Objective:To explore the clinical safety and efficacy of 4.8 F visual micro-percutaneous nephrolithotomy for the treatment of renal microlithiasis of aircrew.Methods:From March 2017 to September 2021, 4.8 F visual micro-percutaneous nephrolithotomy were performed to treat renal microlithiasis of 28 cases in Armed Police Forces Hospital of Henan, which underwent flexible ureteroscopy without success, it was difficult to place the guide sheath because of ureteral stricture in 19 cases, or no stones were found in 9 cases. Then, retrograde surgical method was perfromed and patients were placed in lithotomy position, then turned to the prone position to complete the operation.Results:All 28 cases were operated successfully in one stage. Mean operative time was (18.5±6.5) min. Hemoglobin decreased by 1.2-3.5 g/L, with an average of (2.6±0.5) g/L, 2 hours after operation. One patient had postoperative severe gross hematuria, after expectant treatment the patient got better. Followed up 3 days after operation, there was no serious complication such as pleural effusion, perirenal effusion or peripheral organ injury. All patients discharged average was (3.6±0.7) d after operation. Followed up 1 month after operation, the renal CT showed no residual stones. Followed up 3 and 6 month after operation, color Doppler ultrasonography showed no recurrence of stones.Conclusion:4.8 F visual micro-percutaneous nephrolithotomy-treatment is safe and effective in the treatment of renal microlithiasis of aircrew, especially when flexible ureterosopic lithotripsy fails, it can be tried.

目的:观察体外冲击波碎石术(ESWL)联合排石通淋汤与盐酸坦索罗辛缓释胶囊治疗泌尿系结石湿热蕴结证的临床疗效.方法:选择86例泌尿系结石湿热蕴结证患者,采用随机数字表法分为观察组和对照组各43例.2组均给予ESWL治疗,对照组术后服用盐酸坦索罗辛缓释胶囊治疗,观察组术后给予排石通淋汤联合盐酸坦索罗辛缓释胶囊治疗,2组均治疗2周,随访3个月.比较2组临床疗效、症状消失时间、不良反应发生率、复发率.结果:治疗后,观察组治愈率97.67％,高于对照组83.72％,差异有统计学意义(P＜0.05).观察组结石排尽、腰痛消失及肉眼血尿消失时间均短于对照组(P＜0.05).观察组不良反应发生率2.33％,与对照组4.65％比较,差异无统计学意义(P＞0.05).观察组复发率4.76％,低于对照组19.44％,差异有统计学意义(P＜0.05).结论:ESWL联合排石通淋汤与盐酸坦索罗辛缓释胶囊治疗泌尿系结石湿热蕴结证临床效果显著,可有效缩短结石排尽及症状消失时间,降低复发率,提高结石排尽率,安全性好.

目的:研究前列腺癌患者根治术后首次血清前列腺特异性抗原(Prostate-specific antigen,PSA)水平及其影响因素.方法:选取我院2018年11月至2021年1月收治的110例前列腺癌患者,比较手术前及手术6 w后首次血清PSA水平;根据患者手术6w后PSA水平分为PSA<0.2 ng?mL-1组和PSA≥0.2 ng?mL-1组,采用Logistic回归模型分析影响前列腺癌患者根治术后首次血清PSA水平的独立危险因素.结果:患者术后血清PSA水平明显低于术前;吸烟史、Gleason评分、病理分期、有无淋巴结清扫、术前有无电切为影响前列腺癌患者根治术后首次PSA水平的单因素(P<0.05).Logistic回归模型分析显示:Gleason评分(8～10分)、病理分期(进展期)、有无淋巴结清扫(有)、术前有无电切(有)为影响前列腺癌患者根治术后首次PSA水平的独立危险因素(P<0.05).结论:前列腺癌患者根治术后首次血清PSA水平普遍下降,其中Gleason评分、病理分期、有无淋巴结清扫、术前有无电切为影响其首次PSA水平的独立危险因素.

