泌尿系结石是泌尿外科的常见疾病,相关数据显示[1] ,我国泌尿系结石发病率为1％ ～5％,南方高达5％ ～10％,其中输尿管结石在泌尿系结石中占据首位. 如果不能及时处理,疾病进展会出现输尿管梗阻而导致肾积水,当药物排石或体外震波碎石无效情况下,则需要进行手术治疗. 通常情况下,术后常规放置单根 D -J 管引流,留置一段时间后取出[2]. 然而D-J管管径较细,在某些情况下,放置单根D-J管并不能保证通畅的尿液引流,输尿管结石患者术后多伴有输尿管壁炎性水肿,引流不畅,加重肾功能损伤,而放置双重D-J管,两管之间空隙及管腔可保证尿液的通畅引流[3,4]. 但目前关于双重D-J管引流术在输尿管结石伴中重度肾积水中的疗效评价研究甚少,且多为回顾性研究. 本研究中通过前瞻性研究比较了双重D-J管引流术与单根D-J管引流术在输尿管结石伴中重度肾结石中的疗效,以期为双重D-J管引流术的应用提供更多临床证据.

Objective:To investigate the preventive effect of Relinqing Granule on urinary tract infection after kidney calculi operation and the effects on removing calculi and pain after operation.Methods:Seventy-two cases of patients with kidney calculi who were treated by operation in our hospital between May 2012 and April 2015 were selected.According to the random number table method,the patients were divided into control group and observation group with 36 cases in each.The control group was treated with intravenous infusion of Levofloxacin Hydrochloride and Sodium Chloride Injection after operation.On the basis,the observation group was additionally treated with Relinqing Granule.Both of the two groups were treated for 1 week.The treatment effects of the two groups were observed.The rate of stone being removed and time of removing clearly were statistically analyzed.The relief of dysuria,frequent micturition,hematuria,renal pain,percussion pain and other symptoms and signs scores were observed.The incidence of adverse reactions during treatment was monitored and the incidence rates of urinary tract infection in the two groups in postoperative 1 month were recorded.Results:①Total effective rate of observation group was slightly higher than that of the control group(P ＞ 0.05).②After 1 week of treatment,the scores of hematuria,frequent micturition,dysuria,urgent urination,renal pain,percussion pain and other symptoms in the observation group were lower than those in the control group (P ＜ 0.05).③The rate of stone being removed in the observation group was higher than that in the control group (P ＜ 0.05) and the time of removing clearly was shorter than that in the control group (P ＜ 0.05).④The incidence rates of adverse reactions in the two groups were similar (P ＞ 0.05).There were no severe adverse reactions in the two groups.⑤The incidence of urinary tract infection in observation group was lower than that in the control group (P ＜ 0.05).Collusion:The overall effect of Relinqing Granules applied in prevention of urinary tract infection after PCNL is good.It can promote stone expulsion and reduce the symptoms such as dysuria and renal pain,with high safety and fewer adverse reactions.

OBJECTIVE To observe the efficacy and safety of placement of ureteral double‐J tubes in treatment of gestational ureteral calculi complicated with acute pelvic infections so as to provide guidance for clinical treatment . METHODS A total of 66 patients with gestational ureteral calculi complicated with acute pelvic infections who re‐ceived transurethral ureteroscopy from Jun 2011 to Jun 2016 were enrolled in the study ,all of the patients received anti‐infection therapy and were treated with placement of double‐J tubes under ureteroscope at the same time ,the stageⅠ holmium laser lithotripsy was conducted for the patients with better stone location ,without further exac‐erbation of intraoperative infection ,with stable vital signs ,and the curative effect and safety were observed . RESULTS The body temperature of 6 patients with gestational ureteral calculi complicated with acute pelvic infec‐tion returned to normal within 1‐4 days after the placement of double‐J tubes under ureteroscope ,the white blood cell counts returned to normal within 3‐6 days;the levels of C‐reactive protein and procalcitonin were remarkably lower after the intubation than before the intubation ,and there was significant difference (P<0 .05) .5 patients had septic shock before the surgery and were immediately transferred to ICU for anti‐infection therapy ;ureteral catheterization or holmium laser lithotripsy was successfully conducted after the infection was controlled ,the cau‐ses of acute pelvic infection were resolved .The inserted double‐J tubes of all the patients were removed after 2‐8 months .The follow‐up was conducted for all of the patients till the delivery ,4 patients voluntarily ordered induced labor ,the rest of patients delivered successfully and did not have severe obstetric complications .CONCLUSION&nbsp;The placement of ureteral double‐J tubes is safe and effective in treatment of the patients with gestational ureteral calculi complicated with acute pelvic infection ,and the insertion of ureteral double‐J tubes may facilitate the further treatment of ureteral calculi .

