者手术之后不良事件的发生率,有效改善患者的生活质量.

目的：：探讨输尿管狭窄的原因和输尿管镜治疗策略。方法：回顾性分析39例输尿管狭窄患者的临床资料。结果：本组39例输尿管狭窄中3例采取输尿管镜硬性扩张法，5例采取多导管扩张法，7例采取气囊扩张法，16例采取内窥镜下电钩内切开，5例采取输尿管镜下钬激光内切开；3例输尿管镜操作失败而二次行开放手术。39例中，治愈36例，治愈率为92.31%。结论：腔内泌尿外科技术可有效诊断及治疗不同类型的输尿管狭窄。

目的:探讨不同部位尿路结石合理选择使用输尿管软、硬镜的治疗效果.方法:同顾分析2012年10月-2014年12月170例泌尿系结石患者的临床资料,170例尿路结石患者中,肾结石46例、输尿管上段结石40例、输尿管下段结石54例、膀胱结石30例.结果:3例肾下盏结石患者手术失败;1例输尿管下段结石患者,术后发现输尿管上端扩张,肾盂积水,2例输尿管下段结石伴肾积水患者,术中出现寒战、高热,并有1例术中出现休克,术中经抗感染、抗休克治疗后均好转.其余病例均一次性手术成功,无并发症.结论:合理使用输尿管软、硬镜联合钬激光碎石治疗尿路结石疗效可靠,可最大程度地减少并发症,缩短手术时间.

Objective To discuss the relationship between the renal pelvis, ureter and their adjacent structures and organs; and to explore the significant anatomical symbols and their clinical significances. Methods We retrospectively analyzed the clinical data and the anatomical data of 8 corpses. The following contents were observed: the relationship between the renal pelvis/ureter above the plane of the lower renal lobe and the renal vessels, the relationship between the ureter at the plane of the lower renal lobe and the lower renal lobe, psoas major muscle and surrounding vessels, the relationship between the lower renal lobe to the ureter at the level of the fifth lumbar vertebrae and psoas major muscle, genital vessels, genitoformal nerve. Results Between the renal hilus and the lower renal lobe, the renal pelvis and ureter ambulated from posterior to anterior and lied in front of the kidney at the level of the lower renal kidney, and the angle of anterior tilt was 0～12 degrees, averagely 8.6 degrees. Among the 16 kidneys of the 8 corpses, there were 13 cases in which ramification vessels of the renal arteries and veins set off the second level of vessels at the place within 1 cm away from the renal hilus, 2 cases within 1～2 cm and 1 case more than 2.7 cm. the posterior branch of the second level vessels entered the kidney from behind the renal pelvis, therefore the second level vessels did not enter or depart from the renal hilus according to the position relationship of the renal arteries, veins and renal pelvis. The incidence that the ureter intercrossed the genitoformal nerve was 75%(6/8). The intercrossing point lied in the 2～3 cm from the forth to the fifth lumbar vertebra. The distances between the intercrossing point and the lateral side of the psoas major muscle in the left side and right side were 1.73±0.81 cm and 1.76±0.53 cm respectively. Above the intercrossing point, the incidence that the ureter lies at the lateral side of the genitoformal nerve is about 83.3% (5/6). Conclusion This study on the anatomy of the renal pelvis and ureter provides anatomical guides to carry out minimally invasive laparoscopic surgeries of the renal pelvis and ureter.

目的探讨应用输尿管镜手术时上镜困难的处理方法。方法用多导管法处理17例上镜困难患者。结果17例成功上镜;1例中转开放手术。结论多导管法处理输尿管上镜困难是一种有效的方法。

目的:探讨输尿管镜手术时上镜困难的原因与对策。方法:报告在收治的239例输尿管镜手术患者中用多导管法处理17例上镜困难者的临床资料。结果:17例成功上镜;1例中转开放。结论:多导管法处理输尿管上镜困难是一种有效的方法。

目的探讨中心静脉导管对经皮肾镜手术中建立通道的临床应用价值。方法在彩超引导下对26例患者用中心静脉导管行经皮肾穿刺微造瘘术,然后在经皮肾镜手术中经中心静脉导管置入导丝行扩张建立通道。结果26例患者均经皮肾穿刺微造瘘术成功,其中25例在经皮肾镜手术中建立通道成功。结论用中心静脉导管分步建立通道对经皮肾镜手术有重要的临床应用价值。