Objective:To evaluate the clinical efficacy and safety of using the F4.8 Visual Puncture Micro-percutaneous nephrolithotomy to treat the female distal calculi associated with stricture.Methods:From June 2017 to December 2019, 32 female patients with distal ureteric calculi associated with stricture, aged(35.0±10.3) years ( range from 16 to 75 years)old, were enrolled into this retrospective study. They were diagnosed by colour doppler ultrasound, IVU(intravenous Urography), or CT, et al. The average stone size was (13.0±3.6)mm in diameter(range from 3 to 20 mm), and the stone obstruction duration was from 2 to 35 days, with average of(5±17) days. Twenty-seven cases were on the unilateral ureter and 5 cases were on the bilateral ureters. There were 17 cases undergoing ESWL 2 weeks before. Six cases of stone diameter less than 6 mm were administered medical therapy for more than 7 days. All the 32 case underwent ureteroscopic lithotripsy but failed because of the ureter stricture. They all suffered from hydronephrosis, with the diameter of renal collecting system from 15 to 45 mm, with(23±15)mm on average. The lithotomy position was taken, and the F4.8 Visual Micro-percutaneous nephrolithotomy using 0.9% Sodium chloride was applied to enter into ureter through urethra. There were 21 cases of ureter orifice stricture, including 8 cases associated with avulsion or perforation, 9 cases associated with intramural ureter abnormality and stricture, the zebra guidewire being failed to enter. The F4.8 Visual Micro-percutaneous nephrolithotomy cooperated with water pressure modulation was used to flush and open the ureter orifice and intramural ureter for entering. Holmium lase was used for lithotripsy. Two cases stone were infective and obstructed seriously. F4.8 Visual Micro-percutaneous nephrolithotriptor entered the ureter and destroyed the stones, and the stone fragments were discharged. Stone migrated upward and escaped occurred in 1 case, then the zebra guidewire was indwelled and ureteroscope was used for lithotripsy successfully. All cases were indewelled F4.7 doubld-J tube and urethral catheter after operation.Result:All the 32 patients underwent lithotripsy successful by one-stage. The operation time was 15-43 min [averaged (35.0±8.7)min]. All patients were recovered and discharged 4-7(averaged 5.3) days after operation. Three patients occured fever, T>38.5℃, and they recovered by using sensitive antibiotics according to the blood and urine culture. No severe complications occurred, such as ureteral perforation or extravasation. All patients were reviewed by ultrasound and KUB 3 days after operation, finding 24 cases with stone free, and 8 cases of a little residual stone, with the stone free rate of 75%. One month later, ultrasound and IVU was performed, and no residual stone was detected, with the stone free rate of 100%. The hydronephrosis alleviated by varying degrees. The diameter of the renal collecting system was from 0 to 35 mm, with(12±9)mm on average. The IVU showed the ureter was unobstructed. Conclusions:The F4.8 Visual Micro-percutaneous nephrolithotomy is safe and effective for the female distal calculi associated with stricture, when routine ureteroscopic lithotripsy failed.

目的 探讨超声引导下针状可视肾镜联合钬激光处理直径1.0～2.5 cm肾盏憩室结石的临床疗效.方法 全身麻醉成功后输尿管镜下在患侧放置F5输尿管导管,并留置F18三腔尿管固定.改行俯卧位,在超声引导、显示器直视下,针状可视肾镜进入目标盏,留置硬导丝,应用扩张套件从F8逐号扩张至F14,连接F8可视肾镜碎石清石系统,550μm钬激光光纤将结石粉碎并吸出.若憩室盏颈口难以寻及,沿输尿管导管逆行推注10％亚甲蓝,找到盏颈口后用钬激光将盏颈口切开,顺行置入F6输尿管支架管.结果 36例均一次碎石取石成功.手术时间33～65 min,平均47.5 min.术后血红蛋白下降0.6～1.9 g/L,平均1.35 g/L.1例术中第1天出现发热,体温38.5℃,积极抗感染后体温恢复正常.6例术后出现肉眼血尿,尿管引流液呈暗红色,给予对症止血、卧床及膀胱冲洗后血尿逐渐停止,均无需输血.术后住院4～6 d,平均5.2 d.术后6、12个月复查肾脏CT,36例肾脏结石无复发,清石率100.0％(36/36).结论 针状可视肾镜治疗肾盏憩室结石安全、有效.