目的:回顾性分析前列腺患者进行开放手术后导致尿道狭窄的原因,并提出有效处理方法.方法:研究对象为2010年6月-2012年6月余姚市第二人民医院收治的24例进行开放手术后导致尿道狭窄的前列腺患者,回顾性分析其发生尿道狭窄的原因.结果:行开放性前列腺摘除术的13例患者的尿道狭窄发病原因包括膀胱颈创面狭窄(53.5％)、手术的时间(46.1％)、切除的前列腺重量(46.1％)、留置尿管的时间(61.5％)、留置尿管的材质(53.8％);行前列腺癌根治术11例患者的尿道狭窄发病原因包括前列腺的体积(54.5％)、患者的年龄(81.98％)、肿瘤的体积(63.6％)、包膜侵犯(54.5％)、淋巴结转移(72.7％)、精囊受累(45.4％)、肿瘤复发(45.4％).结论:对于进行开放手术后导致尿道狭窄的前列腺患者,要详细分析其发病原因,并进行针对性处理.

目的：探讨微创经皮肾镜碎石取石术（mPCNL）并发出血的原因及防止措施。方法回顾性分析本院2008年8月至2012年12月应用mPCNL治疗上尿路结石263例患者的临床资料，发生严重出血的10例，约占3.80%，其中7例为开展手术后两年内发生，另外3例为开展该手术2年后发生。结果10例严重出血病人经治疗后均取得成功，其中术中出血5例，术后出血5例，接受输血治疗8例；其中3例接受高选择性肾动脉栓塞，其余7例保守治疗成功，无中转开放手术及失肾患者。结论微创经皮肾镜碎石取石术并发大出血较常见，笔者认为术者既要重视预防，充分认识出血的原因，又要根据具体情况运用一切有效手段积极治疗，及时采取措施，两者都有重要意义。

Objective To analyze the effect of tamsulosin in the treatment of upper ureteral calculi( UUC) and prevention of renal colic. Methods 62 cases w ith UUC treated by USHL therapy w ere randomly divided into 2 groups. 30 cases in control group w ere treated w ith niaoshitong pill,w hile 32 cases in treatment group w ere treated w ith tamsulosin. The stone clearance rate and occurrence of renal colic w ere observed. Results The stone clearance rate of treatment group w as higher than that of control group( P 0. 05); the time of lithecbole of treatment group w as shorter than that of control group( P 0. 05); the renal colic incidence and analgesic drug use rate in treatment group w ere low-er than those of control group( P 0. 05). Conclusion Tamsulosin crushed stones can promote natural discharge and shorten the expulsion time,alleviate renal colic effectively.

目的 随访观察浅表膀胱癌经尿道膀胱肿瘤电切术(TURBt)后吡柔比星膀胱保留灌注化疗对干预膀胱癌复发的影响.方法选取浅表膀胱癌TURBt术后患者109例,分为观察组62例和对照组47例.术后,对照组未给予膀胱保留灌注化疗,观察组予以膀胱保留灌注吡柔比星治疗,随访2年,观察两组的复发率,以及观察组膀胱保留灌注化疗的不良反应.结果术后3～6个月内,对照组膀胱癌复发率呈下降趋势,此后呈逐渐升高的趋势;观察组各时间段内膀胱癌复发率基本呈现降低趋势;两组累积复发率均呈逐渐升高的趋势,但观察组累积复发率升高趋势平缓,而对照组累积复发率升高趋势急剧.各时间段内观察组膀胱癌复发率、累积复发率均低于对照组(P＜0.05).结论吡柔比星膀胱保留灌注化疗有效降低了浅表膀胱癌TURBt术后膀胱癌的复发率,且未出现严重的不良反应,临床应用比较安全,对预防TURBt术后膀胱癌复发具有积极而重要的干预意义.

目的:探讨包皮过长、包茎行包皮环切术的年龄选择。方法:研究对象为男性包皮过长、包茎患者234例,年龄8～46岁,其中包皮过长患者186例,(其中8岁到第二性征出现前110例,第二性征出现后到46岁76例)包茎患者48例(其中8岁到第二性征出现前26例,第二性征出现后到46岁22例)。共分别设两个对照组,包皮过长一组,称作A组,其中分两个小组:分别为8岁到第二性征出现前行包皮环切术的一组A1(共80例),此年龄段设一平行对照组,选择未行包皮环切术的包皮过长患者行保守观察治疗,此为C组(共30例)。第二性征出现后到46岁行包皮环切术的一组A2(共76例)。包茎一组,称作B组,其中分两个小组:分别为8岁到第二性征出现前一组B1(共26例),第二性征出现后到46岁一组B2(共22例)。A2组及B2组术中直接目测观察龟头大小与阴茎体比例关系。A1组及B1组通过术后随访龟头及阴茎体发育情况,随访至第二性征出现后龟头、阴茎体完全发育后。C组为保守观察随访至第二性征出现后龟头、阴茎体完全发育后。结论:包皮过长及包茎手术时机:包皮过长手术时机选择在第二性征出现后手术。若在8岁及第二性征出现前手术,容易失去随第二性征出现后龟头、阴茎体发育后包皮过长自愈的机会。包茎手术时机选择在8岁到第二性征出现前。如果在第二性征出现后手术,容易影响龟头和阴茎体发育,尤其是龟头。8岁前不宜行包皮环切术,严重包茎的患者可行包皮分离扩张术。

良性前列腺增生(benign prostatic hyperplasia,BPH)是老年男性常见疾病.经尿道前列腺汽化电切术(TUVP)与传统开放性手术比较,具有微创、适应证广、住院时间短、无伤口等优点.但由于患者多属高龄,体质差,且合并多种其他疾病,术中和术后极易出现各种并发症.我科自2008年6月到2010年12月,共对66例75岁以上的BPH患者行TUVP术,出现并发症11例,并发症发生率17.0％,经治疗均好转,疗效较满意,现分析报告如下.

Objective To improve therapeutic selection of benign prostatic hyperplasia ( BPH) with lower urinary tract symptoms (LUTS). Methods Two hundred and nine BPH patients with LUTS were divided into transurethral resection (group A,115 patients) and tamsulosin (group B,94 patients). The international prostate symptoms score (IPSS),quality of life (QOL),maximal flow rate (Qmax),international index of erectile function 5 (ITEF-5) and satisfactory degree were used for investigating safety and efficacy before and after the treatments. Results Mean follow-up periods were 15 months (ranged 10 to 22 months),all patients were followed up. IPSS,QOL and satisfactory degree between the two groups were no statistically significance after treatment. Qmax of group A was superior to group B [ (20.6 ± 2.8) ml/s vs (17.1 ±3.2) ml/s,P＜0.05],while IIEF-5 of group A was superior to group B [(19.3 ±3.4) scores vs (16.5 ±4.7) scores,P＜ 0.05]. Conclusions Therapeutic selections should be based on complete evaluations of patients symptoms and sexual status. Tamsulosin can improve both of the LUTS and sexual function,while transurethral resection of the prostate can relieve bladder outlet obstruction markedly but decrease patients' erectile function.

目的总结医源性膀胱损伤的诊治经验。方法回顾性分析17例医源性膀胱损伤的临床资料。结果17例患者均痊愈,未出现尿漏、尿外渗及败血症等严重并发症。经3～6个月的随访,排尿均正常,尿线粗,排尿有力,无排尿困难发生。输尿管再植术患者术后静脉尿路造影显示上尿路功能良好,无肾积水。结论医源性膀胱损伤诊断的关键在于提高对本症的认识,损伤当时或术中及时发现。手术修补效果满意。

2002年4月至2007年4月,本院采用输尿管镜结合电切镜治疗尿道狭窄68例,取得满意疗效.现报告如下.

目的 探讨囊性肾癌(CRCC)的影像学表现及治疗方法.方法 对8例CRCC患者的临床资料进行回顾性分析.结果 8例患者术后病理确诊为囊性肾透明细胞癌7例,囊腺癌1例.随访2～10年,1例术后2年死于肿瘤转移,1例死于非肿瘤因素(心肌梗死),6例存活至今,未发现肿瘤复发或转移.无其他后遗症.结论 CRCC的诊断以B超、CT为主,确诊后应行根治性肾切除术或肾部分切除术.

随着B超及CT等影像技术的不断发展,肾囊肿的诊断率也随之提高.临床上对于4cm以下的单纯性肾囊肿多不作处理,对于4cm以上或有并发症的肾囊肿既往多采用经皮囊肿穿刺注射硬化剂或开放性囊肿去顶术治疗.90年代后,腹腔镜下肾囊肿去顶术正成为肾囊肿治疗的主要方法,该方法损伤小、手术彻底、不易复发,效果较满意,术后基本无复发或仅极个别复发[1].