Objective:To evaluate the clinical safety and efficacy of using the visual puncture micro-percutaneous nephrolithotomy to treat the mid and distal calculi in children.Methods:From May 2017 to December 2019, 25 children patients with mid and distal ureteric calculi were enrolled into this retrospective study. There were16 males and 9 femals (age range from 2 to 12 years) who were diagnosed by colour doppler ultrasound, CTU, et al. The average stone size was (12±6) mm in diameter (range from 5 to 21 mm). 23 cases got stones in the unilateral ureter and 2 cases in the bilateral ureters, 10 cases in the mid ureter, 15 cases in the distal ureter. 6 cases received ESWL and 3 cases received ureteroscopic lithotripsy, but they were failed. In the lithotomy position, the visual puncture micro-percutaneous nephrolithotomy linked with 0.9% sodium chloride was applied to enter into ureter through urethra. Holmium laser was used for lithotripsy.Result:All the 25 patients were operated successful onestage. The operation time was 15-50 min (32±10) min. All patients were recovery and discharged from hospital 4-7 (6) days later. No calculi moved up and escaped. Serious irritative symptoms of bladder occurred in 2 patients who recovered after pulled out the catheter. Fever (T>38.5℃) occurred in 2 patients who, and they became normal by changed sensitive antibiotic. No severe complications such as ureteral perforation and extravasation occurred. All patients were rechecked by ultrasound and KUB 3 days later, the stone clearance rate was 88%. One month later ultrasound was rechecked, no stone was residual, the stone clearance rate was 100%.Conclusion:As a worth promoting treatment for the mid and distal calculi in children, the visual puncture micro-percutaneous nephrolithotomy is safe, minimally invasive, and effective.

目的 探讨对复杂性肾结石患者联合应用可视经皮肾镜及软镜碎石治疗的疗效.方法 选取2017年8月至2019年7月,在武警河南省总队医院治疗的120例复杂性肾结石患者,根据随机数字表法将其分为两组.对照组60例,采取可视经皮肾镜碎石治疗;观察组60例,采取可视经皮肾镜联合软镜碎石治疗.比较两组的结石清除率、手术时间、下床时间、住院时间、出血量及生活质量评分.结果 观察组患者结石清除率为88.33％(53/60),残留率为11.67％(7/60),对照组患者结石清除率为63.33％(38/60),残留率为36.67％(22/60),差异有统计学意义(χ2=26.94,P<0.05).观察组并发症发生率低于对照组,差异有统计学意义(P<0.05).观察组患者的手术时间、下床时间、住院时间均明显短于对照组,出血量少于对照组,且生活质量评分高于对照组(P<0.05).结论 可视经皮肾镜联合软镜碎石治疗可提高结石清除效果,缩短康复时间,减少术后并发症发生,改善患者生活质量.

Objective To investigate the efficacy of standard channel combined with visual nephroscopy in the treatment of staghorn kidney stones,and study its effects on renal function and complications.Methods A total of 120 patients with kidney stones diagnosed and treated in Henan Provincial Armed Police Corps Hospital from March 2017 to April 2018 were selected as subjects.All patients were diagnosed as kidney stones in hospital.According to the types of kidney stones,they were divided into study group and control group.Forty-two cases in the study group were diagnosed as staghorn kidney stones and 78 cases in the control group were diagnosed as non-staghorn kidney stones.All patients in the two groups were given routine preoperative examination and preparation of operation.Both groups received general anesthesia.The patients in the control group were mainly treated by standard channel percutaneous nephrolithotomy.Patients in the study group were mainly treated by standard channel percutaneous nephroscopy combined with visual endoscopy.The differences in operation time,amount of bleeding,catheterization time and hospital stay between the two groups were compared.And the occurrence of renal function and postoperative complications before and after operation were compared between the two groups.Results There was no significant difference in operation time or catheterization time between the two groups (P>0. 05 ).The amount of blood loss and hospital stay in the study group were significantly lower than those in the control group (P<0. 05 ).Before treatment,there was no significant difference in renal function or renal blood flow between the two groups (P>0. 05 ).After treatment,the blood urea nitrogen and serum creatinine level were significantly different between the two groups (P <0. 05 ), however,the maximum velocity of renal blood flow in the study group was significantly higher than that in the control group (P<0. 05).The stone clearance rate in the study group was 88. 10％(37/42),which did not differ from the 83. 33％(65/78 ) in the control group (P >0. 05 ).But the incidence of complications in the study group was 19. 05％(8/42),significantly lower than the 32. 05％(25/78)in the control group (P <0.05).Conclusions Standard channel combined with visual endoscopy in the treatment of staghorn kidney stones has relatively small invasive,less intraoperative bleeding,shorter hospital stay,and less postoperative related complications,and by which patients can be cured fast.

目的 探讨超声引导下针状可视肾镜钬激光碎石联合排石颗粒治疗直径1.0～2.0 cm无积水肾下盏结石的临床疗效.方法 我院2018年1～8月采用针状可视肾镜联合钬激光碎石术治疗50例无积水肾下盏结石,全身麻醉后输尿管镜下患侧放置F4.8输尿管支架管及F18双腔尿管,膀胱灌注后改俯卧位,在超声定引导、显示器直视下,将针状可视肾镜进入肾下盏,用200μm钬激光光纤,功率0.8 J/10 Hz,将结石粉末化,碎石后加压注水将碎石颗粒冲至肾盂.结果 所有患者均一次性碎石成功,手术时间20～58 min,平均42 min.术后第1天血红蛋白下降0.6～1.3 g/L,平均0.96 g/L.术后发热1例,体温39.0℃,经抗感染、地塞米松磷酸钠注射液后体温恢复正常;术后疼痛5例,给予止痛药物对症止痛后好转;术后出现肉眼血尿8例,未做特殊处理,嘱患者多饮水、休息后好转,均无需输血.术后住院2～6 d,平均3 d.术后第2天复查腹部平片,6例术后碎石已完全排出,其余44例口服排石颗粒,适当倒立体位排石,1个月后复查腹部平片,42例结石完全排出,术后1个月结石清除率96.0％(48/50).术后6个月随访:50例复查彩超,48例双肾未见明显异常,2例右侧肾下盏3～5 mm小结石.结论 超声引导下针状可视肾镜钬激光碎石联合排石颗粒治疗直径1.0～2.0 cm无积水肾下盏结石安全、有效,结石清除率高.

目的 比较微通道经皮肾镜取石术、标准通道经皮肾镜取石术在肾结石疾病治疗中的应用效果与安全性.方法 随机选取2018年6月至2019年3月在武警河南省总队医院接受治疗的肾结石患者100例为研究对象,每组50例.通过数字随机法将患者分为对照组与观察组,对照组接受标准通道经皮肾镜取石术治疗,观察组接受微通道经皮肾镜取石术治疗,对两组患者治疗效果进行比较分析.结果 观察组并发症发生率为6.00％(3/50),对照组为16.00％(8/50),观察组明显低于对照组(P<0.05),在血清炎症因子水平及临床相关指标方面观察组也均明显优于对照组(P<0.05).结论 与标准通道经肾皮镜取石术比较,微通道经肾皮镜取石术在治疗肾结石疾病中能有效降低患者炎症因子水平、改善患者肾功能,还能降低并发症发生率,有助于患者术后恢复,安全、有效,值得在临床中推广应用.

Objective To explore the nursing measures of patients with high risk benign prostatic hyper-plasia (BPH),who underwent transurethral electrovaporization of the prostate (TUVP)during the periop-erative period.Methods Clinical data of 157 patients with high risk BPH in our hospital from January 2010 to July 2013 were analyzed retrospectively.Results A total of 157 cases with high risk BPH successfully received TUVP treatment.Transurethral resection syndrome (TURS)happened in one patient after 1 hour of surgery.Two patients underwent bleeding at the day of operation and were sent back to the operation room to stanch.Other patients had no nursing related complications.Conclusion The implementation of pre-operative nursing can help to promote the compliance of patients underwent surgery,prevent and reduce compli-cations,assure the safe of patients with high risk for BPH during the perioperative period.