目的:观察体外冲击波碎石机(ESW L)治疗泌尿系结石的疗效。方法:采用国产JDPN-VB型X线定位体外冲击波碎石机;根据不同部位的结石采用不同的体位分别对肾结石≤2cm、输尿管结石≤1.5cm、鹿角型结石≥2.5cm的结石进行治疗;治疗电压10~14KV,冲击次数600±800次,平均700次;术后行抗炎、解痉、利尿以及中药加体位排石等;15天后腹部平片(KU B)复查。结果:393例肾结石一次碎石成功272例,占69.5%;再次ESW L治疗119例,占30.5%;938例输尿管结石一次碎石成功703例,占75.1%,再次ESW L治疗233例,占24.9%;单侧79例输尿管结石因绞痛发作急诊碎石一次成功71例,占90.85%,再次ESW L治疗18例,占9.15%。结论:ESW L治疗泌尿系结石是一种损伤小、见效快、便捷安全有效方法。

OBJECTIVE:To determine the levels of MMP-2 and COX-2 mRNA in bladder transitional cell carcinoma tissues and explore their relationship. METHODS:We enrolled in this study 42 patients with bladder transitional cell carcinoma, including Ta-T1 (n = 18), T2-T4 (n = 24), G1 (n = 12), G2 (n = 19), G3 (n = 11), metastasis (n =26) and non-metastasis (n = 16). Another 5 cases of normal bladder tissues were taken as controls, and the levels of MMP-2 and COX-2 mRNA were detected by RT-PCR. RESULTS:The relative expressions of COX-2 mRNA were 1.038 +/- 0. 484 in Ta-T1, 1.489 +/- 0.584 in T2-T4, 0.920 +/- 0.442 in G1, 1.338 +/- 0.584 in G2 and 1.632 +/- 0.515 in G3, all significantly higher than that of the controls (0.460 +/- 0.224, P < 0.05). And the corresponding relative levels of MMP-2 mRNA were 1.107 +/- 0.384, 1.604 +/- 0.425, 0.971 +/- 0.370, 1.445 +/- 0.378 and 1.755 +/- 0.387, also significantly higher than that of the latter group (0.423 +/- 0.227, P < 0.05). The COX-2 and MMP-2 mRNA levels in the tumor tissues with and without metastasis were 1.591 +/- 0.455 vs 0.815 +/- 0.430 and 1.676 +/- 0.339 vs 0.927 +/- 0.228, (P < 0.01), respectively, with a positive correlation between the mRNA level of COX-2 and that of MMP-2 (r = 0. 703, P < 0.01). CONCLUSION:MMP-2 and COX-2 mRNA are highly expressed in bladder transitional cell carcinoma tissues and their expressions are positively correlated with the degree of malignancy. MMP-2 and COX-2 might play a synergetic role in the pathogenesis and progression of bladder transitional cell carcinoma.

膀胱癌是泌尿系肿瘤中最常见的恶性肿瘤之一,上尿路肿瘤术后膀胱癌再发率为15%-40%,但膀胱癌术后再发上尿路癌的发生率文献报道不一.我院自1996-2006年共收治膀胱癌316例,术后再发上尿路癌11例,行根治性患侧上尿路全切术10例,输尿管部分切除+膀胱部分切除+输尿管膀胱吻合术1例,现报告如下.

ESWL治疗后石街的形成是泌尿系统结石患者术后较为常见的并发症,发生率较高,危害较大,轻者会延长治疗时间,重者可因梗阻而加重肾功能损害,有效的预防和及时的处理就显得非常重要.现对在我院行ESWL治疗后石街形成的患者的临床资料作一回顾性分析,报道如下.

目的总结肾皮质感染的诊治经验。方法回顾性分析12例肾皮质感染患者的诊治资料。按病灶中央有无液化分为非脓肿组(A组),3例;脓肿组(B组),9例。A组行单纯性抗生素治疗,B组行抗生素加经皮穿刺置管引流治疗。结果两组患者均获治愈,随访1年均无复发。讨论结合B超、CT检查使肾皮质感染获得早期诊断,配合药物及经皮穿刺置管引流及时、有效的治疗,病例一般均能获得良好预后。

目的 探讨膀胱癌术后再发上尿路肿瘤的危险因素、诊断及治疗方法.方法 回顾性分析11例膀胱移行细胞癌术后发生上尿路癌的临床资料,原膀胱癌单发5例,多发6例,分级G1～G29例,G2～ G32例;分期T1N0M0～ T2N0M010例,T3N0M01例.结果 行根治性患侧上尿路全切术10例,输尿管部分切除膀胱部分切除输尿管再植术1例.3例膀胱癌再发,其中1例行TURBt,2例因膀胱癌再发行膀胱全切及输尿管皮肤造瘘.11例随访6个月～10年,1例术后2年因肾功能衰竭死亡.结论 膀胱癌多源性可能为再发上尿路肿瘤的危险因素,再发与肿瘤分级、分期无关.B超、CT检查应作为诊断首选方法.根治性上尿路切除是主要治疗方法.